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Oncology: Assessment & Management of Breast Cancer Patients

Learn about the pathophysiology of breast cancer, treatment modalities, nursing care, and patient education for comprehensive care. Topics include radiation and chemotherapy, diagnostic findings, and surgical management.

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Oncology: Assessment & Management of Breast Cancer Patients

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  1. Oncology Assessment and Management of Patients With Cancer Breast Prepared by Dr. Iman Abdullah

  2. 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

  3. 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

  4. Learning Objectives On completion of this lecture, the student will be able to: • Compare the structure and function of the normal cell and the cancer cell • Differentiate 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

  5. 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

  6. 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

  7. Management of Cancer • Surgery • Radiation therapy • Chemotherapy • Bone Marrow Transplantation • Hyperthermia • Targeted therapies • Photodynamic therapy

  8. Radiation Therapy Types of Radiation • External Radiation • Internal radiation • Radiation Dosage

  9. 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

  10. Nursing Management in Radiation Therapy • Protecting skin and oral mucosa • Protecting caregivers

  11. Chemotherapy • Administration of Chemotherapeutic Agents • The route of administration usually depends on: • The type of agent • The required dose • The type, location, and extent of tumor being treated • Special Problems Extravasation • Indications of extravasation during administration of vesicant agents

  12. 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 System • Hematopoietic System • Cardiopulmonary System • Renal System • Reproductive System • Neurologic System • Miscellaneous

  13. Nursing Management in Chemotherapy • Assessing fluid and electrolyte status • Modifying risks for infection and bleeding • Administering chemotherapy • Protecting caregivers

  14. Anatomic and Physiologic Overview

  15. Assessment • Health History • Physical Assessment: Female Breast • Diagnostic Evaluation

  16. 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

  17. 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

  18. 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

  19. Breast Cancer Prevention Strategies in the High-Risk Patient • Long-Term Surveillance • Chemoprevention • Chemoprevention • Prophylactic Mastectomy

  20. Clinical Manifestations

  21. Assessment and Diagnostic Findings Techniques to determine the diagnosis of breast cancer include various types of biopsy, which have been discussed previously.

  22. Staging or Classification of Tumors • Stage 0 • Stage 1 • Stage II and stage III,stage IV

  23. 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).

  24. Surgical Management • Modified Radical Mastectomy • Total Mastectomy • Breast Conservation Treatment

  25. Nursing Process The 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

  26. Monitoring and managing potential complications • Lymphedem • Hematoma Formation • Seroma Formation • Infection • Promoting Home and Community-Based Care

  27. Radiation Therapy • Types of radiation • External-beam radiation • Brachytherapy • Intraoperative radiation therapy • Acute Side Effects • Nursing Management

  28. 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

  29. II- Hormonal Therapy • Managing 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

  30. 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.

  31. Reference Brunner, 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.]

  32. Thank you

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