Breast cancer
Risk factors
Main factors: genes, hormones and lifestyle
Increasing age
Genetic mutation: first degree relative with breast cancer
first or second degree relative with breast or ovarian cancer or early or premenopausal age
first or second degree male relative with cancer of the breast, colon or prostate
• Liver cirrhosis in men lowers androgen level and raises oestrogen level
• Overweight and obesity
Increased fat and sugar diet
• Hormonal factors – increased exposure to oestrogen
• Gynecology factors like early menarche, Nulliparity
,delayed childbirth, late menopause
• History of other cancers such as cancer of the ovaries, endometrial or colon, high grade prostrate cancer
• Unhealthy lifestyle
Findings during breast examination
Early-stage breast cancer usually has no symptoms or signs, but New lump in the breast or underarm (armpit),above the collarbone that doesn’t go away is a warning sign of breast cancer.
• It is usually not painful.
• Most people discover breast cancer before symptoms appear.
• either by finding an abnormality on mammography
• or feeling a breast lump
Warning signs
Thickening or swelling of part of the breast.
• Dimpling of breast skin or “orange peel”.
• Redness or flaky skin in the nipple area or the breast.
• Inversion of the nipple or pain in the nipple area.
• Nipple discharge other than breast milk, including blood.
• Any change in the size or the shape of the breast.
• Pain in any area of the breast.
• Changes in the feel, size, or shape of the breast tissue
Types
Ductalcarcinomainsitu(DCIS)
Is cancer cells that are only in the lining of the milk ducts and have not spread to other tissues in the breast. It is considered as pre-cancer.
• Invasive ductal carcinoma.
The cancer cells are inside and outside milk ducts, has affected parts of the breast tissue, metastasize to other organs of the body.
• Invasive lobular carcinoma.
Cancer cells in the lobules, to the breast tissues that are close by. It can also metastasize to other body organs
Inflammatory breast cancer
Is a rare and very aggressive disease. The affected breast may be larger, firmer, tender ,pitting, reddish, itchy and cancer cells blocks the lymph vessels in the skin of the breast.
• Paget disease
Is a rare type of cancer on the skin of the nipple, the areola. Most people with Paget disease of the breast also have one or more tumors inside the same breast.
Triple-Negative Breast Cancers
Caused by BRCA1 gene(produces proteins that repair injury) mutation.
Negative results for estrogen receptors, progesterone and pathology report.
This type doesn’t respond to hormone therapy or
HER2 (human epidermal growth factor receptor 2) therapy
Staging criteria
Staging in breast cancer is based on the size of the tumor
• which parts of the breast are involved,
• how many and which lymph nodes are affected, and
• whether cancer has metastasized to another part of the body.
• Physicians may refer to cancers as invasive if they spread to other tissues.
• Cancer that does not spread to other tissues is noninvasive.
• Carcinoma in situ is noninvasive cancer.
Stages
Stage 0
• is noninvasive breast cancer that is, carcinoma in situ with no affected lymph nodes or metastasis.
• This is the most favorable stage of breast cancer. Stage I
• is breast cancer that is less than 2 cm (3/4 in) in diameter
• and has not spread from the breast.
Stage II
• is breast cancer that is small
• but has not spread to lymph nodes in the armpit or
• cancer that is somewhat larger but has not spread to the lymph nodes
Stage III
• is breast cancer of a larger size,
• greater than 5 cm (2 in),
• with greater lymph node involvement, or of the inflammatory type.
Stage IV
• ismetastaticbreastcancer
• a tumor of any size or type that has metastasized to other part of the body.
• This is the least favorable stage.
Nursing assessments
Abnormalities identified during Breast examination:
• Breast lump: single, non-tender, painful at a later stage irregular and hard/ firm
• Nipple retraction
• Nipple discharge: dark brown or red
• Breasttexture:unexplainedchanges
• Nipple scaling
• Skin: puckering or dimpling or ulcerating and fungating lesions
Pain: if present: when did it start, its type, what aggravates it and what relieves it
Self examination: find out if patient can do self breast examination
• Diagnostic tests: mammogram screening done yearly
• Reproductive history: when was her first menstruation, is menstruation regular, last menstrual cycle, pregnancy history, parity, miscarriages, breastfeeding practices and any use of hormonal products for contraception or replacement
Family health history: any relative with cancer of the breast and ovaries
• Social history: marital status and family support system
• Occupation: type of work that the patient is doing can also put patient on the risk of exposure to carcinogens
• Lifestyle: diet and drug abuse can also pose risk factors
Diagnostic tests
Breast tissue Biopsy. Is a removal of breast tissue or fluid through the microscopy
Breast ultrasound:
• uses sound waves to make pictures, called sonograms, of
areas inside the breast.
Diagnostic mammogram:
• is a more detailed X-ray of the breast.
Breast magnetic resonance imaging (MRI):
• is MRI scan that make detailed pictures of areas inside the breast through the computer.
Treatment (redo)
Radiation Therapy for Breast Cancer.
• Radiation is a local treatment used to kill tumor cancer cells
that are directly in its beam.
• It is a painless procedure often done to people who have
undergone conservative surgery such as lumpectomy.
• Conservative surgery is designed to leave as much of the
breast tissue in place as possible.
• Radiation therapy is usually given for few minutes per five days a week over a period of five to six weeks.