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Nursing Management of Breast Cancer: Learning Outcomes
Nursing Management of Breast Cancer: Learning Outcomes
Learning Outcomes:
At the end of the lesson, you will be able to:
!. Identify the methods of breast cancer prevention and screening.
2. Identify the risk factors of breast cancer.
3. Trace the concept map of cancer of the breast
4. Apply the nursing process in the care of a client with cancer
5. Plan and Implement health education in a post mastectomy client.
Introductory Statement:
A woman who finds a breast mass or a lump will probably first suspect of cancer, though
8 out of 10 lumps are benign. Breast cancer is the most common cancer in women. In the US one
in every eight women will develop breast cancer in her lifetime (American Cancer Society). With
the advancement in technology, breast cancer is easily detected.
Nurses have a responsibility to educate his/her client, family and to a greater scope the
public about breast cancer, early detection and prevention. It is also of prime importance to
understand the flight of clients having the disease, therefore compassionate care should be
communicated through gentle and humane care.
Did you know that in the Philippines, BSE, aspiration, and open biopsy are the most
effective strategies in detecting breast malignancies.
It is the most frequently occurring breast disorder in women between 35 and 50 years
of age but often begins at an early age of 20. Fibrocystic changes has a close association with
the heightened responsiveness of the breast to circulating hormones (Estrogen and
progesterone). It commonly occurs in women with:
1. Premenstrual abnormalities
2. Nulliparous women
3. Women with history of spontaneous abortion
4. Nonusers of oral contraceptives
5. Women with early menarche and menopause
FIBROADENOMA
Fibroadenoma are firm, round, movable benign tumors. They can occur from puberty to
menopause with a peak incidence of 30 years of age. These masses are non tender and are
sometimes biopsied or removed for definitive diagnosis (Hinkle & Cheever, 2018).
Breast Cancer
Breast cancer is a major health concern in the United States. Current statistics indicate
that over a lifetime (birth death) a woman’s risk to developing cancer is about 12% or one in
eight (Hinkle & Cheever, 2018).
Female breast cancer incidence rates vary substantially by race and ethnicity. Higher death
rates in African-Americans have been attributed to late stage at diagnosis and poorer stage-
specific survival. In Asia, the Philippines has the highest reported incidence of breast cancer. It
is the most common cancer which is prevalent in the 35-to 40 year old group of Filipino women.
Etiology and Risk Factors
Although the is not completely understood, number of factors are thought to relate to the
cause of breast cancer. The following contribute to the development of breast cancer:
1. Heredity or genetics:
Women with BRCA 1 mutations have 40-80% chance to develop breast cancer
2. Hormonal regulation of the breast
Sex hormones (estrogen and progesterone) act as tumor promoters to stimulate breast
cancer growth
3. Modifiable risk factors :
● weight gain during adulthood
●sedentary life style
●dietary fat intake
●obesity
●alcohol intake
●combined hormone replacement therapy (estrogen and progesterone)
●oral contraceptive therapy
4. Environmental factors: radiation exposure
5. Family history (first degree relative –mother, daughter, sister
According to recent local study, four risk factors for breast cancer have been found to be
prevalent in Filipino women(Borromeo, 2014):
1. Passive smoking
2. First degree family history,
3. Consumption of scalding hot food
4. . Increased age at first pregnancy
The study also identified protective factors against breast cancer namely:
1. Inverted cigarette smoking
2. Consumption of canned meat, patis and bagoong
Pathophysiology:
Breast cancers are malignant tumors that typically begin on the ductal lobular epithelial
cells of the breast and spread via the lymphatic system to the axillary lymph nodes. The tumor
may the metastasize to distant regions of the body, including the lungs, liver, bone and brain.
The finding of breast cancer in the axillary lymph nodes is an indicator of the tumor’s ability for
potential distant spread and it is not merely contiguous growth into the adjacent region of the
breast. Most cancer of the breast are adenocarcinoma located in the upper outer quadrant of
the breast (Black, et al.,2009)
Classic symptoms that define breast cancer:
1. Firm, painless, nontender, nonmobile mass
2. Solitary, irregularly shaped mass
3. Adherence to muscle skin causing a dimpling effect
4. Involvement of upper outer quadrant or central nipple portion of the breast
5. Asymmetry of the breast
6. Orange peel skin
7. Retraction of the nipple
8. Abnormal discharge from the nipple
Management:
1. Excision of mass or lump
Management
PostOperative Care
*Position the client on her back or on the unaffected side.
*Deep breathing and coughing, turning should be done once the client is awake from anesthesia.
*Jackson Pratt drain or hemovac drain may be in place to drain fluids that accumulate when lymph
nodes are removed.
Source: https://my.clevelandclinic.org/health/articles/21104-how-to-care-for-your-
jackson-pratt-drain
*Note signs of bleeding on dressing and reinforce pressure dressing as needed.
*Encourage early range of motion exercises to prevent contractures and lymphedema.
*Use unaffected arm only to provide IV fluids and take blood pressure.
Drug Alert
**Monitor signs of deep vein thrombosis, pulmonar tumor regression.y embolism and
stroke, including shortness of breath , leg cramps and weakness.
** Instruct client to immediately report decreased visual acuity
Hormonal Therapy
Estrogen can promote the growth of breast cancer cells if the cells are estrogen receptor positive.
Hormonal therapy blocks the source of estrogen thus promoting regression.,
Estrogen deprivation can occur by blocking ovarian functions in surgery, radiation therapy or drug
therapy. Tamoxifen is an anti estrogen drug, the hormonal agent of choice in estrogen receptor
positive in women with all stages of breast cancer.
* Discharge Instructions:
1. Use caution when lifting heavy objects with arm on affected side.
2. Avoid injury and infection on affected side. Wear rubber gloves when washing dishes
and garden gloves when working outside
3. Arm exercises to continue even after discharge from the hospital.
4. Do not allow procedures (blood pressure taking or venipuncture) on the affected side.
5. Refer client to support groups for psychological support.
6. Diet should be rich in vitamins and minerals.
7. Take prescribed meds (antibiotics, pain medication, anticancer drugs)
8. Report for signs of wound infection (pain, swelling, redness, foul smelling discharge,
fever.
9. Follow up visit.