Breast Cancer Nursing Care Plan & Management
Description
- 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 woman’s 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 | DEFINITION |
Stage 0 | Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue. |
Stage I | Cancer is 2 centimeters or less and is confined to the breast (lymph nodes are clear). |
Stage IIA | No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm)ORthe tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodesOR the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes. |
Stage IIB | The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodesORthe tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes. |
Stage IIIA | 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 breastboneORthe 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. |
Stage IIIB | The tumor may be any size and has spread to the chest wall and/or skin of the breastANDmay have spread to axillary lymph nodes that are 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. |
Stage IIIC | 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 breastANDthe cancer has spread to lymph nodes either above or below the collarboneAND the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone. |
Stage IV | The cancer has spread — or metastasized — to other parts of the body. |
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 Paget’s 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 metastasis.