EBP: Breast CancerSamantha DuvalSMH/Fall2013/UD

OverviewUnderstand the prevalence of this diseaseLearning the pathophysiologyUnderstanding how this disease affects you and your practiceTreatment options availableDiagnostic testingPrognosis/OutcomeNursing Diagnosis / Nursing Role

Taking a Closer Look

Among all cancers, breast cancer has been the 2nd leading cause of death in women (right behind lung cancer)

Causes about 40,000 deaths annually About 5-10% of women who develop

this cancer have a genetic predisposition with the BRCA1 gene.

Breast cancer also affects glands and the lymphatic system

Pathophysiology

About 80% of breast cancers arise in the ductal tissue, while the other remaining 10-15% occurs in the lobular tissue

As with many cancers, breast cancer is highly influenced by hormones- our female sex hormones such as FSH, Estrogen, Progesterone can stimulate the growth of a tumor

How does it become cancer? Cells of the breast may undergo growth changes during tissue renewal and differentiation that can ultimately give rise to cancer.

Stages of Breast Cancer

Pathophysiology

Those who study breast cancer and how it arises understand that the developmental pathways of the breast tissues (ducal and lobular) and its responses to the hormones and growth factors that regulate tissue development

The cellular abnormalities of why tumors occur is not yet known, however researchers do know that tumors originate in the breast tissue and begin to proliferate abnormally as a direct result of genetic changes within the breast and hormones.

Symptoms= tumor that may or may not be palpable

DCIS Vs. LCIS

DCIS- Ductal carcinoma in situ= Abnormal cells arise in the ductal tissue, where is can progress through the lining of the milk ducts and invade the fatty tissue of the breast. In the normal process of tissue development during puberty, ductal tissue develops in response to estrogen.

LCIS=lobular carcinoma in stiu= begins in the lobules that produce milk and may progress to infiltrating invasive lobular carcinoma.

Risk Factor: Genetic Link

What is BRAC?› Breast and Ovarian Cancer gene › BRAC 1 was the first gene identified; carries

with this mutation have a higher risk of developing breast or ovarian cancer during their lifetime

› BRAC2 an inherited gene also significantly increases risks

› Both BRCA1 and 2 have been shown to promote the development of breast cancer as a result of their growth-promoting effects on breast tissue.

Other contributing factors

A vast majority of cases are in the ABSENCE of genetic predisposition

Age- increases over 50 First menstruation before the age of 12 First childbirth after the age of 35 Menopause after the age of 50

Diagnosis

Self breast examination Mammogram To determine malignancy:

› Biopsy- removal of small amonut of tissue from the breast

› Ultrasonography- uses sound waves to explore tissue structure

› Mammogram-radiography of the soft tissue of the breast

Treatment

Primary treatment= surgical removal of tumor

Mastectomy Radiation Chemotherapy Hormone therapy Protein Medications: Tamoxifen, Evista, a newer

class of antiestrogens called aromatase inhibitors (AI)

Prognosis

Prognosis is all dependent on tumor size, appearance, local invasiveness, and lymph node involvement for possible metastasis

Individualized ;age, menopause etc. are also taken into account for prognosis

Interventions

Medical› Alternative

treatments› Consent› Prescriptions› Surgical

interventions

Nursing› Patient education› Empathy› Symptom

management› Support› Coordination of care› Medication

administration› Consult› Multidisciplinary care

Nursing diagnosis

Ineffective coping Risk for disturbed body image Pain Impaired self-esteem Risk for infection Depression Anxiety Social isolation

My clinical experience with a breast cancer patient

Scenario HPI Signs and symptoms Gaps between clinical experience and

new research

NCLEX Question

A nurse is caring for a patient who has just found out she has stage 2 breast cancer. She asks the nurse what could have caused this. The nurse would reply

A. “You might have had trauma in the past that lead to tissue damage”

B. “There is nothing you could have done to prevent it, try not to worry”

C. Breast cancer can be caused by a number of factors including hormones, age, childbirth, onset of menses and menopause and even genetics”

D. “ You just have bad genes”

NCLEX Question

A nurse is explaining the process of an ultrasonography to a patient. The nurse knows the patient understands what the procedure is when she says which of the following?

A. “There will be a needle inserted into my breast tissue”

B. “The use of sound waves will explore my breast structure”

C.” My breast will be placed between a table and compressed”

D. “I will need to be prepared for surgery”

NCLEX Question

A nurse is treating a 55 year old women who had of a left mastectomy 6 months ago. The patient states she feels pressure under her arm. Upon assessment the nurse notes +4 edema on the left arm. What conclusion can the nurse make based upon these assessment findings?

A. The patient is having a reaction to anesthesia. She is showing signs of sepsis Her cancer has now spread to her lymph nodes The patient is now suffering from lymphedema

due to her mastectomy

References

Crawford, Sarah, PH.D., Alder, Richard, Ph.D., (2013). Breast Cancer. Magill’s Medical Guide (Online Edition). Retrieved from http://eds.a.ebscohost.com.ezproxy.lib.usf.edu/eds/detail?sid=3e78d67e-132e-48d6-abfc-ee94a2e3a562%40sessionmgr4005&vid=4&hid=4203&bdata=JnNpdGU9ZWRz LWxpdmU%3d#db=ers&AN=86193952

Korber, Susan F., Padula, Cynthia., Gray, Julie., Powell, Margot., (2011). A Breast Navigator Program: Barriers, Enhancers, and Nursing Interventions. Oncology Nursing Forum. 38(1), 1-49. Retrieved from http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?sid=2a6b876d-566c-49f1-a96e-891eb8a23870%40sessionmgr4004&vid=8&hid=4213

http://www.youtube.com/watch?v=8Ik1i9YT374