Breast cancer is a major problem in the United States. Its overall incidence rose by 54% between 1950 and 1990. In the 1990s, the incidence leveled off and stabilized (American Cancer Society [ACS], 2002). At present, there is no cure for breast cancer. Between 1990 and 1994, the mortality for breast cancer decreased by 5. 6%, the largest short-term decline in more than 40 years, suggesting that the combination of early detection and better systematic treatment option is having an effect on overall survival. II. Background A. Etiology • Hormones
The role of hormones and their relationship to breast cancer remain controversial. Research suggests that a relationship exists between estrogen exposure and the development of breast cancer. In laboratory studies, tumor grows much faster when exposed to estrogen, and epidemiologic research suggests that women who have longer exposure to estrogen have a higher risk for breast cancer. Early menarche, nulliparity, childbirth after 30 years of age, and late menopause are known but minor risk factors. The assumption is that these factors are all associated with prolonged exposure to estrogen because of menstruation.
The theory is that each cycle (which has high levels of endogenous estrogen) provides the cells of the breast another chance to mutate, increasing the chance for cancer to develop. Estrogen itself does not cause breast cancer, but it is associated with its development. • Genetics Where there is gene mutation on BRCA1, these are the genes found in chromosome 17. Other risk factors include increasing age, personally or family history, early menarche, late menopause, obesity, exposure to ionizing radiation, hormonal replacement therapy, alcohol intake and nulliparity.
B. Clinical Manifestations • The clinical manifestations may include: • Orange peel or dimpling due to obstruction or no blood flow • Nipple retraction • Skin with ulcerating and fungating lesion • Asymmetry in breast size • Redness and swelling of the breast Discharges from the nipple C. Prophylactic Mastectomy Some women who are at high risk for breast cancer may elect to undergo prophylactic mastectomy. This procedure can reduce the risk for cancer by 90% (Hartmann et al. , 2000), so as more appropriate term for this surgery is “risk-reducing” mastectomy.
The procedure, performed by a breast surgeon, consists of a total mastectomy (removal of breast tissue only). Possible candidates are women with a strong family history of breast cancer, a diagnosis of LCIS or atypical hyperplasia, a diagnosis of BRCA-1 or BRCA-2 gene mutation, an extreme fear of cancer (“cancer phobia”), or previous cancer in one breast. Many women opt for immediate reconstruction with the mastectomy. The woman needs to understand that this surgery is elective and not emergent.
To be sure that she understands the implications of surgery, the woman should be offered a consultation with a plastic surgeon, a genetic counseling session, and a psychological evaluation. Women who make an informed decision tend to demonstrate more satisfaction with the cosmetic results (Rowland, 2003). Nursing interventions for the woman considering a risk-reducing mastectomy include ensuring that the patient has information about reconstructive options and providing referrals to the plastic surgeon, genetic counselor, and psychological counselor.
Many women need time to think over the procedure, and the nurse can be helpful in answering questions about the procedure and its implications and in assisting the patient to decide whether the surgery is an appropriate option. The woman considering this option may wish to talk with a woman who ahs had the procedure. D. Lymphedema This is the result of the dissection in the axilla. One of the treatments for breast cancer is axillary lymph node dissection, where in it is the removal of some or all of the fat- enmeshed axillary lymph nodes.
This is worsened by using radiation therapy to patients undergoing surgeries like this. So, radiation is one of the etiology or cause of Lymphedema. In Linda T. Miller, who is a physical therapist, said that using care that is only given by PT’s are very necessary in Lymphedema. The Breast Cancer Physical Therapy Center is an organization where in patients who suffers breast cancer and Lymphedema as a complication are being treated in here. They use exercises such as aerobic activities, strengthening and flexibility.
They use three techniques for the treatment and these are the Manual Lymphatic Therapy; which is used to change the direction of the lymphatic fluids; Compression Bandages, which are used to let the patients control and handle edema; and lastly, the Compression Pump, which is used to reduce and make as great as possible the fluids. III. Prognosis Several features of breast tumors contribute to the prognosis. Generally, the smaller the tumor, the better the prognosis. Carcinoma of the breast is not a pathologic entity that develops overnight. It starts with a genetic alteration in a single cell.
It can take about 16 doubling times for a carcinoma to become 1 cm or larger, at which point it becomes clinically apparent. The prognosis also depends on whether the cancer has spread. In addition to tumor size, nodal involvement, evidence of metastasis, and histologic type, other measures in determining prognosis. The presence of estrogen and progesterone receptor proteins indicates retention of regulatory controls of the mammary epithelium. The presence of both receptor proteins associated with improved prognosis; their absence is associated with a poorer prognosis.
Similarly, a tumor with a high degree of differentiation is associated with a better prognosis than a poorly differentiated anaplastic tumor. The assessment of a tumor’s proliferative rate and DNA content by laboratory assay may help to determine prognosis because these two factors are strongly correlated with other prognostic factors. Reference: 1. Boyd, J. (2005). BRCA2 as a low penetrance cancer gene. Journal of the National Cancer Institute, 88 (19), 1408-1409. 2. Hartmann L. C. , Sellers, T. A. , Schaid, D. J. , et al. , (2000).
Clinical options for women at high risk for breast cancer. Surgical Clinics of North America, 79 (5), 1189-1206. 3. Kauff, N. , & Satagopan, J. M. (2002). Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. New England Journal of Medicine, 346 (21), 1609-1615. 4. Miller, Linda PT. Breast Cancer Physical Therapy Center. Recover in Motion. http://www. breastcancerpt. com 5. Rowland, J. H. (2003). Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. Journal of the national Cancer Institute, 92 (17), 1422-1429.