RUBEN M. ASIS, JR., RN.

Mariano Marcos State University

Graduate School
Most common cancer among females

2nd most common cause of cancer

death among females
 Early diagnosis

Treatment evolution
Exact cause: unknown
Primary risk factors:
 Gender  99% occurs in female
 Age  risk increases after 50 years old
 Personal history  15% of women develop the
disease in the opposite breast.
 Family History  woman who have first degree relative
with breast cancer have 2x – 3x
increased risk.
(genetics: BRCA1, BRCA2)
Exact cause: unknown
Secondary risk factors:
having given birth (nulliparity)
Giving birth to the first child after 30
Prolonged hormonal stimulation
- early menarche (<12 y/o)
- late menopause (>50 y/o)
Atypical hyperplasia on previous breast biopsy
Excessive exposure to ionizing radiation
History of endometrial, ovarian, or colon cancer
Other probable causes:
Alcoholic intake

48% 15%
1
4
7

11% 6%
Retraction
Mass
Increase venous prominence
Peau d’Orange
Nipple Inversion
Retraction

Can occur with the involvement of the dermal

lymphatics because of the retraction of
cooper’s ligaments, or involvement of the
pectoralis facia.
Mass
 Venous Prominence
Obstruction of venous return
by fast-growing tumor; or
obstruction dilates
superficial veins
 Peau d’Orange
Plugging of the dermal
lymphatics can cause skin
thickening and exaggeration
of the usual skin markings,
giving the skin the
appearance of an orange
peel.
Nipple Inversion
In late stages,
infiltration,
induration and
dimpling (pulling in)
of the overlying skin
and nipple may
occur.
Shortening of the
mammary glands.
Breast Self Examination
Clinical Breast Examination
Mammography
Chest X ray
Sentinel Lymph Node Biopsy
1.Tumor Size
2.Tumor Location
3.Breast Size
4.Patients preference and
attitude, and access to
radiation facility.
.A biopsy is the only way to know for sure if
you have cancer, because it allows your
doctors to get cells that can be examined
under a microscope. There are different types
of biopsies; they differ on how much tissue is
removed. Some biopsies use a very fine
needle, while others use thicker needles or
even require a small surgical procedure to
remove more tissue. Your team of doctors will
decide which type of biopsy you need
depending on your particular breast mass.
1. Provide education and preparation about surgical treatment.
2. Reduce fear and anxiety and improving coping ability.
3. Promote decision making ability.
1. Relieve pain and discomfort.
2. Manage post op sensations
3. Promote (+) body image
4. Promote adjustment and coping.
5. Improve sexual function.
1. A. varying time of sexual activity
2. Assuming more comfortable positions
3. Expressing affection using alternative methods-hugging,
kissing, manual stimulation

6. Monitor and manage potential complications.

Lumpectomy (Breast Conservation Therapy)
Removes only the breast lump and surrounding margin of
normal tissue.
reexcision- surgical procedure done after lumpectomy
if cancer cells were found in the tissue previously removed
which involves excission of additional surrounding tissue.

Quadrantectomy (Partial or Segmental Mastectomy)

Removes more breast tissue than lumpectomy which is up
to one quarter of the breast.

for both lumpectomy and quadrantectomy:

 radiation is ussually given after
Side effects include: temporary swelling; tenderness;
hardness
Recomended for: Stage I and II
Mastectomy (simple or total mastectomy)
Surgical procedure which involved removal of the
entire breast, including the nipple, but does not
remove lymph nodes and muscles.

Modified radical Mastectomy

Involves removal of the entire breast and some of
the axillary lymph nodes

Radical Mastectomy (Halstead Surgery)

An extensive operationremoving the entire breast,
axillary lymph nodes, and the pectoral muscles under
the breast.
-combos:
cyclophosphamide, mothotrexate, flourouracil
doxarobucin, and cyclophospamide
doxurubicin, cycloposphamide, flurouracil
Radiotherapy
Breast cancer is often treated with radiation therapy.
Radiation therapy refers to use of high energy x-rays to kill
cancer cells. Patients having radiation usually need to come
to a radiation therapy treatment center 5 days a week for up
to 6 weeks to receive treatment. The treatment takes just a
few minutes, and it is painless. Radiation therapy is used in
all patients who receive breast conservation therapy (BCT). It
is also recommended for patients after a mastectomy who
have had large tumors, lymph node involvement, or
close/positive margins after the surgery. Radiation is
important in reducing the risk of local recurrence and is often
offered in more advanced cases to kill tumor cells that may
be living in lymph nodes. Your radiation oncologist can
answer questions about the utility, process, and side effects
of radiation therapy in your particular case.
Hormonal Therapy
When the pathologist examines a tumor specimen, he or she may
determine that the tumor is expressing estrogen and/ or progesterone
receptors. Patients whose tumors express estrogen receptors are
candidates for therapy with estrogen blocking drugs. Estrogen-blocking
drugs include Tamoxifen and a family of drugs called aromatase
inhibitors. These drugs are delivered in pill form for 5 - 10 years after
breast cancer surgery. These drugs have been shown to drastically
reduce your risk of recurrence if your tumor expresses estrogen
receptors. They may be accompanied by side effects, however. When
taking Tamoxifen, patients may experience weight gain, hot flashes and
vaginal discharge.. Taking Tamoxifen may also increase risk of serious
medical issues, such as blood clots, stroke, and uterine cancer. Patients
taking aromatase inhibitors may experience bone or joint pain, and are at
increased risk for thinning of the bones (osteopenia or osteoporosis).
Patients taking aromatase inhibitors should have yearly bone density
testing, and may require treatment for bone thinning.
Biologic Therapy
The pathologist also examines your tumor for the presence
of HER-2/neu overexpression. HER-2/neu is a receptor that
some breast cancers express. A compound called Herceptin
(or Trastuzumab) is a substance that blocks this receptor
and helps stop the breast cancer from growing. Patients
with tumors that express HER-2/neu may benefit from
Herceptin, and this should be discussed with a medical
oncologist when the treatment plan is decided upon.
Nursing Diagnosis:

Pain related to surgical incision and manipulation of tissues

as manifested by grimacing face, guarding behavior and
verbalization of the client regarding the presence and
degree of pain in the operative area.

Altered sexual pattern related to loss of body part as

manifested by decrease in sexual desire and
responsiveness.
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