UNIVERSITY OF EASTERN AFRICA BARATON

SCHOOL OF NURSING AND HEALTH SCIENCES

DEPARTMENT OF NURSING

A PRESENTATION DONE IN A PARTIAL FULFILMENT OF THE REQUIREMENT OF THE COURSE

NRSG 418 CHILD BEARING FAMILY III

NAME

NCKY KIPNGENO KORIR

ID

SKORNI2012

LECTURER

SUSAN HEPZI

DATE DUE

22/9/2023

Breast cancer
Introduction

Breast cancer is a cancer that forms in the cells of the breast. After the skin cancer, breast cancer is the
most common cancer diagnosed in women in the united States. Breast cancer can occur in both men
and women , but it is far common in women.

Definition

Breast cancer is that form of cancer that forms in the cells of the breast. It is the most common cancer
diagnosed in women.

Types

1. Angiosarcoma
2. Ducta carcinoma in situ
3. Inflammatory breast cancer
4. Invasive lobular carcinoma
5. Male breast cancer
6. Paget's disease of the breast
7. Recurrent breast cancer

1. Angiosarcoma

Angiosarcoma is cancer that forms In the lining of the blood vessels and lymph vessels. It often affect the
skin and may appear as a bruise like lesion that grows over time.

2. Inflammatory breast cancer

Often appear as enlarged breast with red, thickened skin

3. Invasive lobular carcinoma

This is a type of breast cancer that begins in the milk producing glands ( lobules) of the breast.

4. Lobular carcinoma in situ

Develops in the milk producing glands ( lobules ) and does not spread into nearby breast tissue

5. Male breast cancer

Male breast cancer is rare cancer that forms I the breast tissue of men. Though breast cancer is most
common thought of as a disease that affect womens , breast cancer does occur in men.

Male Breast cancer is most common in older men though it can occur at any age
6. Paget's disease

Paget's disease of the breast occur most often in women older than age of 50

Breast and nipples changes can be sign of breast t

7. Recurrent breast cancer

This is breast cancer that comes after initial treatment. Although the initial treatment is aimed at
eliminating all cancer cells, a few may have evaded treatment and survived.

Risk factors

 Family history- A strong family history of breast cancer, especially in first-degree relatives
(mother, sister, daughter), may indicate the presence of inherited genetic mutations, such as
BRCA1 and BRCA2. These mutations significantly increase the risk of breast cancer.
 Age more than 45 years - Breast cancer risk generally increases with age. This is because as cells
divide over time, there's a greater opportunity for genetic mutations to occur. The risk is
significantly higher in postmenopausal women.
 Obesity - Obesity can lead to changes in hormone levels, particularly an increase in estrogen
production from fat tissue. Elevated estrogen levels can stimulate the growth of some breast
cancer cells, especially in postmenopausal women. Obesity is associated with chronic
inflammation, which may promote cancer development. Obesity often leads to insulin
resistance, which can increase insulin levels in the blood. High insulin levels may contribute to
breast cancer growth.
 Late / early menopause - Women who experience menopause at a later age have a longer
exposure to estrogen and progesterone, as the ovaries continue to produce these hormones.
Prolonged hormonal exposure can increase the risk of breast cancer.Late menopause is
associated with higher levels of circulating hormones, which can stimulate the growth of
hormone-sensitive breast cancer cells. Early menopause reduces the duration of estrogen and
progesterone exposure, potentially reducing the risk of breast cancer. However, this relationship
is more complex and may vary among individuals.
 Alcoholism - Alcohol is broken down in the body to a compound called acetaldehyde, which can
damage DNA and proteins. This damage can lead to the development of cancerous cells.
 Contraception pills- Some forms of birth control pills contain hormones, such as estrogen and
progestin. These hormones can affect breast tissue and may increase breast cancer risk,
although the risk is generally considered small.
 Lack of breastfeeding to baby- Breastfeeding can temporarily suppress ovulation and
menstruation, reducing the cumulative lifetime exposure to estrogen. This may have a
protective effect against breast cancer.Breastfeeding induces changes in breast tissue, reducing
the number of vulnerable cells and potentially lowering the risk of cancer development.
 Late marriage - Late marriage often means a longer duration of exposure to estrogen, as
pregnancy and breastfeeding can temporarily reduce estrogen levels. Extended estrogen
exposure can increase the risk of breast cancer, especially if a woman has not had children.
  High fat diet - : A high-fat diet, particularly one that includes saturated fats, can lead to obesity
and changes in hormone levels. This can result in elevated estrogen levels, which can promote
the growth of certain breast cancer cells.

Causes

Idiopathic ( there bis no exact cause)

Other causes

 Heredity - genetic changes

 Chemical changes
 Obesity
 Hormona changesl
 Radiation

Clinicals features

 A breast lb or thickening that feels different from the sorrounding tissue.

 Change in the size , shape or appearance of the breast.
 Changes to the skin over the breast such as dimpling
 A newly inverted nipple.
 Peeling, sclaling, crusting or flaking of the pigmented area of the skin sorrounding the nipple
( areola) or breast skin.
 Redness or pitting of the skin over the breast, like the skin of an orange.
 Mass, painless, 50% located in the upper quadrant.
 Nipple discharge ( blood of serum).
 Breast assymmetry.
 Nipple retraction.
 Pain
 Ulceration
 Oedema

Diagnosis

 History
 Physical examination
 Mammography
 Biopsy aspiration
 Chest x- ray
 Breast self examination
  Axillary node sampling

Surgical management

1. Lumpectomy

Removing the breast cancer( lumpectomy) . During a lumpectomy , which may be referred to as Breast -
conserving surgery or wide local excision, the surgeon removes the tuomor all small margi of the
surrounding health tissue.

A lumpectomy may be recommended for removing smaller tumors. Some people with large tumors may
undergo chemotherapy before surgery to shrink a tumor and make it possible to remove completely
with a lumpectomy procedure

2. Mastectomy

Removing the entire breast. A mastectomy is an operation to remove all of your breast tissue most
mastectomy procedures remove all the breast tissue, the lobules, ducts, fatty tissue and some skin,
including the nipple and areola.

Other treatment

Chemotherapy

Chemotherapy us a widely used treatment for cancer . This form chemotherapy refers to the drugs that
prevent cancer cells from dividing and growing. It does this by killing dividing cells

Ex: vincristine, methotrexate

 Adjuvant and neoadjuvant chemo drugs

 Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence)
 Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)

5-fluorouracil (5-FU) or capecitabine (Xeloda)

Cyclophosphamide (Cytoxan)

Carboplatin (Paraplatin)

Chemo drugs for breast cancer that has spread (metastatic breast cancer)

 Taxanes: Paclitaxel (Taxol), docetaxel (Taxotere), and albumin-bound paclitaxel (Abraxane)

Ixabepilone (Ixempra)
 Eribulin (Halaven)

 Anthracyclines: Doxorubicin (Adriamycin), liposomal doxorubicin (Doxil), and epirubicin (Ellence)

 Platinum agents (Cisplatin, carboplatin)
 Vinorelbine (Navelbine)
 Capecitabine (Xeloda)
 Gemcitabine (Gemzar)

Antibody drug conjugates (Ado-trastuzumab emtansine [Kadcyla], Fam-trastuzumab deruxtecan

[Enhertu], Sacituzumab govitecan [Trodelvy])

Side effects.

 Hair loss
 Nausea
 Vomiting
 Loss of appetite
 Mouth sores
 Tiredness, easy bruising and an increased chance for infection

Radiation therapy

Radiation therapy used high energy radiation to target Cancer cells . Radiation therapy may be used in
the treatment of leukemia that has spread to the breast or it may be used to target the spleen or other
areas where leukemia cells have accumulated.

Hormonal therapy

Hormonal therapy can be used before or after surgery or other treatment to decrease the chance of
cancer returning. If the cancer has already spread, hormonal therapy may shrink and control it.

Oestrogen and progesterone for breast cancer.

Immunotherapy

Immunotherapy used your immune system to fight cancer. The bodily diseai fighting immune system
may not attack your cancer because the cancdr cell produces proteins that bind the immune system
cells, immunotherapy works by interfering with that process

Eg cytokines , interleukins.
STAGING FOR BREAST CANCER

a. Stage 0 : Carcinoma in situ( Tis-N0-M0)

b. Stage I: Tumor<2cm with negative nodes
c. Stage IIA: Tumor 0 to 2cm with positive nodes, or 2 to 5cm with negative nodes
d. Stage IIB: Tumor 2 to 5cm with positive nodes or >5cm with negative nodes.
e. Stage IIIA: No evidence of primary tumor or tumor <2cm with involved fixed lymph nodes, or
tumor >5cm with involved movable or nonmovable nodes.
f. Stage IIB: Tumor of any size with direct extension to chest wall or skin, with or without involved
lymph nodes, or any size tumor with involved internal mammary lymph nodes.
g. Stage IV: any distant metastasis.

Nursing management
Patient Education:Provide patients with comprehensive information about their diagnosis, treatment
options, and potential side effects.

Educate patients on self-breast exams, recognizing signs of infection or complications post-surgery, and
healthy lifestyle choices.

Emotional Support:Offer emotional support and empathy to help patients cope with the emotional
challenges of a breast cancer diagnosis.

Encourage open communication and provide resources for counseling or support groups.

Pain Management:Assess and manage pain associated with surgery or treatment, ensuring patients are
comfortable and have appropriate pain relief.

Wound Care:Monitor surgical incisions for signs of infection or complications.

Teach patients how to care for their surgical wounds and drains, if applicable.

Lymphedema Management:Educate patients about the risk of lymphedema (swelling in the arm or
chest area) and strategies to minimize its occurrence.

Teach patients lymphedema management techniques, such as exercises and compression garments.

Chemotherapy and Radiation Therapy:Monitor patients for chemotherapy-related side effects, such as
nausea, fatigue, and immune suppression.

Assist in the management of side effects and provide emotional support during chemotherapy and
radiation therapy.

Hormone Therapy:Educate patients about the purpose and potential side effects of hormone therapy.

Monitor patients for side effects and provide guidance on managing them.

Psychosocial Support:Assess patients for psychological distress and refer them to appropriate mental
health services if needed.
Address concerns related to body image, self-esteem, and relationships.

Nutrition and Physical Activity:Promote a healthy diet and physical activity to support overall well-being
and recovery.

Consult with dietitians or physical therapists when necessary.

Medication Management:Administer medications as prescribed, including antibiotics, pain relievers,

and anti-nausea drugs.

Educate patients on medication schedules and potential interactions.

Symptom Management:Help manage common symptoms like fatigue, nausea, and changes in appetite.

Prevention
The medications tamoxifen or raloxifene may be used in an effort to prevent breast cancer in those who
are at high risk of developing it.

Follow-up care
Involves regular laboratory tests in asymptomatic people to try to achieve earlier detection of possible
metastases.

Regular physical exam and yearly mammography

Multidisciplinary rehabilitation programmes, often including exercise, education and psychological help.

REFERENCES

1. Lowdermilk,D, Bobak, M, Perry S. E. 1997. Maternity and women's Health care. C. V. Mosby.

2. Bennet, V. R; Brown L.K. 2006. Myles Textbook for midwives 13th Edition, Churchill . Livingstone.