School of Nursing | 2014

Oral Revalida
Rectal Cancer
Colorectal cancer is cancer that develops in the tissues of the colon and/or
rectum. The colon and the rectum are both found in the lower part of the
gastrointestinal (digestive) system. They form a long, muscular tube called
the large intestine (or large bowel). The colon absorbs food and water and
stores waste. The rectum is responsible for passing waste from the body.
If the cancer began in the colon, which is the first four to five feet of the
large intestine, it may be referred to as colon cancer. If the cancer began in
the rectum, which is the last several inches of the large intestine leading to
the anus, it is called rectal cancer.
Colorectal cancer starts in the inner lining of the colon and/or rectum, slowly
growing through some or all of its layers. It typically starts as a growth of
tissue called a polyp. A particular type of polyp, called an adenoma, can then
develop into cancer.

Etiology
GENERAL

Age: Although colorectal cancer can occur at any age, the chances of
developing the disease dramatically increase after the age of 50.

Racial and ethnic background: African Americans have the highest

incidence of this disease in the United States. Ashkenazi Jews also have a
higher risk of developing colorectal cancer.
BODY

Obesity: Being overweight increases your risk of developing colorectal

cancer.
GENETICS

Family history of colorectal cancer: Although the reasons are not clear
in all cases, inherited genes, shared environmental factors, or a combination
of these factors can increase your colorectal cancer risks.

Inherited syndromes: The two most common inherited syndromes

linked with colorectal cancers are familial adenomatous polyposis (FAP) and
hereditary non-polyposis colorectal cancer (HNPCC). Other syndromes that
can increase the risk of developing colorectal cancer include Lynch
Syndrome, Turcot Syndrome and Peutz-Jeghers Syndrome.
LIFESTYLE

Diet: Diets that are high in red and processed meats (e.g., beef, lamb,
hot dogs) can increase your colorectal cancer risks. Frying, grilling, broiling or
other methods of cooking meats at very high temperatures create chemicals
that may also contribute to an increased risk.

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Inactive lifestyle: Individuals that live a sedentary lifestyle without

physical activity have an increased chance of developing colorectal cancer.

Smoking: Some of the cancer-causing substances associated with

smoking are swallowed and can increase the risk of developing this disease.

Alcohol use: Heavy alcohol use can lead to an increased risk of

colorectal cancer.
OTHER CONDITIONS

Personal history of colorectal cancer or polyps: If you have had

colorectal cancer before, you are more likely to develop cancer in other areas
of the colon and rectum.

History of inflammatory bowel disease (IBD): Having IBD, including

ulcerative colitis and Crohn's disease, increases your chances for developing
colorectal cancer.

Type II diabetes: There may be an increased risk for rectal cancer

associated with type II diabetes. This condition may also affect the prognosis
(outlook).

Incidence Rate
Colorectal cancer is a major cause of morbidity and mortality throughout the
world. It accounts for over 9% of all cancer incidence. It is the third most
common cancer worldwide and the fourth most common cause of death.

Physical Assessment and Review of Systems

Rectal cancer signs
The development of tumors in the rectum or anal canal may change the
consistency, shape or frequency of bowel movements. The severity of the
symptoms may increase or more symptoms might arise as the cancer
spreads throughout the rectum or into the colon. Rectal bleeding may make
the stool bright red. A bleeding tumor may also change the color of the
stools, sometimes making the stool very dark or tarry looking.
Rectal cancer signs related to bowel habit changes may include:

Diarrhea

Constipation

Not being able to completely empty the bowel

Change in the size or shape of stools (narrower than usual)

Bloody stool (either bright red or very dark)

General rectal cancer symptoms

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Early stages of rectal cancer may have no symptoms. However, more

systemic (body-wide) changes may result as the tumor goes deeper into the
layers of tissues lining the rectum or if the cancer spreads (metastasizes)
throughout the body.
Generalized symptoms of rectal cancer may include:

Pain in the rectum

Abdominal pain or discomfort

More frequent gas pains or stomach cramps

Feeling bloated or full

Change in appetite

Unintended weight loss

Fatigue or tiredness
Anatomy and Physiology
Pathophysiology

Diagnostic Tests
Primary tumor (T)
The primary tumor can be categorized as T0 up to T4 for colorectal cancer.
Below is a further description of how tumors are defined using the TNM
staging system.

TX: The main tumor cannot be assessed.

T0: There is no evidence of a primary tumor.
Tis (carcinoma in situ): In situ means that the cancer is in the earliest
stage, and it has not grown beyond the lining of the colon or rectum.
T1: The tumor has grown through the lining (muscularis mucosa) of the
colon or rectum.
T2: The tumor has expanded through the second layer of lining
(submucosa) of the colon or rectum and into the outer layer
(muscularis propria).
T3: The cancer has grown through the muscularis propria and into the
outer layers of the colon or rectum, but not all the way through. The
cancer has not spread to any nearby organs or tissue.
T4a: The cancer has grown all the way through the wall of the colon or
rectum, and has expanded to the surface of nearby organs.
T4b: The cancer has grown through the wall of the colon or rectum and
has now affected nearby tissues or organs.

Regional lymph nodes (N)

N0: The cancer has not spread into the lymph nodes.
N1: The cancer has spread to 1 to 3 regional lymph nodes.
N2: The cancer has spread to more than 4 regional lymph nodes.

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N2a: Cancerous cells have been located in 4 to 6 regional lymph nodes.

N2b: Cancerous cells have been found in more than 7 lymph nodes.

Distant metastasis (M)

M0: The cancer has not spread to distant organs.

M1: The cancer has spread to distant organs.
M1a: Cancerous cells have spread to one distant organ.
M1b: Cancerous cells have spread to more than one distant organ.

Endoscopic procedures
Lab tests
Biopsy
CT scan
MRI
PET-CT scan
Ultrasound

Medical-Surgical Management

Radiation Therapy
Chemotherapy
Surgery
Monoclonal antibody therapy

Drug Studies
Nursing Care Plans

Acute pain
Anxiety
Constipation
Deficient fluid volume
Diarrhea
Fear
Imbalanced nutrition: Less than body requirements
Risk for infection

Discharge Plan
Prognosis
Stage

5-year Observed
Survival Rate

74%

IIA

65%

IIB

52%

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IIC

32%

IIIA

74%*

IIIB

45%*

IIIC

33%

IV

6%

Hodgkins and Non-Hodgkins Disease

Hodgkin's lymphoma formerly known as Hodgkin's disease is a cancer
of the lymphatic system, which is part of your immune system. In Hodgkin's
lymphoma, cells in the lymphatic system grow abnormally and may spread
beyond the lymphatic system. As Hodgkin's lymphoma progresses, it
compromises your body's ability to fight infection. Presence of ReedSternberg cells in biopsy.
Non-Hodgkin's lymphoma, also called non-Hodgkin lymphoma, is cancer that
originates in your lymphatic system, the disease-fighting network spread
throughout your body. In non-Hodgkin's lymphoma, tumors develop from
lymphocytes a type of white blood cell.

Etiology
Doctors know that most Hodgkin's lymphoma occurs when an infectionfighting cell called a B cell develops a mutation in its DNA. The mutation tells
the cells to divide rapidly and to continue living when a healthy cell would
die. The mutation causes a large number of oversized, abnormal B cells to
accumulate in the lymphatic system, where they crowd out healthy cells and
cause the signs and symptoms of Hodgkin's lymphoma. Factors that increase
the risk of Hodgkin's lymphoma include:

Your age. Hodgkin's lymphoma is most often diagnosed in people

between the ages of 15 and 30, as well as those older than 55.
A family history of lymphoma. Having a close family member who has
Hodgkin's lymphoma or non-Hodgkin's lymphoma increases your risk
of developing Hodgkin's lymphoma.
Your sex. Males are slightly more likely to develop Hodgkin's
lymphoma.
Past Epstein-Barr infection. People who have had illnesses caused by
the Epstein-Barr virus, such as infectious mononucleosis, are more
likely to develop Hodgkin's lymphoma than are people who haven't had
Epstein-Barr infections.
A weakened immune system. Having a compromised immune system,
such as from HIV/AIDS or from having an organ transplant requiring
medications to suppress the immune response, increases the risk of
Hodgkin's lymphoma.

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Non-Hodgkin's lymphoma occurs when your body produces too many

abnormal lymphocytes a type of white blood cell. Normally, lymphocytes
go through a predictable life cycle. Old lymphocytes die, and your body
creates new ones to replace them. In non-Hodgkin's lymphoma, your
lymphocytes don't die, but continue to grow and divide. This oversupply of
lymphocytes crowds into your lymph nodes, causing them to swell. Some
factors that may increase the risk of non-Hodgkin's lymphoma include:

Medications that suppress your immune system. If you've had an organ

transplant, you're more susceptible because immunosuppressive
therapy has reduced your body's ability to fight off new illnesses.
Infection with certain viruses and bacteria. Certain viral and bacterial
infections appear to increase the risk of non-Hodgkin's lymphoma.
Viruses linked to increased non-Hodgkin's lymphoma risk include HIV
and Epstein-Barr virus. Bacteria linked to an increased risk of nonHodgkin's lymphoma include the ulcer-causing Helicobacter pylori.
Chemicals. Certain chemicals, such as those used to kill insects and
weeds, may increase your risk of developing non-Hodgkin's lymphoma.
More research is needed to understand the possible link between
pesticides and the development of non-Hodgkin's lymphoma.
Older age. Non-Hodgkin's lymphoma can occur at any age, but the risk
increases with age. It's most common in people in their 60s or older.

Incidence Rate
Hodgkin disease can occur in both children and adults. It is most common in
early adulthood (ages 15 to 40, especially in a persons 20s), where it is
mostly of the nodular sclerosis subtype, and in late adulthood (after age 55),
where the mixed cellularity subtype is more common. Hodgkin disease is
rare in children younger than 5 years of age. About 10% to 15% of cases are
diagnosed in children and teenagers.
Although some types of NHL are among the more common childhood
cancers, more than 95% of cases occur in adults. The types of NHL seen in
children are often very different from those seen in adults. NHL can occur at
any age, but about half of patients are older than 66. The risk of developing
NHL increases throughout life. The aging of the American population is likely
to lead to an increase in NHL cases during the coming years.

Physical Assessment and Review of Systems

Hodgkin's lymphoma signs and symptoms may include:

Painless swelling of lymph nodes in your neck, armpits or groin

Persistent fatigue
Fever and chills
Night sweats
Unexplained weight loss as much as 10 percent or more of your
body weight
Loss of appetite
Itching
Increased sensitivity to the effects of alcohol or pain in your lymph
nodes after drinking alcohol

Non-Hodgkin's lymphoma symptoms may include:

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Swollen lymph nodes in your neck, armpits or groin

Abdominal pain or swelling
Chest pain, coughing or trouble breathing
Fatigue
Fever
Night sweats
Weight loss

Anatomy and Physiology

Pathophysiology
Diagnostic Tests
Stages of Hodgkin's lymphoma include:

Stage I. The cancer is limited to one lymph node region or a single

organ.
Stage II. In this stage, the cancer is in two lymph node regions or the
cancer has invaded one organ and the nearby lymph nodes. But the
cancer is still limited to a section of the body either above or below the
diaphragm.
Stage III. When the cancer moves to lymph nodes both above and
below the diaphragm, it's considered stage III. Cancer may also be in
one portion of tissue or an organ near the lymph node groups or in the
spleen.
Stage IV. This is the most advanced stage of Hodgkin's lymphoma.
Cancer cells are in several portions of one or more organs and tissues.
Stage IV Hodgkin's lymphoma affects not only the lymph nodes but
also other parts of your body, such as the liver, lungs or bones.

Blood and urine tests

CT scan
X-ray
MRI
Biopsy
Needle biopsy
Positron emission tomography (PET)

Medical-Surgical Management

Chemotherapy
Radiation therapy
Stem cell transplant

Drug Studies
Nursing Care Plans

Acute Pain related to the injury of biological agents.

Hyperthermia related to ineffective thermoregulation secondary to
inflammation.
Imbalanced Nutrition Less than Body Requirements related to nausea,
vomiting.

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Knowledge Deficit related to lack of exposure to information

Risk for Ineffective Airway Clearance related to enlarged lymph
medinal / airway edema.

Discharge Plan
Prognosis
Because of advances in treatment, survival rates have improved in the past
few decades. The 1-year relative survival rate for all patients diagnosed with
Hodgkin disease is now about 92%; the 5-year and 10-year survival rates are
about 85% and 80%, respectively. Certain factors such as the stage (extent)
of Hodgkin disease and a persons age affect these rates.
NHL 5-year Survival
Stage
distribution
(%)

Stage at diagnosis

5-year relative
survival (%)

Localized (confined to
primary site)

29

81.1

Regional (spread to
regional lymph nodes)

15

70.5

Distant (cancer has

metastasized)

48

58.5

Unknown (unstaged)

64.1

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH), also known as benign prostatic
hypertrophy, is a histologic diagnosis characterized by proliferation of the
cellular elements of the prostate.

Etiology
Benign prostatic hyperplasia (BPH) is probably a normal part of the aging
process in men. It is caused by changes in hormone balance and cell-growth
factors. Genetics may also play a role. This is especially true for severe BPH
requiring surgery in men younger than 60.
Men who are older than 50 have a higher chance of developing BPH. But why
some men have more severe symptoms than others is not known.

Incidence Rate
BPH, the actual hyperplasia of the prostate gland, develops as a strictly agerelated phenomenon in nearly all men, starting at approximately 40 years of
age. In fact, the histologic prevalence of BPH, which has been examined in
several autopsy studies around the world, is approximately 10% for men in
their 30s, 20% for men in their 40s, reaches 50% to 60% for men in their
60s, and is 80% to 90% for men in their 70s and 80s. No doubt, when living
long enough, most men will develop some histologic features consistent with
BPH.

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Physical Assessment and Review of Systems

Urinary frequency - The need to urinate frequently during the day or

night (nocturia), usually voiding only small amounts of urine with each
episode
Urinary urgency - The sudden, urgent need to urinate, owing to the
sensation of imminent loss of urine without control
Hesitancy - Difficulty initiating the urinary stream; interrupted, weak
stream
Incomplete bladder emptying - The feeling of persistent residual urine,
regardless of the frequency of urination
Straining - The need strain or push (Valsalva maneuver) to initiate and
maintain urination in order to more fully evacuate the bladder
Decreased force of stream - The subjective loss of force of the urinary
stream over time
Dribbling - The loss of small amounts of urine due to a poor urinary
stream

Anatomy and Physiology

Pathophysiology
Diagnostic Tests

Digital Rectal Exam - prostate size and contour can be assessed,

nodules can be evaluated, and areas suggestive of malignancy can be
detected
Urinalysis - Examine the urine using dipstick methods and/or via
centrifuged sediment evaluation to assess for the presence of blood,
leukocytes, bacteria, protein, or glucose
Urine culture - This may be useful to exclude infectious causes of
irritative voiding and is usually performed if the initial urinalysis
findings indicate an abnormality
Prostate-specific antigen - Although BPH does not cause prostate
cancer, men at risk for BPH are also at risk for this disease and should
be screened accordingly (although screening for prostate cancer
remains controversial)
Electrolytes, blood urea nitrogen (BUN), and creatinine - These
evaluations are useful screening tools for chronic renal insufficiency in
patients who have high postvoid residual (PVR) urine volumes;
however, a routine serum creatinine measurement is not indicated in
the initial evaluation of men with lower urinary tract symptoms (LUTS)
secondary to BPH[1]
Ultrasonography - Ultrasonography (abdominal, renal, transrectal) and
intravenous urography are useful for helping to determine bladder and
prostate size and the degree of hydronephrosis (if any)
Endoscopy of the lower urinary tract

Medical-Surgical Management

Transurethral resection of the prostate (TURP)

Radical prostatectomy - used when the prostate is very enlarged. In
open surgery, the surgeon makes an incision in the abdomen or
between the scrotum and the anus to remove prostate tissue

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Drug Studies

alpha-adrenergic blockers - block effects of postganglionic synapses at

the smooth muscle and exocrine glands
5-alpha-reductase inhibitors - inhibit the conversion of testosterone to
DHT, causing DHT levels to drop, which, in turn, may decrease prostate
size

Nursing Care Plans

Urinary retention
Acute pain
Risk for deficient fluid volume
Fear/Anxiety

Discharge Plan
Prognosis
The outlook for benign prostatic hyperplasia is good; although it can cause
significant discomfort, the condition is benign. As the prostate gland grows in
size, symptoms may become worse, warranting medication or surgery. With
appropriate medical and/or surgical management, the symptoms of an
enlarged prostate gland can be treated effectively.

Dementia with Alzheimers disease

Etiology
Incidence Rate
Physical Assessment and Review of Systems
Anatomy and Physiology
Pathophysiology
Diagnostic Tests
Medical-Surgical Management
Drug Studies
Nursing Care Plans
Discharge Plan
Prognosis

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Cerebrovascular Accident
The sudden death of some brain cells due to lack of oxygen when the blood
flow to the brain is impaired by blockage or rupture of an artery to the brain.
A CVA is also referred to as a stroke.
Ischemic Stroke
An ischemic stroke occurs when a blood clot blocks a blood vessel,
preventing blood and oxygen from getting to a part of the brain. There are
two ways that this can happen. When a clot forms somewhere else in your
body and gets lodged in a brain blood vessel, it is called an embolic stroke.
When the clot forms in the brain blood vessel, it is called a thrombotic stroke.
Hemorrhagic Stroke
A hemorrhagic stroke occurs when a blood vessel ruptures, or hemorrhages,
which then prevents blood from getting to part of the brain. The hemorrhage
may occur in a blood vessel in the brain, or in the membrane that surrounds
the brain.
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) also called a ministroke is a brief
period of symptoms similar to those you'd have in a stroke. A temporary
decrease in blood supply to part of your brain causes TIAs, which often last
less than five minutes. Like an ischemic stroke, a TIA occurs when a clot or
debris blocks blood flow to part of your brain. A TIA doesn't leave lasting
symptoms because the blockage is temporary.

Etiology

Being overweight or obese

Physical inactivity
Heavy or binge drinking
Use of illicit drugs such as cocaine and methamphetamines

Potentially treatable risk factors

High blood pressure risk of stroke begins to increase at blood

pressure readings higher than 120/80 millimeters of mercury (mm Hg).
Your doctor will help you decide on a target blood pressure based on
your age, whether you have diabetes and other factors.
Cigarette smoking or exposure to secondhand smoke.
High cholesterol a total cholesterol level above 200 milligrams per
deciliter (5.2 millimoles per liter).
Diabetes.
Obstructive sleep apnea a sleep disorder in which the oxygen level
intermittently drops during the night.
Cardiovascular disease, including heart failure, heart defects, heart
infection or abnormal heart rhythm.

Other risk factors

Personal or family history of stroke, heart attack or transient ischemic

attack.
Being age 55 or older.

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Race African-Americans have higher risk of stroke than do people of

other races.
Gender Men have a higher risk of stroke than women. Women are
usually older when they have strokes, and they are more likely to die of
strokes than are men. Also, they may have some risk from some birth
control pills or hormone therapies that include estrogen, as well as
from pregnancy and childbirth.

Incidence Rate

According to the World Health Organization, 15 million people suffer

stroke worldwide each year. Of these, 5 million die and another 5
million are permanently disabled.
High blood pressure contributes to more than 12.7 million strokes
worldwide.
In developed countries, the incidence of stroke is declining, largely due
to efforts to lower blood pressure and reduce smoking. However, the
overall rate of stroke remains high due to the aging of the population.

Physical Assessment and Review of Systems

difficulty walking
dizziness
loss of balance and coordination
difficulty speaking or understanding others who are speaking
numbness or paralysis in the face, leg, or arm, most likely on just one
side of the body
blurred or darkened vision
a sudden headache, especially when accompanied by nausea,
vomiting, or dizziness

Anatomy and Physiology

Pathophysiology
Diagnostic Tests

Blood tests: Your doctor may want to test your blood for clotting time,
blood sugar levels, or infection. These can all affect the likelihood and
progression of a stroke.
Angiogram: By adding a dye to your blood and then taking an X-ray of
your head, your doctor can find the blocked or hemorrhaged blood
vessel.
Carotid ultrasound: Using sound waves to image the blood vessels in
your neck helps to determine if there is abnormal blood flow towards
your brain.
Computed tomography (CT) scan: A CT scan is often performed soon
after symptoms of a stroke develop to find the problem area or other
problems that might rule out a stroke.
Magnetic resonance imaging (MRI): MRIs can also be used to check for
damaged blood vessels.
Echocardiogram: This imaging technique uses sound waves to create a
picture of your heart. It can help to find the source of blood clots.

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Medical-Surgical Management

Endovascular Procedures - Endovascular procedures may be used to

treat certain hemorrhagic strokes similar to the way the procedure is
used for treating an ischemic stroke. These procedures are less
invasive than surgical treatments, and involve the use of a catheter
introduced through a major artery in the leg or arm, then guided to the
aneurysm or AVM; it then deposits a mechanical agent, such as a coil,
to prevent rupture.
Surgical Treatment - For strokes caused by a bleed within the brain
(hemorrhagic stroke), or by an abnormal tangle of blood vessels (AVM),
surgical treatment may be done to stop the bleeding. If the bleed is
caused by a ruptured aneurysm (swelling of the vessel that breaks), a
metal clip may be placed surgically at the base of the aneurysm to
secure it.

Drug Studies

Anticoagulants/Antiplatelets- Antiplatelet agents such as aspirin and

anticoagulants, such as warfarin, interfere with the blood's ability to
clot and can play an important role in preventing stroke. Read more
about anticoagulants.
Antihypertensives- Antihypertensives are medications that treat high
blood pressure. Depending on the type of medication, they can lower
blood pressure by opening the blood vessels, decreasing blood volume
or decreasing the rate and/or force of heart contraction

Nursing Care Plans

Ineffective cerebral tissue perfusion

Impaired physical mobility
Impaired verbal communication
Disturbed sensory perception
Risk for impaired swallowing

Discharge Plan
Prognosis
If you suffer from a stroke, your prognosis depends on the type of stroke,
how much damage it causes to your brain, and how quickly you are able to
receive treatment. The prognosis after an ischemic stroke is better than after
a hemorrhagic stroke.

Breast Cancer
Breast cancer refers to a malignant tumor that has developed from cells in
the breast. It is the most common site of cancer in women. It is second only
to lung cancer as a cause of death from cancer in women. Breast cancer
usually is discovered by the woman herself. She notes a single lump that is
painless, non-tender and movable which is frequently found in the upper
outer quadrant.

Etiology

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Gender:
Female
Age:
Increasing
Personal
History
Family
History
Genetic
Radiation
Obesity
High-fat
diet
Alcohol

99% occurrence in female

Increasing age highly associated with an increasing risk
Risk of developing breast cancer in same or opposite breast is
significantly increased
1st-degree relative increases it twofold; 2 1st-degree relatives
increases it fivefold
BRCA1 and BRCA2 mutations
Highest while still developing in younger years
Fat tissue increases estrogen levels
More research needed
2 to 5 drinks daily increases the risk about one and a half
times

Incidence Rate
Breast cancer is the most common cancer in women both in the developed
and less developed world. It is estimated that worldwide over 508 000
women died in 2011 due to breast cancer (Global Health Estimates, WHO
2013). Although breast cancer is thought to be a disease of the developed
world, almost 50% of breast cancer cases and 58% of deaths occur in less
developed countries (GLOBOCAN 2008). Incidence rates vary greatly
worldwide from 19.3 per 100,000 women in Eastern Africa to 89.7 per
100,000 women in Western Europe. In most of the developing regions the
incidence rates are below 40 per 100,000 (GLOBOCAN 2008). The lowest
incidence rates are found in most African countries but here breast cancer
incidence rates are also increasing.

Physical Assessment and Review of Systems

Skin dimpling
Peau d'orange
Nipple inversion
Nipple discharges
Painless lump
Breast distortion or change in contour

Anatomy and Physiology

Pathophysiology
Diagnostic Tests
Breast Self-Examination (BSE) is widely taught for detection of lumps in the
breast and it should be done monthly in women older than 18 years of age.
The American Cancer Society and National Cancer Institute recommend that
mammogram must be obtained in woman between 35 and 39 years of age.
Women between 40 and 49 years of age should have a mammogram should
have it every 2 years or annually if high risk while all women at 50 years of
age or older should have a mammogram every year.
Mammogram

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Ultrasound of the breast

Needle aspiration biopsy is sufficient if benign cysts are suspected, however,
excision and biopsy of the mass is the definitive diagnosis for malignant
tumors.
Cancer
Stage
I
Stage
II
Stage
III
Stage
IV

Staging Breast Cancer

T1 tumor 2 cm or less in diameter; N0 No lymph nodes
involved; M0 No metastasis
T0 T2 tumor less than 5 cm in diameter; N1 nodes involved;
M0 no metastasis
T3 tumor larger than 5 cm in diameter; N1 or N2 nodes
involved; tumor may be fixed; M0 no metastasis
T4 tumor any size but fixed to chest wall or skin; N1 clavicular
nodes involved (spread); M1 metastasis present

Medical-Surgical Management

Mastectomy
Radical mastectomy Radical mastectomy is the most extensive
type of mastectomy: The surgeon removes the entire breast, the
lymph nodes, and the chest wall muscles
Modified radical mastectomy Modified radical mastectomy
involves the removal of both breast tissue and lymph nodes
Simple mastectomy Simple or total mastectomy concentrates
on the breast tissue itself
Lumpectomy

Drug Studies
Nursing Care Plans

Acute pain
Body image disturbance related to significance of loss of part or all of
the breast
Anxiety
Fear
Imbalanced nutrition: Less than body requirements
Impaired physical mobility
Impaired skin integrity

Discharge Plan
Prognosis
Several different factors must be taken into consideration when determining
the prognosis of a patient with breast cancer. The two most important factors
are tumor size and whether it has spread to the lymph nodes under the arm
(axilla). Generally, the smaller the tumor, the better the prognosis. Prognosis
also depends on the extent of spread of the breast cancer. The 5-year
survival rate can be as high as 98.1% for a stage I breast cancer but also as
low 27.1% for a stage IV cancer.