Oncology Assessment and Management of Patients With Cancer Breast Prepared by Dr. Iman Abdullah.
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Transcript of Oncology Assessment and Management of Patients With Cancer Breast Prepared by Dr. Iman Abdullah.
Out Line Pathophysiology of the Malignant Process Proliferative Patterns Characteristics of Malignant Cells Management of Cancer Radiation Therapy Types of Radiation Toxicity Nursing Management in Radiation Therapy Chemotherapy Administration of Chemotherapeutic Agents Special Problems Extravasation Toxicity Nursing Management in Chemotherapy
Out Line Anatomic and Physiologic Overview of Breast Assessment Malignant Conditions of the Breast Types of Breast Cancer Risk Factors Breast Cancer Prevention Strategies in the High-Risk Patient Clinical Manifestations Assessment and Diagnostic Findings Staging or Classification of Tumors Prognosis Surgical Management Nursing Process Systemic Treatments
Learning ObjectivesOn completion of this lecture, the student will be able to:
Compare the structure and function of the normal cell and the cancer cellDifferentiate between benign and malignant tumors.Describe the roles of radiation therapy, and chemotherapy in treating cancer.Describes the special nursing needs of patients receiving chemotherapy.Develop a teaching plan for breast self-examination
Cont.Identify the diagnostic tests used to detect the breast disorders.
Use the nursing process as a framework for care of the patient undergoing breast cancer surgery.
Compare the therapeutic usefulness of chemotherapy, surgery and radiation in treating breast cancer
Describe the physical, psychological and rehabilitative needs of the patient who has had mastectomy
Pathophysiology of the Malignant Process
Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA.
Proliferative Patterns
Characteristics of Malignant Cells
Management of Cancer
Surgery
Radiation therapy
Chemotherapy
Bone Marrow Transplantation
Hyperthermia
Targeted therapies
Photodynamic therapy
Toxicity
Altered skin integrity is a common effect
Alterations in oral mucosa
The entire gastrointestinal mucosa may be involved
Anorexia nausea, and vomiting, and diarrhea
If sites containing bone marrow (Anemia, Leukopenia, Thrombocytopenia (bleeding)
Systemic side effects
ChemotherapyAdministration of Chemotherapeutic AgentsThe route of administration usually depends on:
The type of agentThe required dose The type, location, and extent of tumor being
treated
Special Problems Extravasation Indications of extravasation during administration of
vesicant agents
Toxicity Cells with rapid growth rates (eg, epithelium, bone marrow, hair follicles, sperm) are very susceptible to damage, and various body systems may be affected as well.Gastrointestinal SystemHematopoietic SystemCardiopulmonary SystemRenal SystemReproductive System
Neurologic System
Miscellaneous
Nursing Management in Chemotherapy
Assessing fluid and electrolyte status
Modifying risks for infection and bleeding
Administering chemotherapy
Protecting caregivers
Malignant Conditions of the Breast Types of Breast Cancer
Ductal Carcinoma in Situ (DCIS) Invasive Cancer • Infiltrating Ductal Carcinoma• Infiltrating Lobular Carcinoma• Medullary Carcinoma• Mucinous Carcinoma • Tubular Ductal Carcinoma• Inflammatory Carcinoma• Paget Disease
Risk Factors Non Genetic Risk Factors Gender and Age
Personal History
Hormonal Factors
Radiation Exposure
Benign Proliferative Breast Disease
Fat Intake and Obesity
Alcohol Use
Other Possible Risk Factors
Genetic Risk Factors
More than 80% of all breast cancer cases have no known family history of the disease.
In familial cases, the risk is determined by which family member has the disease. Having a first-degree relative increase the risk twofold.
Protective Factors
Breast Cancer Prevention Strategies in the High-Risk Patient
Long-Term Surveillance
Chemoprevention
Chemoprevention
Prophylactic Mastectomy
Assessment and Diagnostic FindingsTechniques to determine the diagnosis of breast cancer
include various types of biopsy, which have been discussed previously.
Prognosis
The two most important factors when determining the prognosis of a patient with breast cancer are:
Tumor size
Whether the tumor has spread to the lymph nodes under the arm (axilla).
Nursing ProcessThe Patient Undergoing Surgery for Breast Cancer
Assessment
Diagnosis (Preoperative Nursing Diagnosis)
Diagnosis (Postoperative Nursing Diagnosis)
Potential Complications
Planning and Goals
Preoperative Nursing Interventions
Postoperative Nursing Interventions
Monitoring and managing potential complications
Lymphedem
Hematoma Formation
Seroma Formation
Infection
Promoting Home and Community-Based Care
Radiation TherapyTypes of radiation
External-beam radiation
Brachytherapy
Intraoperative radiation therapy
Acute Side Effects
Nursing Management
Systemic Treatments I- Chemotherapy
Common physical side effects of chemotherapy for breast cancer
Specific side effects vary with the type of chemotherapeutic agent used.
The side effects of the anthracyclines
Nursing Management
II- Hormonal TherapyManaging Side Effects of Adjuvant Hormonal
Therapy in Breast Cancer Hot Flashes Vaginal Dryness Nausea and Vomiting Musculoskeletal Symptoms Risk of Endometrial Cancer Risk for Thromboembolic Events Risk for Osteoporosis or Fractures
III- Targeted Therapy
Trastuzumab (Herceptin) is a monoclonal antibody that binds specifically to the HER-2/neuprotein.
This protein, which regulates cell growth, is present in small amounts on the surface of normal breast cells and in most breast cancers.
Trastuzumab targets and inactivates the HER-2/neuprotein, thus slowing tumor growth.
Unlike chemotherapy, trastuzumab spares the normal cells and has limited adverse reactions, which may include fever, chills, nausea, vomiting, diarrhea, and headache.
ReferenceBrunner, L. and Suddarath, D. (2010). Text Book of Medical Surgical Nursing. 12th Edition. J.B. Lippincott Williams & Wilikins, Library of Congress Catalging-in-Publication Data.]