BREAST CANCER

Stage IV

BSN IV Group 1B
Feb. 8, 2011
 INTRODUCTION
Cancer is a major health problem worldwide and the
morbidity and mortality from cancer give rise to much
suffering. The risk of developing cancer in an individual's
lifetime is about 33%, and the risk of dying of cancer is
25%. Cancer is not only a disease of the elderly although
for many cancers the incidence increases with age. Breast
cancer in the US and Western Europe is the commonest
female cancer, and accounts for the most cancer deaths in
women. Eighteen percent of women who develop breast
cancer will be under 50 years of age and with an average
of 50% mortality this will produce a significant number of
deaths in a population of wives and mothers who are
making major contributions to the nurture of future
generations and the economy.
 INTRODUCTION
Loss of life in this age group has very serious
consequences both for society in general and for
the individual families involved. There are now
major health programs throughout the world
involved in research and development into
prevention, early detection, and new treatments
with the aim of reducing the morbidity and mortality
from breast cancer. It is of some considerable
interest that the East in general has amongst the
lowest rates of breast cancer in the world. This is
assumed to be a combination of environmental
and genetic factors and their interaction.
 INTRODUCTION
In the UK 30,000 new cases of breast cancer are
diagnosed each year making this the commonest
malignancy in women and causing nearly 15,000
deaths per year. Randomized studies of
prevention strategies particularly with the anti-
oestrogens Tamoxifen and more recently
raloxifene, and retinoids have either been
completed or are ongoing. The final analysis is
awaited but it is likely that effective preventive
measures will be available in the not too distant
future.
 INTRODUCTION
A national population-based breast-screening
program was commenced 6 years ago on the
evidence from randomized trials, which demonstrate
a reduction in breast cancer mortality from
screening. This remains an area of considerable
medical debate, which centers on the question of
cost-effectiveness. In the not too distant future it
should be possible to better define women who are
at increased risk of breast cancer, to discover the
reasons for their increase in risk, and then to target
both specific preventive and early detection
strategies at this "at risk" population.
 INTRODUCTION
In Asia, the Republic of the Philippines has the
highest reported incidence rate of breast cancer.
From 43.2 in 2003-2005, the age standardized-
incidence rate (ASR) is now 47.7 per 100,000
females, and this figure exceeds the rate reported
for several Western countries, including Spain,
Italy, and most Eastern European countries.
 INTRODUCTION
Many breast cancers are diagnosed among 35 to
50-year-old Filipino women. In terms of breast
cancer detection, a local study revealed that the
use of breast self-examination (BSE) and
aspiration biopsy/open biopsy are the most cost-
effective strategies in the Philippine setting,
incurring savings for the government by almost 3
million Philippine Pesos or US $60,000 (1989
value) per year per 100,000 women.
Mammography is neither readily available nor
affordable especially in the rural areas.
 PATIENTS DATA
Name: Mrs. Hopeful
Age: 51 y/o
Sex: Female
Civil Status: Married
Religion: Roman Catholic
Address: Naguilian, Isabela
Birthday: May 12, 1959
Diagnosis: Pleural Effussion;
Breast CA; PTB
 CHIEF COMPLAINT

Difficulty of
breathing and
edema on the left
upper extremity.
 FAMILY HISTORY

On her father side, her

grandmother died due to
cancer. No other serious
illnesses were noted base
from the family health
history.
 PAST HISTORY
According to the patient, she had
measles and chicken pox in her grade
school. She didnt recall if she had
immunizations. She had coughs and
colds once in a while and managed it
with OTC (over the counter) drugs.
Furthermore, she does not have any
allergy on foods nor on medicines. Aside
from that no other illnesses were noted.
 PAST HISTORY (Cont.)
She stated that last June of 2006, she palpated
a mass on her left upper breast; she was working as a
domestic helper in Hongkong at that time. She had her
checked up in one of the hospitals in Hongkong and
undergone biopsy and was diagnosed to have a
breast cancer Stage II. She went home to the
Philippines and on October 6, 2006 she had
undergone left mastectomy operation at the PGH
(Philippine General Hospital). Then, on 2007 at the
same hospital she underwent chemotherapy for 6
months. Next, she also had undergone Cobalt therapy
at the Jose Reyes Hospital.
 PRESENT HISTORY

1 year PTA, the patient

had an edema on her left
upper extremity, followed
with body weakness and
difficulty of breathing.
 SOCIAL HISTORY
They originally come from an
Ilocano background, she and her
husband are from Isabela. She doesn't
smoke nor drink alcoholic beverages.
She had a good relationship with
her family, her only daughter was
already married and the family lives
with them.
 GORDONS
11 FUNCTIONAL HEALTH
PATTERNS
Health Perception/ Health Management
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She regards health She realizes that it It was her 5th

as a momentous is a must to take hospital
part of life; it is responsibility in our experience, she
something not to be health. Our health values health and
taken for granted. reflects the her health status
She take vitamins, consequences of somehow gave her
brushes her teeth our actions. realization that
2x a day. actions of staying
healthy is more
important than just
merely knowing on
how to be healthy.
NUTRITIONAL METABOLIC
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She sometimes Lesser appetite Some of her

skips her meals, because of her medication
she doesnt medication and suppresses her
have too much condition appetite which
appetite, (dysphagia). aggravates her
however, she usual appetite
usually eats even before
vegetable and hospitalization.
meat.
SLEEP REST
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She sleeps 4-6 She only sleeps She admits that

hours. She usually for 2-3 hours in a she cant help
goes to bed at day. thinking about her
10pm and wakes condition
up at about 4am in especially at night,
the morning. she also
mentioned that
she had a hard
time breathing
especially when
her lips are dry.
ELIMINATION
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She usually Urinates 1-2 Changes in

defecates not times a day with bowel
more than two slightly movement is
times a day and yellowish urine due to decrease
micturates 3-5 and defecates mobility or
times. every other day exercise.
with hard
formed stool.
ACTIVITY EXERCISE
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She is a very Still performs her Her body is still

hardworking daily living weak brought
mother; she helps activities but with about prolonged
her daughter in an assistance. disease process
taking good care Confessed that and decline of her
of their kids. She she gets tired body system.
also do household easily these past
chores which is few days.
the activities that
keeps her fit.
COGNITIVE PERCEPTUAL
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

Her senses are Her senses are No change,

functional. still functional, since the
However, she and still wear operation
use eyeglasses glasses when performed was
when reading, reading. localized at her
other than that breast.
she doesnt
wear any other
aids or
prosthesis.
SELF-PERCEPTION/ SELF CONCEPT
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She is a strong Shes strong Her personality as

willed and reliable enough to accept a strong-willed
person; she tries her illness, person somehow
her best to help however, she helps her to accept
her family admits that there her condition but
especially in taking are times when nevertheless, as
good care of her she just lose part of a woman it
grandchildren. hopes, but tries is expected for her
her best not to to be emotional at
show it to her times.
family.
ROLE RELATIONSHIP
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She did not mention She gets along well Being an optimist
any specific with other patient and dependable
problems with her and to health care person, she values
family. She admitted providers. She relationship with
that she had a good sometimes feels sad others regardless of
relationship with her and fears that she her condition,
husband and to her might not be able to however, she cant
daughter. perform her role in help to have fears to
the family. the anticipated
procedures she
have to undergo if
her illness will get
worse.
SEXUALITY REPRODUCTIVE
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

At the age of 49, Her At her age, she

she had her hospitalization admits that she
menopausal caused her to rarely had sexual
period. She have limited urges (decrease
admits that her movements. Her libido) and her
relationship with husband just husband was
her husband are stays with her for contented just to
already in support and be with her even
platonic level and confidant. without coitus.
do not practice
coitus.
COPING/ STRESS TOLERANCE
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She had a very Her family supports She is a family-

close relationship her and she tries oriented person.
with her family; they her best to stay She values her
were very strong for them. family and her faith,
supportive on her She had a strong which influenced
condition. In faith in God and its her coping
addition, she one of the reasons mechanism in
strongly believes in that keep her going. dealing with lifes
the power of prayer unexpected
in solving problems challenges.
and in making
decisions in her life.
VALUE BELIEF
BEFORE DURING RATIONALE
HOSPITALIZATION HOSPITALIZATION

She is a Roman She became closer The values she had

Catholic. She values with her faith, and remains with her no
the gift of life, admits at times she matter how difficult
despite the odds questions it but her things are.
and ironies it brings. faith is much
She bravely faces stronger than her
this obstacle. She doubts.
have a strong belief
in God above all
things and attend
mass if have the
chance.
BREAST CANCER

Stage IV

P A T I E N T B A S E D

PATHOPHYSIOLOGY
PREDISPOSING FACTORS: PRECIPITATING FACTORS:
Age (Pt. is 51 y/o) Unknown
Gender (Pt. Is female)
Late Menopausal (Pt. was
menopaused at 49)
Lifestyle (Stress)
Hereditary (Pt.s grandmother
died because of cancer)

Neoplasm formation in the breast

Primary tumor begins S/Sx: pain on the

in the breast left upper breast
Surgery (Pt.
undergone Tumor becomes invasive
mastectomy)
Travel (metastasize) to Progress beyond
other organ systems in breast to regional
the body lymph nodes

It becomes systemic

Primary cancer spreads

Chemotherapy Progress beyond

Radiotherapy breast to regional
Interstitial laser thermotherapy lymph nodes
 Removal of the breast Cancer cell
spreads into major
organs

Cancer cell Some cancer

destroyed/ cell remains
removed

LUNGS LIVER NECK

S/Sx: DOB, S/Sx: RLQ pain S/Sx: Horseness of
Cough, voice
Pleural Efussion

BONES BRAIN

S/Sx: Back & bone pain S/Sx: Headache

DRUG STUDY
 DOPAMINE HYDROCHLORIDE
BRANDS:
Dopastat, Intropin, Revimine
CLASSIFICATIONS:
Autonomic Nervous System Agent;
Alpha- and Beta-adrenergic Agonist
(Sympathomimetic)
ACTION:
Naturally occurring neurotransmitter and immediate
precursor of nor-epinephrine. Major cardiovascular
effects produced by direct action on alpha- and beta-
adrenergic receptors and on specific dopaminergic
receptors in mesenteric and renal vascular beds.
 DOPAMINE HYDROCHLORIDE
INDICATION:
To correct hemodynamic imbalance in shock
syndrome due to MI (cardiogenic shock), trauma,
endotoxic septicemia (septic shock), open heart
surgery, and CHF.
CONTRA INDICATIONS:
Pheochromocytoma; tachyarrhythmias or ventricular
fibrillation. Safe use during pregnancy (category C),
lactation, or children is not established.
 DOPAMINE HYDROCHLORIDE
NURSING RESPONSIBILITIES:
Monitor blood pressure, pulse, peripheral pulses, and
urinary output at intervals prescribed by physician. Precise
measurements are essential for accurate titration of
dosage.
Report the following indicators promptly to physician for
use in decreasing or temporarily suspending dose:
Reduced urine flow rate in absence of hypotension;
ascending tachycardia; dysrhythmias; disproportionate rise
in diastolic pressure (marked decrease in pulse pressure);
signs of peripheral ischemia (pallor, cyanosis, mottling,
coldness, complaints of tenderness, pain, numbness, or
burning sensation).
 DOPAMINE HYDROCHLORIDE
NURSING RESPONSIBILITIES:
Monitor therapeutic effectiveness. In addition to
improvement in vital signs and urine flow, other indices of
adequate dosage and perfusion of vital organs include loss
of pallor, increase in toe temperature, adequacy of nail bed
capillary filling, and reversal of confusion or comatose
state.
SURGICAL TREATMENT
 MASTECTOMY
Mastectomy is an operation in which the entire breast,
usually including the nipple and the areola, is removed.
Mastectomy is usually performed as a treatment of breast
cancer.
In general, women with breast cancer can decide whether
to be treated with a lumpectomy or a mastectomy.
A lumpectomy is the removal of the cancerous breast
tissue as well as a surrounding rim of healthy breast tissue.
A lumpectomy is a breast-conserving surgery that is usually
followed by radiation therapy (high-dose X-rays or other
high-energy rays to kill cancer cells).
 MASTECTOMY
There are four main types:
Total mastectomy - removal of breast tissue and nipple
Modified radical mastectomy - removal of the breast, most
of the lymph nodes under the arm and often the lining over
the chest muscles
Lumpectomy - surgery to remove the tumor and a small
amount of normal tissue around it
Radical mastectomy - the removal of the breast, lymph
nodes and chest muscles. This is no longer common
Which surgery you have depends on the stage of cancer,
size of the tumor, size of the breast and whether the lymph
nodes are involved. Many women have breast
reconstruction to rebuild the breast after a mastectomy.
MEDICAL TREATMENT
 CHEMOTHERAPY
Chemotherapy treatment uses medicine to weaken
and destroy cancer cells in the body, including
cells at the original cancer site and any cancer
cells that may have spread to another part of the
body. Chemotherapy, often shortened to just
"chemo," is a systemic therapy, which means it
affects the whole body by going through the
bloodstream.
There are quite a few chemotherapy medicines. In
many cases, a combination of two or more
medicines will be used as chemotherapy treatment
for breast cancer.
 CHEMOTHERAPY
Chemotherapy is used to treat:
EARLY-STAGE INVASIVE BREAST CANCER to
get rid of any cancer cells that may be left behind
after surgery and to reduce the risk of the cancer
coming back
ADVANCED-STAGE BREAST CANCER to
destroy or damage the cancer cells as much as
possible

***In some cases, chemotherapy is given before

surgery to shrink the cancer.***
How Is Chemotherapy Given for
Breast Cancer?
For breast cancer, chemotherapy drugs are given
intravenously (directly into a vein) or orally (by
mouth). Once the drugs enter the bloodstream,
they travel to all parts of the body in order to reach
cancer cells that may have spread beyond the
breast -- therefore chemotherapy is considered a
"systemic" form of breast cancer treatment.
Chemotherapy is given in cycles of treatment
followed by a recovery period. The entire
chemotherapy treatment generally lasts several
months to one year, depending on the type of
drugs given.
 RADIATION THERAPY
Radiation therapy, sometimes
called radiotherapy, x-ray therapy
radiation treatment, cobalt therapy,
electron beam therapy,
or irradiation uses high
energy, penetrating waves or particles
such as x rays, gamma rays, proton
rays, or neutron rays to destroy cancer
cells or keep them from reproducing.
 RADIATION THERAPY
Purpose
The purpose of radiation therapy is to kill or damage cancer cells.
Radiation therapy is a common form of cancer therapy. It is used in
more than half of all cancer cases. Radiation therapy can be used:
alone to kill cancer
before surgery to shrink a tumor and make it easier to remove
during surgery to kill cancer cells that may remain in
surrounding tissue after the surgery (called intraoperative
radiation)
after surgery to kill cancer cells remaining in the body
to shrink an inoperable tumor in order to reduce pain and
improve quality of life
in combination with chemotherapy
 RADIATION THERAPY
How Radiation Therapy Works
The protein that carries the code controlling most activities
in the cell is called deoxyribonucleic acid or DNA. When a
cell divides, its DNA must also double and divide. High-
energy radiation kills cells by damaging their DNA. This
blocks their ability to grow and increase in number.
One of the characteristics of cancer cells is that they grow
and divide faster than normal cells. This makes them
particularly vulnerable to radiation. Radiation also damages
normal cells, but because normal cells are growing more
slowly, they are better able to repair radiation damage than
are cancer cells. In order to give normal cells time to heal
and reduce side effects, radiation treatments are often
given in small doses over a six- or seven-week period.
 RADIATION THERAPY
Preparation
Before radiation therapy, the size and location of the
patient's tumor are determined very precisely
using magnetic resonance imaging (MRI) and/or computed
tomography scans (CT scans). The correct radiation dose,
the number of sessions, the interval between sessions, and
the method of application are calculated by a radiation
oncologist based on the tumor type, its size, and the
sensitivity of the nearby tissues.
The patient's skin is marked with a semi-permanent ink to
help the radiation technologist achieve correct positioning
for each treatment. Molds may be built to hold tissues in
exactly the right place each time.
Thank You...