PREPARED BY: AILYN ANTOQUE

Breast cancer

• is a cancer that starts in the cells of the breast in women and men.

• Most commonly occurring in women and second leading cause of death.

• More prevalent in African American women up to the age of 40 years.

• Premenopausal women.

Causes• Inherited genetic abnormality: Some people are born

with an abnormal gene passed on by a parent. They have one abnormal gene from that parent and one normal gene from the other parent.

• Acquired (or non-hereditary) genetic abnormality: A gene can became abnormal as a result of wear and tear, through an error in how the gene reproduces, or from a variety of other factors—toxic exposure, environmental effects, diet, hormonal influences, or unknown causes. Acquired genetic abnormalities account for 85% to 90% of breast cancers.

Sx and symptoms• Breast mass or thickening• Unusual lump in the

underarm or above the collarbone.

• Persistent rash near the nipple area.

• Nipple discharge.• Change in nipple position• Burning, stinging or

pricking sensation.

Classification• Tumor -which depend on the presence or

absence of invasive cancer, the dimensions of the invasive cancer, and the presence or absence of invasion outside of the breast

• Lymph node -which depend on the number, size and location of breast cancer cell deposits in lymph nodes.

• Metastasize -whether there are distant metastases (whether the cancer has spread to other parts of body)

Type of Breast Cancer

• ductal carcinoma,(DICIS) malignant cancer in the breast's ducts- refers to the development of cancer cells within the milk ducts of the breast.

• invasive lobular carcinoma, malignant cancer in the breast's lobules-

Tumor• TX means the tumor can't be measured or

found.• T0 means there isn't any evidence of the primary

tumor.• Tis means the cancer is "in situ" (the tumor has

not started growing into the breast tissue).• T1 -Tumor 2cm or less in its greatest dimension. • T2 -Tumor more than 2.0cm but not more than 5.0cm in

its greatest dimension. • T3 - Tumor more than 5cm in its greatest dimension. • T4 - any size with direct extension to (a) chest wall or

(b) skin.

Lymph node• Nx - regional lymph nodes cannot be assessed. Perhaps

due to previous removal. • N0 - no regional lymph node metastasis. • N1 - metastasis to movable regional axillary lymph nodes

on the same side as the affected breast. • N2 - metastasis to fixed regional axillary lymph nodes, or

metastasis to the internal mammary lymph nodes, on the same side as the affected breast.

• N3 - metastasis to supraclavicular lymph nodes or infraclavicular lymph nodes or metastasis to the internal mammary lymph nodes with metastasis to the axillary lymph nodes.

Metastases

• MX means metastasis can't be measured or found.

• M0 means there are no distant metastases.

• M1 means that distant metastases were found.

Early stage• Stage 0• Stage 0 is used to describe non-invasive breast cancers,

such as DCIS and LCIS. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.

• Stage I• Stage I describes invasive breast cancer (cancer cells

are breaking through to or invading neighboring normal tissue) in which:

• the tumor measures up to 2 centimeters, AND• no lymph nodes are involved.

• Stage II• Stage II is divided into subcategories known as IIA and

IIB.• Stage IIA describes invasive breast cancer in which:• no tumor can be found in the breast, but cancer cells are

found in the axillary lymph nodes (the lymph nodes under the arm), OR

• the tumor measures 2 centimeters or less and has spread to the axillary lymph nodes, OR

• the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes

• Stage IIB describes invasive breast cancer in which:• the tumor is larger than 2 but no larger than 5

centimeters and has spread to the axillary lymph nodes, OR

• the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.

Later or advance stage• Stage III• Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.• Stage IIIA describes invasive breast cancer in which either:• no tumor is found in the breast. Cancer is found in axillary lymph

nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone, OR

• the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR

• the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures

• Stage IIIB describes invasive breast cancer in which:• the tumor may be any size and has spread to the chest wall and/or

skin of the breast AND• may have spread to axillary lymph nodes that are clumped together

or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone

• Inflammatory breast cancer is considered at least stage IIIB.

• Stage IIIC describes invasive breast cancer in which:• there may be no sign of cancer in the breast or, if there

is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast, AND

• the cancer has spread to lymph nodes above or below the collarbone, AND

• the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

• Stage IV• Stage IV describes invasive breast cancer in which:• the cancer has spread to other organs of the body --

usually the lungs, liver, bone, or brain• "Metastatic at presentation" means that the breast

cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.

Prevention

• Lower age of first childbirth• having more children.• and breastfeeding • Folic acid (folate)• Phytoestrogens and soy

DiagnosisBreast self examination

• Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.

• Here's what you should look for:• Breasts that are their usual size,

shape, and color.• Breasts that are evenly shaped

without visible distortion or swelling.• If you see any of the following

changes, bring them to your doctor's attention:

• Dimpling, puckering, or bulging of the skin.

• A nipple that has changed position or become inverted (pushed inward instead of sticking out).

• Redness, soreness, rash, or swelling.

• Step 1

• Raise your arms and look for the same changes.

• While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).

• Step 2 &3

• Feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.

• Cover the entire breast from top to bottom, side to side—from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

• Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in Step 4.

mammogram

• uses x-rays to examine the breast for any uncharacteristic masses or lumps.

displaying breast cancer, indicated with an arrow

Treatment

• Surgery• Chemotherapy• Radiation therapy• Targeted therapy• Herceptin (trastuzumab), Tykerb (lapatinib),

Avastin (bevacizumab)-works against HER2-positive breast cancers by blocking the ability of the cancer cells to receive chemical signals that tell the cells to grow.

Adjuvant hormonal therapy• Tamoxifen citrate (nolvadex) is an oral

med that interferes with estrogen activity.• Or an aromatase inhibitors (AI).

Patient with advanced local-regional recurrence of breast cancer with an ulcerating axillary mass

Mastectomy patient

• Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma)

Nursing care

• Conduct a monthly BSE.• Have a clinical breast examination every 3

years from ages 20-39 years.• And annual mammogram each years

starting at 40 years.