FACTS & FIGURES MOST FREQUENT SITES OF CANCER BREAST & UTERUS = WOMEN MALE & FEMALE BENIGN LESIONS...
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Transcript of FACTS & FIGURES MOST FREQUENT SITES OF CANCER BREAST & UTERUS = WOMEN MALE & FEMALE BENIGN LESIONS...
FACTS & FIGURESFACTS & FIGURES
MOST FREQUENT SITES OF CANCERBREAST & UTERUS = WOMEN
MALE & FEMALE BENIGN LESIONSMORE FREQUENT THAN MALIGNANT
182,000 NEW CASES EACH YEAR:1/3 WILL DIE
Leading cause of CA death in Leading cause of CA death in women ages 40 to 55women ages 40 to 55
MORTALITY RATE MORTALITY RATE ::
SCREENINGSCREENING•DETECTION @ EARLIER AGEDETECTION @ EARLIER AGE•MORE EFFECTIVE TX’SMORE EFFECTIVE TX’S
FIBROCYSTIC BREAST CONDITIONFIBROCYSTIC BREAST CONDITION
AGES 20 – 50 YRS
CAUSE: FEMALE HORMONESa.MENTAL STRESSb.CAFFEINEc.NO SX USUALLYd.AFTER MENOPAUSE, HORMONESe.CYSTS IN SIZE, f. RISKS FOR BREAST CANCER
THEN
DANAZOL (DANOCRINE) ESTROGEN
FIBROADENOMAFIBROADENOMA
LATE TEENS – EARLY 20’S*NO MALIGNANT POTENTIAL*
USUALLY FIRM, ROUND, ENCAPSULATED
EASILY REMOVED WITH A SMALL INCISION
<1% PROVE TO BE MALIGNANTAFRICAN AMERICAN WOMEN
INTRADUCTAL INTRADUCTAL PAPILLOMAPAPILLOMA
•WART-LIKE *BENIGN TUMOR
EPITHELIAL CELLS
•GROWS IN COLLECTING DUCT OR IN AREA OF CYSTIC DZ
•BLEED & BLOOD COLLECTS
PAGETS DISEASEPAGETS DISEASE
> 45 YEARS – UNILATERAL
BEGINS AS MILD ECZEMACONDITION – SPREADS
*TRUE CARCINOMA
EARLY & TOTAL REMOVAL OF BREAST
DETECTION & DIAGNOSIS (CA)DETECTION & DIAGNOSIS (CA)
90% DISCOVERED BY BSEAVERAGE SIZE OF TUMOR = 2.5CM
INCIDENCE – NO CHILDREN
INCIDENCE – MULTIPLE PREGNANCYOR BIRTH BEFORE 34 YEARS
INCIDENCE - HYSTERECTOMY
EARLY DETECTION
•TUMORS - 2 CM OR < LYMPH NODES•85% - 90% SURVIVAL
•+ LYMPH NODES =25% - 35% SURVIVAL
STAGING
TNM SYSTEM ♦
T = PRIMARY TUMOR {TUMOR SIZE}
N = REGIONAL LYMPH NODES{#NODES INVOLVED}
M = DISTANT METASTASIS{METASTASES}
T = TUMOR
T0 = NO TUMOR CLINICALLY
TIS = CARCINOMA IN SITU[SITE OF ORIGIN]
T1, T2 , T3, T4 = ASCENDING DEGREESOF IN TUMOR SIZE AND
INVOLVEMENT
N = NODES
N0 = NO REGIONAL LYMPH NODEINVOLVEMENT ASSESSEDCLINICALLY
NX = REGIONAL LYMPH NODES CANNOT BE ASSESSED CLINICALLY
N1, N2, N3, N4 = ASCENDING DEGREE OF NODAL INVOLVEMENT
M = METASTASIS
M0 = NO EVIDENCE OF DISTANTMETASTASIS
M1, M2, M3, M4 = ASCENDINGDEGREE OF METASTATICINVOLVEMENT OF HOST
CLINICAL STAGES – CA OF BREAST
SIZE TUMOR LYMPH NODES METS
I SMALL - 0 II 2CM 5CM - OR + 0
III LG 5 CM + 0
IV ANY SIZE + OR - ++
STAGE I – CA CONFINED TO MAMMARYLOBULES; NO NODE INVOLVEMENT
STAGE II – EXTENSION OUTSIDE LOBULES, TETHERING TO SKIN,AXILLARY NODES MAYBE +
STAGE III – INFILTRATED SKIN,
PEAU D’ ORANGE, PENETRATION
STAGE IV – PEAU D’ ORANGE, FIXATION, METS
DIAGNOSIS
SELF-EXAMONLY 25% TO 35% WOMEN DO BSE
REASONS$ FACTORS, EDUCATION,NO PAIN, *FEAR*, MODEST,DEPRESSIONAGE
INSPECTION
SYMMETRY, ERYTHEMA, EDEMA,
PITTING, PEAU D’ ORANGE,
ULCERATION, RASHES
NIPPLE DISCHARGE, (7 DAYS)
DIMPLING/RETRACTION
DON’T FORGET MALE BREASTS
DON’T FORGET MALE BREASTS
1% IN MEN ♦60 –65 YRS
SIMILAR CHARACTERISTICS
POORER PROGNOSIS
MAMMOGRAMSMAMMOGRAMSCAN DETECT MASSES LESS THAN
1 CM
AGES 35 – 50 NEED BASELINEAMERICAN CA SOCIETY SAYS AGE 40
ULTRASOUNDULTRASOUND
SOUND WAVES ♦MRIMRI IMAGING OF SUSPICIOUS AREAS
BIOPSY
NEEDLE-ASPIRATION90% ACCURATE
INCISIONAL – REMOVES PIECE
EXCISIONAL – REMOVES ALL
BREAST CANCER
BEGINS IN AN ATYPICAL AREA
(SINGLE TRANSFORMED CELL)
PROGRESSES TO CARCINOMA IN SITU
INVASIVE STAGE
MOST OFTEN - OUTER QUADRANTAS GROWS, BECOMES ATTACHED TOCHEST WALL OR OVERLYING SKIN
BREAST CANCER
METASTASIS MOST OFTEN – • LUNGS,• BONES,• MEDIASTINAL LYMPH NODES,• LIVER
IF UNTREATED – DEATH –USUALLY OCCURS 2 – 3 YEARS
Breast Cancer-Nursing Diagnosis
Anxiety
Grieving ♦Acute pain
Disturbed sleep pattern
Disturbed body image
Sexual dysfunction
HIGH RISKS
WOMEN OVER 40 YEARS OF AGENATURAL MENOPAUSE AFTER 50FAMILIAL HISTORYEARLY MENARCHECHRONIC STRESSNO KIDS OR 1ST CHILD AFTER 30EXPOSURE OTHER CANCER
SINGLE MOST MAJOR RISK
----OLDER---FEMALE
CLINICAL MANIFESTATIONS
USUALLY OUTER QUADRANT
NO PAIN, LOCALIZED DISCOMFORT,BURNING, STINGING, ACHING,DIMPLING, ORANGE PEEL APPEARANCE,
ASYMMETRY, ELEVATION OF AFFECTED BREAST, NIPPLE RETRACTION,ULCERATION, MALNUTRITION,
GENERAL ILL HEALTH
4 ORGANS – BREAST METASTASIS
1. LUNGS & PLEURA
2. BONES
3. CNS (BRAIN)
4. LIVER
HORMONES
LUMPECTOMY
OOPHORECTOMY
ADRENALECTOMY
ANTIESTROGEN THERAPY
TAMOXIFEN
Breast Cancer-Interventions ♦Nonsurgical management
Hormonal therapy
Chemotherapy
Radiation
Surgical management
Breast-conserving surgery
1. Lumpectomy
2. Partial mastectomy
Modified radical mastectomy
Breast reconstruction
RADIATION THERAPYRADIATION THERAPY
• 5 – 6 WEEKS• 5 DAYS/WEEK M – F• WEEKEND RESTS
SIDE EFFECTS: FATIGUE, EDEMA,
TENDERNESS OF BREAST, SKIN CHANGES
SURGICAL PROCEDURES
1.SIMPLE EXCISION (LUMP)
2.SIMPLE MASTECTOMY (BREAST)
3.MODIFIED RADICAL MASTECTOMY ENTIRE BREAST, NIPPLE & AXILLARY LYMPH NODES
4.RADICAL MASTECTOMY – ENTIRE BREAST, AXILLARY LYMPH NODES, BOTH PECTORALIS MUSCLES
111
22
3344
CHEMOTHERAPY
• ANTIMETABOLITES (CELL CYCLE SPECIFIC)
• ALKYLATING AGENTS (DNA LADDER STRUCTURE)
• CORTICOSTERIODS (PREDNISONE)
BREAST RECONSTRUCTION
1.SILICONE IMPLANTATION
2.TISSUE EXPANSION
3.MYOCUTANEOUS FLAPTRAM
PSYCHOSOCIAL CARE
1)RECURRENCE OF DX
2)PERSONAL, SOCIAL, SEXUALMEANINGS
3)PHYSICAL EFFECTS & ADJUVANT TX
FACTORS INFLUENCING ADJUSTMENTS
1.PATIENTS PERSONALITY
2.PAST & PRESENT COPING MECHANISMS
3.QUALITY OF FAMILY, SEXUAL, SOCIAL
4.PSYCHOSOCIAL SUPPORTS
8-10 WEEKS POST-OP
PRE-OP TEACHING
• DETAILS OF SX – LOCATION & EXTENT
• BLOOD LOSS• RADIATION & SIDE EFFECTS• CHEMO• PHYSICAL ‘S
POST OP - TO WATCH FORINTEGUMENTARY
OXYGENATION
CIRCULATION
MUSCULOSKELETAL
EXERCISES
PSYCHOSOCIAL
POST-OP TEACHING
INFECTIONPNEUMONIAHEMORRHAGEEXERCISESPSYCHOSOCIALVASOCONSTRICTION
REACH TO RECOVERY
HAND AND ARM CARE FOLLOWING AHAND AND ARM CARE FOLLOWING AMASTECTOMY MASTECTOMY
•PROTECT HAND AND ARM ON OPERATED SIDE•APPLY HAND LOTION•USE A THIMBLE WHEN SEWING•WEAR A MEDIC ALERT TAG•NOTIFY MD IF ARM GET RED OR SWOLLEN
AVOID:CUTS, BRUISES, BURNSWORKING NEAR THORNY BUSHESDIGGING IN THE GARDENBLOOD DRAWINJECTIONSB/P TAKEN ON AFFECTED ARMCARRYING HEAVY PURSE
QUESTIONS