Breast Cancer - Medsurg Nursing Lecture 2024 PDF

MEDSURG NURSING LECTURE jeanne FIRST SEMESTER: CELLULAR ABERRATION REVIEWER 2024...

MEDSURG NURSING LECTURE jeanne FIRST SEMESTER: CELLULAR ABERRATION REVIEWER 2024 ★ Carcinoma of the contralateral breast or BREAST CANCER endometrium - there is a correlation between reproductive organs of the female when exposed to estrogen, ★ This is the most common type of cancer; and other reproductive systems may be affected -> the 2nd leading cause of death among pwedeng magkaroon ng sequela with regards to CA women. formation - if one of the breasts had developed CA formation in the form of metastasis -> adjacent organs (other CARCINOMA OF THE BREAST breast) may be affected ★ Geographic influence -> women in western areas Carcinoma: type of cancer that originates in the are much more prone to breast CA skin or coverings of a tissue or organ. Most common non-skin malignancy in women. RISK FACTORS (it evolves in the coverings of the breast tissue itself, not particularly with skin) Age ★ Most important risk factor is gender -only 1% of o 76-80 y/o is the peak breast cancer occur in men. (much more prominent Family History with women). Early menarche and Late Menopause ★ Incidence rises throughout the woman’s lifetime, o hormonal in nature - “estrogen”) peaking at age of 75 to 80 years, and then declining Previous CA of the breast, uterus or ovaries slightly thereafter. (as women get older, they Nulliparity, late first birth become more prone to breast ca but after 80 years Obesity and diet old there is a decline in the incidence of breast ca o (high-fat diet can elevate your estrogen levels) among women) (smoking/ alcoholic has carcinogenic effects) ★ Another factor that contributes the development of o Caffeine decreases the incidence of breast CA cancer is hormonal, in the form of estrogen. High-dose radiation exposure to chest ★ Women who reach menarche when younger than 11 years of age have 20% increased risk compared with women who are more than 14 years of age at AJCC STAGING menarche. (early exposure to estrogen) ★ Late menopause (last mens or cessation) also increases risk. (longer exposure to estrogen) Stage T: Primary Lymph Node M: distant 5-year ★ Cancer (LNs) metastases survival Another factor that could contribute to longer (%) exposure to estrogen is taking pills that contain estrogen components. ★ 0 DCIS or LCIS None Absent 92 Full term pregnancy at ages younger than 20 years - can be seen in PET Scan, CT Scan, MRI have half the risk of nulliparous women or women with age 35 at their first birth. I Invasive carcinoma ≤ 2cm None Absent 87 o Early pregnancy o Nulliparous II Invasive None Absent 75 o 1st pregnancy @ 35 yrs old carcinoma 1 to 3 positive Absent ★ >2cm 5cm 1 to 3 positive Absent 46 o atypical hyperplasia -> proliferation of Any size ≥4 positive Absent With skin or chest 0 to 10 positive Absent abnormal cells wall involvement o race/ethnicity -> white/caucasians are or inflammatory carcinoma more prone rather than black & asians o estrogen exposure o breast density -> how heavy (mass) IV Any size Negative or Present 13 carcinoma positive LNs o radiation exposure PAGE 1  MEDSURG NURSING LECTURE jeanne FIRST SEMESTER: CELLULAR ABERRATION REVIEWER 2024  The higher the staging, the lower the survival rate.  Early detection is important. NON-SURGICAL MANAGEMENT ★ Chemotherapy “dolor” ★ Radiation Therapy o solid tumor ★ Hormonal Manipulation o decreases estrogen level (Normally, it produces milk) o they will give progestin-type-only medication to balance progesterone ★ Monoclonal Antibodies o ends w/ “zumab” EARLY DETECTION Anually 35 y/o or CBE 40 y/o Peau d’orange Skin - it is because the breast tissues are inflamed circular wedges up & down SURGICAL MANAGEMENT ★ Lumpectomy ★ Partial or Segmental Mastectomy (quadrantectomy) ★ Total Mastectomy ★ Modified Radical Mastectomy ★ Radical Mastectomy PAGE 2  MEDSURG NURSING LECTURE jeanne FIRST SEMESTER: CELLULAR ABERRATION REVIEWER 2024 1. LUMPECTOMY 3. TOTAL MASTECTOMY The tumor and a small amount of surrounding With a simple or total mastectomy, the entire tissue called the margin is removed (because the breast is removed, but no lymph nodes are surrounding tissue that is connected with to the removed in this procedure. main tumor might be carrying abnormal cells) Simple mastectomy is most frequently used for “ectomy” – removal further cancer prevention or when the cancer does Considered as breast-conserving management not go to the lymph nodes. (because this is applicable to small type of tumor and it will create only one incision, maintaining breast appearance) Women who are not usually eligible for a lumpectomy include: 1. Those who have already had radiation therapy to the affected breast (anything that was exposed to the radiation, the area is becoming sensitive) 2. Have two or more areas of cancer in the same breast that are too far apart to be removed through one incision (only one incision per breast, they will probably remove the breast tissues instead) 3. Or have cancer that was not completely removed 4. MODIFIED RADICAL MASTECTOMY during the lumpectomy surgery The surgeon removes all of the breast tissue along with the nipple. Lymph nodes in the armpit are also removed. The chest muscles are left intact. For many patients, mastectomy is accompanied by either an immediate or delayed breast construction. This can be done quite effectively using either breast implants or patient’s own tissue – usually from the lower abdomen. 2. QUADRANTECTOMY During a partial or segmental mastectomy or quadrantectomy, the surgeon removes more breast tissue than with a lumpectomy. The cancerous area and a surrounding margin of normal tissue are removed, and radiation therapy is usually given after surgery for 6 to 8 weeks. Has something to do with the 4 quadrants of the breast. PAGE 3  MEDSURG NURSING LECTURE jeanne FIRST SEMESTER: CELLULAR ABERRATION REVIEWER 2024 ○ Affected arm should be the one in independent position. 5. RADICAL MASTECTOMY ★ Don’t use to carry ★ Medic alert The surgeon removes all the breast tissue along with the nipple, lymph nodes in the armpit, and NURSING INTERVENTION chest wall muscles under the breast. This procedure is rarely performed today because ★ Monitor for adverse effects of radiation therapy modified radical mastectomy has proved to be as such as fatigue, sore throat, dry cough, nausea, effective, and is less disfiguring. anorexia. (localized effect) ★ 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. (CA patients are being referred to a support group that will give them emotional support) ★ 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. POST – OPE MANAGEMENT ★ Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue. ★ Administer antiemetics prophylactically (for nausea ★ Position: and vomiting) (should be given 30 minutes before o Semi-fowler’s position chemotherapy starts), as directed, for patients (because in mastectomy there is the receiving chemotherapy. involvement of possibly operated lymph nodes, ★ Administer I.V. fluids and hyperalimentation as and our lymphatic system has specific indicated. circulation, our fluids should be drained ★ Help patient identify and use support persons or properly) family or community. o Turn from back to unaffected side ★ Teach all women the recommended cancer- (ex: right breast is operated -> left side lying) screening procedure o Affected arm elevated above the heart level (to prevent accumulation of fluids in the area) *** promote drainage and prevent lymphedema – accumulation of fluid in the lymphatic system POST MASTECTOMY ★ Avoid overuse of affected arm (few months) o No BP taking o No puncturing o No heavy lifting ★ Incision care ○ Proper wound care to prevent infection ★ BSE on the remaining breast o To detect if there’s a possible of metastasis already on the other breast ★ No hang dependent (affected) ○ This is something about lower position ○ Independent: above PAGE 4