Ma ‘DIBDIBANG’

Usapan
Breast Cancer Awareness Seminar
 Review of the
Anatomy and Physiology
of the Breast
 What is breast cancer?
Breast cancer is a malignant tumor that starts from
cells of the breast. A malignant tumor is a group of
cancer cells that may grow into (invade)
surrounding tissues or spread (metastasize) to
distant areas of the body. The disease occurs
almost entirely in women, but men can get it, too.
Common causes
• Gender is the biggest risk because
breast cancer occurs mostly in women.
• Age is another critical factor. Breast
cancer may occur at any age, but it is
more common in age 40 and up.
• A woman with a personal history of
cancer in one breast .
• Genetic causes. Family history has long
been known to be a risk facto for
breast cancer.
Common causes
• Lifestyle and diet. Breast cancer seems
to occur more frequently in countries
with high dietary intake of fat, and
being overweight or obese is a known
risk factor for breast cancer,
particularly in postmenopausal
women.
• Environmental causes like exposure
from radiation.
 Symptoms
• Early breast cancer has no symptoms. It is usually
not painful.
• A lump in the armpit or above the collarbone
that does not go away.
• Breast discharge. Discharge is most concerning if
it is from only one breast or if it is bloody.
• Nipple inversion. Nipple inversion is a common
variant of normal nipples, but nipple inversion
that is a new development can be of concern.
• Changes in the skin of the breast include redness,
changes in texture, and puckering. These changes
are usually caused by skin diseases but
occasionally can be associated with breast
cancer.
 Diagnostic Tests
Examination of the Breast
• A complete breast examination includes
visual inspection and careful palpation
(feeling) of the breasts, the armpits, and
the areas around your collarbone.
• During that exam, your health-care
provider may palpate a lump or just feel
a thickening.
 Diagnostic Tests
Mammography
• Mammograms are x-rays of the breast that
may help define the nature of a lump.
Mammograms are also recommended for
screening to find early cancer.
• Usually, it is possible to tell from the
mammogram whether a lump in the breast is
breast cancer, but no test is 100% reliable.
Mammograms are thought to miss as many
as 10-15% of breast cancers.
 Diagnostic Tests
• A false-positive mammogram is one that
suggests malignancy (cancer) when no
malignancy is found on biopsy.
• A false-negative mammogram is one that
appears normal when in fact cancer is
present.
• A mammogram alone is often not enough to
evaluate a lump. Your health-care provider
will probably request additional tests.
• All breast lumps need to be clearly defined as
benign or should be biopsied.
 Diagnostic Tests
Ultrasound
• Ultrasound of the breast is often done
to evaluate a breast lump.
• Ultrasound waves create a "picture" of
the inside of the breast.
• It can demonstrate whether a mass is
filled with fluid (cystic) or solid. Cancers
are usually solid, while many cysts are
benign.
• Ultrasound might also be used to guide
a biopsy or the removal of fluid.
Diagnostic Tests
MRI
• MRI may provide additional information
and may clarify findings which have
been seen on mammography or
ultrasound.
• MRI is not routine for screening for
cancer but may be recommended in
special situations.
 Diagnostic Tests
Biopsy
• The only way to diagnose breast cancer with
certainty is to biopsy the tissue in question.
Biopsy means to take a very small piece of
tissue from the body for examination and
testing by a pathologist to determine if cancer
is present. A number of biopsy techniques are
available.
• Fine-needle aspiration consists of placing a
needle into the breast and sucking out some
cells to be examined by a pathologist. This
technique is used most commonly when a
fluid-filled mass is identified and cancer is not
likely.
 Diagnostic Tests
• Core-needle biopsy is performed with a
special needle that takes a small piece of
tissue for examination. Usually the needle is
directed into the suspicious area with
ultrasound or mammogram guidance. This
technique is being used more and more
because it is less invasive than surgical biopsy.
It obtains only a sample of tissue rather than
removing an entire lump. Occasionally, if the
mass is easily felt, cells may be removed with
a needle without additional guidance.
Diagnostic Tests
• Surgical biopsy is done by making an
incision in the breast and removing the
piece of tissue. Certain techniques allow
removal of the entire lump.
• Regardless of how the biopsy is taken,
the tissue will be reviewed by a
pathologist. These are physicians who
are specially trained in diagnosing
diseases by looking at cells and tissues
under a microscope.
 Diagnostic Tests
• If a cancer is diagnosed on biopsy, the tissue
will be tested for hormone receptors.
Receptors are sites on the surface of tumor
cells that bind to estrogen or progesterone. In
general, the more receptors, the more
sensitive the tumor will be to hormone
therapy. There are also other tests (for
example, measurement of HER-2/neu
receptors) that may be performed to help
characterize a tumor and determine the type
of treatment that will be most effective for a
given tumor.
•
Stages of breast cancer
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 fairly small in size but
has 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 is metastatic breast cancer: a tumor of any
size or type that has metastasized to another part of
the body. This is the least favorable stage.
 Treatment
Radiation therapy is used to kill tumor cells if there are
any left after surgery.
• Radiation is a local treatment and therefore works
only on tumor cells that are directly in its beam.
• Radiation is used most often in 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 five days a week
over five to six weeks. Each treatment takes only a
few minutes.
• Radiation therapy is painless and has relatively few
side effects. However, it can irritate the skin or cause
a burn similar to a bad sunburn in the area.
 Treatment
Chemotherapy consists of the administration
ofmedications that kill cancer cells or stop them from
growing. In breast cancer, three different
chemotherapy strategies may be used:
1. Adjuvant chemotherapy is given to people who have
had curative treatment for their breast cancer, such
as surgery and radiation. It is given to reduce the
possibility that the cancer will return.
2. Pre-surgical chemotherapy is given to shrink a large
tumor and/or to kill stray cancer cells. This increases
the chances that surgery will get rid of the cancer
completely.
3. Therapeutic chemotherapy is routinely administered
to women with breast cancer that has spread
beyond the confines of the breast or local area.
 Treatment
Hormonal therapy may be given because breast
cancers (especially those that have ample
estrogen or progesterone receptors) are
frequently sensitive to changes in hormones.
Hormonal therapy may be given to prevent
recurrence of a tumor or for treatment of
existing disease.

• Tamoxifen (Nolvadex), an antiestrogen (a drug

that blocks the effect of estrogen), has been
the most commonly prescribed hormone
treatment. It is used both for breast cancer
prevention and for treatment.
Treatment
• Fulvestrant (Faslodex) is another drug
that acts via the estrogen receptor, but
instead of blocking it, this drug
eliminates it. It can be effective if the
breast cancer is no longer responding to
tamoxifen. Fulvestrant is only given to
women who are already in menopause
and is approved for use in women with
advanced breast cancer.
• Toremifene (Fareston) is another anti-
estrogen drug closely related to
tamoxifen.
Treatment
• Aromatase inhibitors, which block the
effect of a key hormone affecting the
tumor, may be more effective than
tamoxifen in the adjuvant setting. The
drugs anastrozole (Arimidex),
exemestane (Aromasin), and letrozole
(Femera) have a different set of side
effects and risks than tamoxifen.
Surgery
• Surgery is generally the first step after the
diagnosis of breast cancer. The type of
surgery is dependent upon the size and
type of tumor and the patient's health and
preferences.
• Lumpectomy involves removal of the
cancerous tissue and a surrounding area of
normal tissue. This is not considered
curative and should almost always be done
in association with other therapy such as
radiation therapy with or without
chemotherapy or hormonal therapy.
• At the time of lumpectomy, the axillary lymph
nodes (the glands in the armpit) need to be
evaluated for the spread of cancer. This can
be done by either removing the lymph nodes
or by sentinel node biopsy (biopsy of the
closest lymph node to the tumor).
• If a sentinel node biopsy is done at the time
of lumpectomy, it may allow the surgeon to
remove only some of the lymph nodes. In this
procedure, a dye is injected into the area of
the tumor. The path of the substance is then
followed as it travels to the lymph nodes. The
first node reached is the sentinel node. This
node is considered most important to biopsy
when evaluating the spread of the tumor.
• If the sentinel node biopsy is positive, the
surgeon will usually remove of all of the lymph
nodes found in the axilla (armpit).
• Simple mastectomy removes the entire breast
but no other structures. If the cancer is invasive,
this surgery alone will not cure it. It is a common
treatment for DCIS, a noninvasive type of breast
cancer.
• Modified radical mastectomy removes the
breast and the axillary (underarm) lymph nodes
but does not remove the underlying muscle of
the chest wall. Although additional
chemotherapy or hormonal therapy is almost
always offered, surgery alone is considered
adequate to control the disease if it has not
metastasized.
• Radical mastectomy involves removal of
the breast and the underlying chest wall
muscles, as well as the underarm
contents. This surgery is no longer done
because current therapies are less
disfiguring and have fewer
complications.
Prevention
Breast self-examination (BSE) is cheap and easy. Routine
monthly examination may be helpful. Previously
considered critical, more recent studies suggest that self
breast exam may be less valuable than previously
thought, especially for women who are having routine
clinical breast examination and/or mammography.
• For women who are menstruating, the best time for
examination is immediately after the monthly period.
• For women who are not menstruating or whose
periods are extremely irregular, picking a certain date
each month seems to work best.
• Instruction in the technique of breast self-examination
can be obtained from your health-care provider or
from any one of several organizations interested in
breast cancer.
Prevention
• Mammograms are recommended every one to two
years starting at age 40 years. For women at high risk
for the development of breast cancer, mammogram
screening may start earlier, generally 10 years prior to
the age at which the youngest close relative developed
breast cancer.
• Obesity after menopause and excessive alcohol intake
may increase the risk of breast cancer slightly.
Physically active women may have a lower risk. All
women are encouraged to maintain normal body
weight, especially after menopause and to limit excess
alcohol intake. Hormone replacement should be
limited in duration if it is medically required.
Nursing Interventions
• Monitor for adverse effects of radiation therapy such
as fatigue, sore throat, dry cough, nausea, anorexia.
• Monitor for adverse effects of chemotherapy; bone
marrow suppression, nausea and vomiting, alopecia,
weight gain or loss, fatigue, stomatitis, anxiety, and
depression.
• Realize that a diagnosis of breast cancer is a
devastating emotional shock to the woman. Provide
psychological support to the patient throughout the
diagnostic and treatment process.
• Involve the patient in planning and treatment.
• Describe surgical procedures to alleviate fear.
• Prepare the patient for the effects of chemotherapy,
and plan ahead for alopecia, fatigue.
Nursing Interventions
• Administer antiemetics prophylactically, as directed,
for patients receiving chemotherapy. Administer I.V.
fluids as indicated.
• Help patient identify and use support persons or
family or community.
• Suggest to the patient the psychological interventions
may be necessary for anxiety, depression, or sexual
problems.
• Teach all women the recommended cancer-screening
procedures.
 THE END.
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