Is the leading type of cancer in women.

Most breast cancer begins in the lining of the milk ducts, sometimes the lobule. The cancer grows through the wall of the duct and into the fatty tissue. Breast cancer metastasizes most commonly to auxiliary nodes, lung, bone, liver, and the brain. The most significant risk factors for breast cancer are gender (being a woman) and age (growing older). Other probable factors include nulliparity, first child after age 30, late menopause, early menarche, long term estrogen replacement therapy, and benign breast disease. Controversial risk factors include oral contraceptive use, alcohol use, obesity, and increased dietary fat intake. About 90% of breast cancers are due not to heredity, but to genetic abnormalities that happen as a result of the aging process and life in general. A womans risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women diagnosed with breast cancer have a family history of breast cancer.

STAGES OF BREAST CANCER STAGE Stage 0 Stage I Stage IIA DEFINITION Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue. Cancer is 2 centimeters or less and is confined to the breast (lymph nodes are clear). No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm) OR the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes OR the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes. The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes OR the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes. No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone OR the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone. The tumor may be any size and has spread to the chest wall and/or skin of the breast AND may have spread to axillary lymph nodes that are

Stage IIB

Stage IIIA

Stage IIIB

clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. Inflammatory breast cancer is considered at least stage IIIB. There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast AND the cancer has spread to lymph nodes either above or below the collarbone AND the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone. The cancer has spread or metastasized to other parts of the body.

Stage IIIC

Stage IV

ASSESSMENT

A firm lump or thickness in breast, usually painless; 50% are located in the upper outer quadrant of the breast. Spontaneous nipple discharge; may be bloody, clear or serous. Asymmetry of the breast may be noted as the woman changes positions; compare one breast with the other. Nipple retraction or scalliness, especially in Pagets disease. Enlargement of auxiliary or supraclavicular lymph nodes may indicate metastasis.

DIAGNOSTIC EVALUATION

Mammography (most accurate method of detecting non-palpable lesions) shows lesions and cancerous changes, such as microcalcification. Ultrasonography may be used to distinguish cysts from solid masses.

Biopsy or aspiration confirms diagnosis and determines the type of breast cancer. Estrogen or progesterone receptor assays, proliferation or S phase study (tumor aggressive), and other test of tumor cells determine appropriate treatment and prognosis.

Blood testing detects metastasis; this includes liver function tests to detect liver metastasis and calcium and alkaline phosphatase levels to detect bony metastasis. Chest x-rays, bone scans, or possible brain and chest CT scans detect matastasis.

PHARMACOLOGIC INTERVENTIONS
1. Chemotherapy is the primary used as adjuvant treatment postoperatively ; usually begins 4 weeks after surgery (very stressful for a patient who just finished major surgery).

Treatments are given every 3 to 4 weeks for 6 to 9 months. Because the drugs differ in their mechanisms of action, various combinations are used to treat cancer.

Principal breast cancer drugs include cyclosphosphamide, methotrexate, fluorouracil, doxorubicin, and paclitaxel. Additional agents for advanced breast cancer include docetaxel, vinorelbine, mitoxantrone, and fluorouracil. Herceptin is a monoclonal antibody directed against Her-2/neu oncogene; may be effective for patients who express this gene

2. Indications for chemotherapy include large tumors, positive lymph nodes, premenopausal women, and poor prognostic factors. 3. Chemotheraphy is also used as primary treatment in inflammatory breast cancer and as palliative treatment in metastatic disease or recurrence. 4. Anti-estrogens, such as tamoxifen, are used as adjuvant systemic therapy after surgery. 5. Hormonal agents may be used in advanced disease to induce remissions that last for months to several years.

SURGICAL INTERVENTIONS
1. Surgeries include lumpectomy (breast-preventing procedure), mastectomy (breast removal), and mammoplasty (reconstructive surgery). 2. Endocrine related surgeries to reduce endogenous estrogen as a palliative measure. 3. Bone marrow transplantation may be combined with chemotherapy.

NURSING INTERVENTIONS
1. Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. 2. Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression. 3. Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. Provide psychological support to the patient throughout the diagnostic and treatment process. 4. Involve the patient in planning and treatment. 5. Describe surgical procedures to alleviate fear. 6. Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue. 7. Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy. 8. Administer I.V. fluids and hyperalimentation as indicated. 9. Help patient identify and use support persons or family or community. 10. Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. 11. Teach all women the recommended cancer-screening procedures.