BREAST CANCER

BSN 4B
Erive, Dianne
Leonar, Maria Victoria
Quimba, Shanta S.
Ramos, Kristine
Ramirez, Horance Victorio

INTRODUCTION

The World Health Organization (WHO)

statistics showed that breast cancer is the
most common form of cancer in women at
present, accounting for 16 % of all forms of
cancer in women worldwide.

Cont.

In the Philippines, The Department of Health

and the Philippine Cancer Society, Inc.
confirmed the high prevalence of breast
cancer in the country has overtaken lung
cancer as the leading form of cancer, not just
in women, but for both sexes. Among
Filipinos, the malignancy accounts for 15
percent of all cancers and almost 30 percent
of all female cancers.

Cont.

Projections are that three out of every 100

Filipinas will develop breast cancer in their
lifetime and that, under prevailing conditions,
one out of every 100 are likely to die from the
disease before age 75. The survival rate for
breast cancer in the Philippines is below 40
percent, which is much lower than the 80-98
percent in developed countries

Cont.

The low survival rates for breast cancer in

underdeveloped countries like the Philippines
is mainly due to lack of awareness about the
disease resulting in a high proportion of
women suffering from late-stage disease and
only secondarily to the lack of adequate
diagnosis and treatment facilities.
Reference: Philippine Information Agency Wednesday 3rd of October 2012
http://www.pia.gov.ph/news/index.php?article=1141349070923

Reference: American Cancer Society 2013

I. DESCRIPTION

BREAST CANCER

Breast cancer is a malignant tumor that starts in

the cells of the breast. A malignant tumor is a
group of cancer cells that can grow into
(invade) surrounding tissues or spread
(metastasize) to distant areas of the body. The
disease occurs almost entirely in women, but
men can get it, too. Many people do not
realize that men have breast tissue and that
they can develop breast cancer.

The Normal Breast

To understand breast cancer, it helps to have

some basic knowledge about the normal
structure of the breasts, shown in the diagram
below.

The female breast is made up mainly

of lobules (milk-producing glands), ducts (tiny
tubes that carry the milk from the lobules to
the nipple), and stroma (fatty tissue and
connective tissue surrounding the ducts and
lobules, blood vessels, and lymphatic vessels).

Womans
Breast

Mans Breast

cont.

Until puberty (usually around 13 or 14), young

boys and girls have a small amount of breast
tissue consisting of a few ducts located under
the nipple and areola (area around the
nipple). At puberty, a girl's ovaries make
female hormones, causing breast ducts to
grow, lobules to form at the ends of ducts, and
the amount of stroma to increase. In boys,
hormones made by the testicles keep breast
tissue from growing much. Men's breast tissue
has ducts, but only a few lobules.

Cont.

Like all cells of the body, a man's breast duct

cells can undergo cancerous changes. But
breast cancer is less common in men because
their breast duct cells are less developed than
those of women and because they normally
have lower levels of female hormones that
affect the growth of breast cells.
Most breast cancers begin in the cells that line
the ducts (ductal cancers). Some begin in the
cells that line the lobules (lobular cancers),
while a small number start in other tissues.

THE LYMPH (LYMPHATIC) SYSTEM

OF THE BREAST

The lymph system is important to understand

because it is one of the ways that breast cancers
can spread. This system has several parts.

Cont.

Lymph nodes are small, bean-shaped

collections of immune system cells (cells that
are important in fighting infections) that are
connected by lymphatic vessels. Lymphatic
vessels are like small veins, except that they
carry a clear fluid called lymph (instead of
blood) away from the breast. Lymph contains
tissue fluid and waste products, as well as
immune system cells. Breast cancer cells can
enter lymphatic vessels and begin to grow in
lymph nodes.

Cont.

Most lymphatic vessels in the breast connect

to
lymph
nodes
under
the
arm
(axillary nodes). Some lymphatic vessels
connect to lymph nodes near the breast bone
(internal mammary nodes) and either above
or below the collarbone (supraclavicular or
infraclavicular nodes).

Cont.

If the cancer cells have spread to these lymph

nodes, there is a higher chance that the cells
could have also gotten into the bloodstream and
spread (metastasized) to other sites in the body.

The more lymph nodes that have breast cancer

cells, the more likely it is that the cancer may be
found in other organs as well. Because of this,
finding cancer in one or more lymph nodes often
affects the treatment plan. Still, not all men with
cancer cells in their lymph nodes develop
metastases, and some men can have no cancer
cells in their lymph nodes and later develop
metastases.

VIDEO
PRESENTATIO

STAGES OF BREAST CANCER

STAGE 0 (CARCINOMA IN SITU)

Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are
found in the lining of a breast duct. The
abnormal cells have not spread outside the
duct to other tissues in the breast. In some
cases, DCIS may become invasive cancer and
spread to other tissues. At this time, there is
no way to know which lesions could become
invasive.

Lobular carcinoma in situ (LCIS). Abnormal

cells are found in the lobules of the breast.

Lobular carcinoma in situ (LCIS) is a condition

in which abnormal cells are found in
the lobules of the breast. This condition
seldom becomes invasive cancer. However,
having LCIS in one breast increases the risk of
developing breast cancer in either breast.

STAGE I

Stage I breast cancer. In stage IA, the tumor is 2 centimeters or smaller and has not spread
outside the breast. In stage IB, no tumor is found in the breast or the tumor is 2
centimeters or smaller. Small clusters of cancer cells (larger than 0.2 millimeter but not
larger than 2 millimeters) are found in the lymph nodes.

Cont.

In stage I, cancer has formed. Stage I is divided

into stages IA and IB.
In stage IA, the tumor is 2 centimeters or
smaller. Cancer has not spread outside
the breast.
In stage IB, small clusters of breas
cancer cells (larger than 0.2 millimeter but not
larger than 2 millimeters) are found in
the lymph nodes and either:

no tumor is found in the breast; or

the tumor is 2 centimeters or smaller.

STAGE II A

Stage IIA breast cancer. No tumor is found in the breast and cancer is found in 1 to 3
axillary lymph nodes or lymph nodes near the breastbone (left panel); OR the tumor is 2
centimeters or smaller and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes
near the breastbone (middle panel); OR the tumor is larger than 2 centimeters but not
larger than 5 centimeters and has not spread to the lymph nodes (right panel).

STAGE II B

Stage IIB breast cancer. The tumor is larger than 2 centimeters but not larger than 5
centimeters and small clusters of cancer cells are found in the lymph nodes (left panel);
OR the tumor is larger than 2 centimeters but not larger than 5 centimeters and cancer is
found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (middle panel);
OR the tumor is larger than 5 centimeters and has not spread to the lymph nodes (right
panel).

Stage IIIA

Stage IIIA breast cancer. No tumor is found in the breast or the tumor may be any size
and cancer is found in 4 to 9 axillary lymph nodes or lymph nodes near the breastbone
(left panel); OR the tumor is larger than 5 centimeters and small clusters of cancer cells
(larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph
nodes (middle panel); OR the tumor is larger than 5 centimeters and cancer is found in
1 to 3 axillary lymph nodes or lymph nodes near the breastbone (right panel).

STAGE IIIB

Stage IIIB breast cancer. The tumor may be any size and cancer has spread to the chest wall
and/or to the skin of the breast and caused swelling or an ulcer. Cancer may have spread
to axillary lymph nodes or lymph nodes near the breastbone. Cancer that has spread to
the skin of the breast may be inflammatory breast cancer.

STAGE IIIC

Stage IIIC breast cancer. No tumor is found in the breast or the tumor may be any size and
may have spread to the chest wall and/or the skin of the breast. Also, cancer has spread to
10 or more axillary lymph nodes (left panel); OR to lymph nodes above or below the
collarbone (middle panel); OR to axillary lymph nodes and lymph nodes near the
breastbone (right panel).

STAGE IV

Stage IV breast cancer. The

cancer has spread to other
parts of the body, most
often the bones, lungs,
liver, or brain.
In stage IV, cancer has
spread to other organs of
the body, most often the
bones, lungs, liver, or
brain.

Inflammatory Breast Cancer

In
inflammatory
breast
cancer, cancer has spread to the skin of
the breast and the breast looks red and
swollen and feels warm. The redness
and
warmth
occur
because
the cancer cells block the lymph
vessels in the skin. The skin of the
breast may also show the dimpled
appearance called peau dorange (like
the skin of an orange). There may not
be any lumps in the breast that can be
felt. Inflammatory breast cancer may
be stageIIIB, stage IIIC, or stage IV.
Inflammatory breast cancer of the left
breast showing peau dorange and
inverted nipple.

II.EPIDEMIOLOGY

Epidemiology is the study of the distribution

and determinants of health-related states or
events (including disease), and the application
of this study to the control of diseases and
other health problems.

AGE (65+ VS. <65 YEARS, ALTHOUGH RISK

INCREASES ACROSS ALL AGES UNTIL AGE 80)

This is because the aging process often

inevitably contributes to the decline in
performance, gradual inability in the
adaptation to the environmental changes, and
lower compensatory function. It changes a
healthy young adult into an older, potentially
less healthy person, with an increased risk of
illness, injury, and death.

BIOPSY-CONFIRMED ATYPICAL
HYPERPLASIA

Atypical ductal hyperplasia (ADH) is a medical

condition in which the cells that line the milk
ducts of the breasts experience abnormal
growth. This condition is not cancerous, but it
can indicate an increased cancer risk for a
woman.

CERTAIN INHERITED GENETIC MUTATIONS FOR

BREAST CANCER (BRCA1 AND/OR BRCA2)

While a family history of breast cancer

suggests an inherited influence on disease
risk, BRCA1 or BRCA2 mutations account for
only about 15-20% of familial breast
cancers.61 Breast cancer can also result from
the inheritance of other less common genetic
syndromes.

Cont.

A number of more common genetic mutations

have also been identified that are less strongly
associated with breast cancer risk. Any of
these mutations can be inherited from either
ones mother or father, and they may be
inherited by sons, as well as daughters.
Scientists believe that much of the occurrence
of breast cancer in families results from the
interaction between lifestyle factors and lowrisk variations in genetic factors that may be
shared by women within a family.

PERSONAL HISTORY OF BREAST CANCER

Women with a family history of breast cancer,

especially in a first-degree relative (mother,
sister, daughter, father, or brother), are at
increased risk of developing breast cancer and
the risk is higher if more than one first-degree
relative developed breast cancer.

HIGH
ENDOGENOUS
ESTROGEN
OR
TESTOSTERONE LEVELS, RECENT AND LONGTERM USE OF MENOPAUSAL HORMONE
THERAPY CONTAINING ESTROGEN AND
PROGESTIN,RECENT
ORAL CONTRACEPTIVE
USE

Recent use of oral contraceptives

may slightly

increase the risk of breast cancer; however,

women who stopped using oral contraceptives
for 10 years or more have the same risk as
women who never used the pill.

HIGH BONE DENSITY

(POSTMENOPAUSAL)

High bone mineral density in postmenopausal

women also has been recognized as a risk
factor for breast cancer in most studies. Bone
density is routinely measured to identify
women at increased risk for osteoporosis (high
bone
density
indicates
absence
of
osteoporosis) and may help determine a
womans risk for developing breast cancer. The
association between bone density and breast
cancer is probably mediated by hormonal
factors.

HIGH-DOSE RADIATION TO CHEST

The link between radiation exposure and breast

cancer has been demonstrated in studies of
atomic bomb survivors and women who have
received high-dose radiation therapy to the chest,
particularly those who were first exposed at
younger age. Among atomic bomb survivors,
increased risk of breast cancer was greatest
among women exposed during adolescence. The
development period when the terminal ducts and
lobules of the breast have not completed
differentiation may be a time of increased
susceptibility to carcinogens (cancer-causing
agents).

TOBACCO CONSUMPTION

In 2009, the International Agency for Research

on Cancer concluded that there was limited
evidence that tobacco smoking causes breast
cancer in women based on a review of 150
studies. Subsequently, a large US study of
nearly 80,000 women found current smokers
had a 16% higher risk of breast cancer
compared to women who never smoked.

ALCOHOL CONSUMPTION

Numerous studies have confirmed that

alcohol consumption increases the risk of
breast cancer in women. A meta-analysis of
more than 40 epidemiologic studies suggests
that the equivalent of 2 drinks a day (or 24g of
alcohol) increases breast cancer risk by 21%.
One of the most likely mechanisms by which
alcohol increases risk of breast cancer is by
increasing estrogen and androgen levels.

ASHKENAZI JEWISH HERITAGE

BRCA1 BRCA2 mutations these mutations are

present in far less than 1% of the general
population, but occur more often in certain
ethnic groups such as those of Ashkenazi
(Eastern European) Jewish descent.Women
with BRCA1 mutations are estimated to have a
44-78% risk for developing breast cancer by 70
years of age; the corresponding risk for BRCA2
mutations is 31-56%.

EARLY MENARCHE (<12 YEARS) AND

LATE MENOPAUSE (>55 YEARS)

Reproductive hormones are thought to

influence breast cancer risk by increasing cell
proliferation, thereby increasing the likelihood
of DNA damage, as well as promotion of
cancer growth. Early menarche (<12 years)
and older age at menopause (>55 years) may
increase a womans risk of breast cancer by
increasing lifetime exposure to reproductive
hormones produced by her body.

LATE AGE AT FIRST FULL-TERM

PREGNANCY (>30 YEARS)

Younger age at first full-term pregnancy (<30

years) and a greater number of pregnancies
decrease the risk of breast cancer over the
long term; however, there also appears to be a
transient increase in breast cancer risk
following a full-term pregnancy, particularly
among women who have a first birth at older
ages lowest levels.

NEVER BREASTFED A CHILD

Interestingly, recent studies suggest that

reproductive patterns are more strongly
associated with risk of hormone receptorpositive breast cancer compared to triplenegative breast cancer. Breastfeeding has
been shown to decrease a womans risk of
breast cancer, with greater benefit associated
with longer duration. In a review of 47 studies
in 30 countries, the risk of breast cancer was
reduced by 4.3% for every 12 months of
breastfeeding.

OBESITY (POSTMENOPAUSAL)/ADULT
WEIGHT GAIN

Postmenopausal women with high levels of

endogenous hormones (estrogen or testosterone)
have about twice the risk of developing breast cancer
compared to women with the with the lowest levels.
Obesity increases the risk of postmenopausal breast
cancer, but appears to protect against breast cancer
before menopause.In postmenopausal women,
circulating estrogen is primarily produced in fat
tissue. Thus, having more fat tissue increases
estrogen levels and the likelihood of developing
breast cancer.

ONE FIRST-DEGREE RELATIVE

WITH BREAST CANCER

It is important to note that the majority of

women with one or more affected first-degree
relatives will never develop breast cancer and
that most women who develop breast cancer
do not have a first-degree relative with the
disease. A family history of ovarian cancer is
also associated with an increased risk of
breast cancer.

PERSONAL HISTORY OF ENDOMETRIUM,

OVARY, OR COLON CANCER

A family history of ovarian cancer is also

associated with an increased risk of breast
cancer. Women with a family history of breast
or ovarian cancer in their mothers, sisters,
daughters, aunts, or grandmothers or a male
relative with breast cancer should discuss this
history with their physicians.

WORKING IN NIGHT SHIFTS

Studies of nurses who work night shifts and

flight attendants who experience circadian
rhythm disruption caused by crossing multiple
time zones find increased risks of breast
cancer
associated
with
long-term
employment.

Cont.

Animal studies suggest that exposure to light

at night causes circadian rhythm disruption
and increases cancer incidence.
Some researchers suggest that the increased
risk of breast cancer may be due to decreases
in melatonin levels that occur as a result of
exposure to light at night; melatonin may
affect estrogen levels, as well as act as a
tumor suppressor.

Cont.

Based on the results of studies in humans and

experimental animals, the International
Agency for Research on Cancer concluded in
2007 that shift work, particularly at night, was
probably carcinogenic to humans.

Rereferences: http://www.age-well.org/cancer-and-aging.html

http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/do
cument/acspc-030975.pdf

III.ETIOLOGY

branch of medical science dealing with the causes

and origin of diseases.

the cause or causes of a disease or abnormal

condition.

what causes breast cancer?

Many risk factors can increase your chance of

developing breast cancer, but it is not yet known
exactly how some of these risk factors cause cells
to become cancerous. Hormones seem to play a
role in many cases of breast cancer, but just how
this happens is not fully understood.

Cont.

DNA is the chemical in each of our cells that

makes up our genesthe instructions for how
our cells function. We usually look like our
parents because they are the source of our
DNA. But DNA affects more than how we look.

Cont.

Some genes contain instructions for

controlling when our cells grow, divide, and
die. Genes that speed up cell division are
called oncogenes. Others that slow down cell
division, or cause cells to die at the right time,
are called tumor suppressor genes. Certain
changes (mutations) in DNA that turn on
oncogenes or turn off tumor suppressor
genes can cause normal breast cells to
become cancerous.

Inherited gene mutations

Certain inherited DNA changes can increase

the risk for developing cancer and are
responsible for the cancers that run in some
families. For example, the BRCA genes
(BRCA1 and BRCA2) are tumor suppressor
genes. Mutations in these genes can be
inherited from parents. When they are
mutated, they no longer suppress abnormal
growth, and cancer is more likely to develop.

Cont.

Women have already begun to benefit from

advances in understanding the genetic basis of
breast cancer. Genetic testing can identify
some women who have inherited mutations in
the BRCA1 or BRCA2 tumor suppressor genes
(or less commonly in other genes such
as PTEN or TP53). These women can then take
steps to reduce their risk of developing breast
cancers and to monitor changes in their
breasts carefully to find cancer at an earlier,
more treatable stage. These are discussed in
later sections of this document.

Acquired gene mutations

Most DNA mutations related to breast cancer

occur in single breast cells during a woman's
life rather than having been inherited.
These acquired mutations of oncogenes
and/or tumor suppressor genes may result
from other factors, like radiation or cancercausing chemicals. But so far, the causes of
most acquired mutations that could lead to
breast cancer are still unknown. Most breast
cancers have several acquired gene mutations.

Cont.

Tests to spot acquired gene changes may help

doctors more accurately predict the outlook
for some women with breast cancer. For
example, tests can identify women whose
breast cancer cells have too many copies of
the HER2oncogene. These cancers tend to be
more aggressive. At the same time, drugs have
been developed that specifically target these
cancers.
References:
http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-

V.SIGNS AND SYMPTOMS

Breast lumps/mass (usually painless, hard, irregular

edge)

*50% located in upper outer quadrant

Discharge (bloody, clear, serous)

Nipple retraction (turning inward)

Breast dimpling fluid build-up because of blocked

lymphatic system
Redness
Like skin of orange/peau d orange dimpled
condition of skin of breast, sometimes found in

Cont.

Enlarged axillary/ supraventricularly lymph nodes

(may indicate metastasis)

Breast swelling of all or part of breast

Changes in size, shape/Asymmetry

Breast scaling

Peeling

Flaking

Can be painful

References:

Cancer.gov/national cancer institute,Breastcancer.org,Mayoclinic

Hormonal
receptor
test

PATHOPHYSIOLOGY

Mammography

DIAGNOSTIC TESTS
AND LABORATORY

Blood
Chemistry

Ultrasound
Chemotherapy

Orange
like skin

Hormone
Receptor
status

dimpling
lumps

BREAST
CANCER

swelling
redness

SIGNS AND
SYMPTOMS

Surgery

Nipple
discharge

MANAGEMENT
RISK FACTORS

Radiation

Hormonal therapy

Inherited/
acquired
gene
mutations

Change in
nipple

Most
common
cancer in
women

Nipple
retraction

Enlarged
lymph
nodes

Change in
Breast
size

ACCORDING TO
WORLD HEALTH ORGANIZATION

Prevention

Control of specific modifiable breast cancer risk

factors as well as effective integrated
prevention of non-communicable diseases
which promotes healthy diet, physical activity
and control of alcohol intake, overweight and
obesity, could eventually have an impact in
reducing the incidence of breast cancer in the
long term.

Early detection

Although some risk reduction might be achieved

with prevention, these strategies cannot
eliminate the majority of breast cancers that
develop in low- and middle-income countries.
Therefore, early detection in order to improve
breast cancer outcome and survival remains
the cornerstone of breast cancer control
(Anderson et al., 2008).

There are two early detection

methods:

Early diagnosis or awareness of early signs and

symptoms in symptomatic populations in
order to facilitate diagnosis and early
treatment, and

Screening that is the systematic application of

a screening test in a presumably
asymptomatic population. It aims to identify
individuals with an abnormality suggestive of
cancer.

Early diagnosis

Early diagnosis remains an important early

detection strategy, particularly in low- and
middle-income countries where the diseases
is diagnosed in late stages and resources are
very limited. There is some evidence that this
strategy can produce "down staging"
(increasing in proportion of breast cancers
detected at an early stage) of the disease to
stages that are more amenable to curative
treatment (Yip et al., 2008).

Mammography screening
Mammography screening is the only screening
method that has proven to be effective. It can
reduce breast cancer mortality by 20 to 30% in
women over 50 yrs old in high-income
countries when the screening coverage is over
70% (IARC, 2008). Mammography screening is
very complex and resource intensive and no
research of its effectiveness has been
conducted in low resource settings.

Breast self examination (BSE)

There is no evidence on the effect of screening

through breast self-examination (BSE).
However, the practice of BSE has been seen to
empower women, taking responsibility for
their own health. Therefore, BSE is
recommend for raising awareness among
women at risk rather than as a screening
method.
References:http://www.who.int/cancer/detection/breastcancer/en/index3.html

VI.MANAGEMENT
PROPHYLACTIC SURGERY

Surgeries include lumpectomy (breastpreventing procedure), mastectomy (breast

removal), and mammoplasty (reconstructive
surgery).
Endocrine related surgeries to reduce
endogenous estrogen as a palliative measure.
Bone marrow transplantation may be
combined with chemotherapy.

Lumpectomy (aka: tylectomy) is

a
common surgical procedure designed to
remove a discrete lump, usually a
malignant tumor or breast cancer, from an
affected woman's or man's breast.

Lumpectomy with sentinel node biopsy or

axillary dissection is done under general
anesthesia as an outpatient. Complications
are rare but include bleeding, infection,
allergic reactions to sentinel node mapping
agents. Arm swelling (lymphedema) may be
seen in 2-3 percent of patients undergoing
sentinel node biopsy and 10-15 percent of
those undergoing axillary dissection. Arm
stiffness and numbness can occasionally be
seen. Recuperation is generally 2-3 weeks.

Mastectomy ( Greek word: breast + removal )

is the medical term for the surgical removal of
one or both breasts, partially or completely.
Mastectomy is usually done to treat breast
cancer;

Mastectomy is the operation that removes the breast

including the nipple-areolar complex. The chest wall
muscles are not removed. Some lymph nodes are by
necessity removed during this operation as there is
an overlap region between the breast tissue and the
lymphatic tissue near the underarm region.
Assessment of the axillary nodes is the same as with
breast-conserving therapy (see sentinel node biopsy
information sheet). Some patients require
mastectomy for medical reasons (see above).
Others may prefer a mastectomy. Occasionally, a
prophylactic mastectomy of the uninvolved breast is
recommended, especially in cases where a
significantly positive family history is present.

RADIATION THERAPY

Radiation therapy as part of breast-conserving

therapy traditionally involves treatment of the
whole breast, a process that takes six weeks. A
boost to the primary site may be given at the
end. Radiation starts 2-4 weeks following
surgery. However, if chemotherapy is needed,
that comes first after surgery and radiation
would follow 2-4 weeks after completion of
chemotherapy.

CHEMOTHERAPY

(often abbreviated to chemo) is the treatment

of cancer with one or more cytotoxic
antineoplastic drugs ("chemotherapeutic
agents") as part of a standardized regimen.
Chemotherapy
may
be
given
with
a curative intent or it may aim to prolong life
or to palliate symptoms. It is often used in
conjunction with other cancer treatments,
such as radiation therapy or surgery.

Chemotherapy may be given at

different stages

Neo-adjuvant therapy - if the tumor is large

the surgeon may want to shrink it before
surgery. This may involve some pre-operative
chemotherapy and/or radiotherapy

Chemoradiation therapy - the chemotherapy

is given in combination with radiotherapy.
Patients with localized Hodgkin's lymphoma
where the tumor is situated above the
diaphragm should be given chemotherapy
combined with radiotherapy

CHEMOTHERAPHY COMMON
DRUGS:

Fluorouracil

Adriamycin

Cyclophosphamide

Methotrexate

Mitomycin

Vinblastine

NURSING MANAGEMENT OF COMMON SIDE

EFFECTS OF CHEMOTHERAPEUTIC DRUGS

NAUSEA & VOMITING

Avoid eating/drinking for 1-2 hrs prior to and after chemotherapy administration.

Eat frequent, small meals. Avoid greasy & fatty foods and very sweet foods &
candies.

Avoid unpleasant sights, odors & testes

Follow a clear liquid diet

If vomiting is severe inform the physician.

Consider diversionary activities

Sip liquids slowly or suck ice cubes and avoid drinking a large volume of water if
vomiting is present.
Administer antiemetics to prevent or minimize nausea. Patient may require routine
antiemetics for 3-5 days following some protocols.
Monitor fluid and electrolyte status.

BONE MARROW DEPRESSION

This can lead to

-Anemia
-Bleeding due to thrombocytopenia
-Infection due to leukopenia

Nursing Actions

Administer packed RBC according to the physician orders.

Monitor hematocrit and haemoglobin especially during

drug nadir
Maintain the integrity of the skin
Avoid activities with the greatest potential for physical
injury

Use an electric razor when shaving

Avoid the use of tourniquets

Eat a soft, bland diet, avoid foods that are thermally,

mechanically and chemically irritating.

Nursing Actions

Maintain the integrity of the mucous membranes of G I tract

Promote hydrate to avoid constipation

Avoid enemas, harsh laxatives & the use of rectal thermometers.

Take steroids with an antacid or milk.

Avoid sources of infection

Maintain good personal hygiene.

Prevent trauma to skin & mucous membranes

Report s/s of infection to physician

Monitor counts

Avoid invasive procedures, no

Raise the arm while pressure is applied after removal of a needle or

ALOPECIA

Explain hair loss is temporary, and hair will grow

when drug is stopped.
Use a mild, protein based shampoo, hair conditioner
every 4-7 days
Minimize the use of an electric dyer.

Avoid excessive brushing and combing of the air.

Combing with a wide tooth comb is preferred.
Select wig, cap, scarf or turban before hair loss
occurs.
Keep head covered in summer to prevent sunburn

FATIGUE

Assess for possible causes chronic pain, stress,

depression and in-sufficient rest or nutritional
intake.

Conserve energy & rest when tired

Plan for gradual accommodation of activities.

Monitor dietary & fluid intake daily. Drink

3000 ml of fluid daily, unless contra-indicated,
in order to avoid the accumulation of cellular
waste products.

ANOREXIA

Freshen up before meals

Avoid drinking fluids with meals to prevent

feeling of fullness
High protein diet
Monitor and record weight weekly. Report
weight loss

STOMATITIS (ORAL)

Symptoms occur 5-7 days after chemotherapy & persist up to 10

days.

Continue brushing regularly with soft tooth brush

Use non irritant mouthwash

Avoid irritants to the mouth

Maintain good nutritional intake, eat soft or liquid foods high in

protein

Follow prescribed medication schedule e.g. drug for oral candidiasis

Report physician if symptom persists

Increase the frequency of oral hygiene every 2 hrs

Glycerin & lemon juice should never be used to clear mouth or

Diarrhea

Some clients experience diarrhea during and after treatment with

chemotherapy.

Nursing Action

Monitor number, frequency and consistency of diarrhoea stools.

Avoid eating high roughage, greasy and spicy food alcoholic beverages,
tobacco and caffeine products

Avoid using milk products

Eat low residue diet high in protein and calories

Include food high in potassium if fatigue is present like bananas, baked

potatoes.

Drink 3000 ml of fluid each day.

Eat small frequent meals ; eat slowly and chew all food thoroughly

Depression

Assess for changes in mood and affect.

Set small goals that are achievable daily

Participate e.g. music, reading, outings

Share feelings

Reassurance

Cystitis

Inflammation of the bladder, which is usually

caused by an infection. Sterile cystitis not
induced by infection, can be a side effect of
radiation therapy or due to cyclophosphamide
(endoxan) administration. The metabolites of
cyclophosphamide are excreted by the kidneys
in the urine

Nursing Actions

Fluid intake at least 3000 ml daily

Empty Bladder as soon as the urge to void is
experienced.
Empty bladder at least every 2-4 hrs.
Urinate at bed time to avoid prolonged exposure of
the bladder wall to the effects of cytoxan while
sleeping. Take oral cytoxan early in the morning to
decrease the drug concentration in the bladder
during the night.

Report increasing symptoms of frequency bleeding

burning on urination, pain fever and chills promptly
to physician

CONT.

Following comfort measures can be adopted if

cystitis is present
Ensure dilute urine by increasing the fluid
intake

Avoid foods & beverages that may cause

irritation to the bladder alcohol, coffee,
strong tea, Carbonated beverages etc.

HORMONAL THERAPY

Deprives breast cancer cells of the

hormone estrogen, which many breast tumors
need to grow. A commonly used hormonal
treatment is the drug tamoxifen, which blocks
estrogen's activity in the body. Studies have
shown that tamoxifen helps prevent the
original cancer from returning and also helps
to prevent the development of new cancers in
the other breast; however, many women
develop resistance to the drug over time.
Tamoxifen can be given to both
premenopausal and postmenopausal women.

COMMON DRUGS:

Tamoxifen

Megestrolacetate
Aminoglutethemide + Cortisone acetate

Side effects of hormonal therapy and

ways to manage them
Hot flashes

Relaxation training
Dietary changes. Avoid caffeine, alcohol, and
spicy foods.
Clothing. Wear absorbent cotton clothing in
layers that can be easily removed.

Use sprays or moist wipes to help lower skin

temperature.
Acupuncture

Fatigue encouraging patient to rest and limit daily

activities.
Nausea and vomiting
This side effect is less common with hormonal therapy
than it is with chemotherapy. Nausea often goes away on
its own. Women can help manage symptoms by eating
bland foods, such as crackers, toast, and cereal, and
drinking lots of fluids6 to 8 glasses of liquids daily, such
as water, broth, or Gatorade. The doctor or nurse may
recommend antinausea medications or antianxiety
medications that prevent or treat nausea or vomiting. If
dehydration occurs, intravenous fluids may be needed.

Diarrhea

Diarrhea is a less common side effect of

hormone therapy. Dietary measures, such as
eating a bland diet and avoiding foods such as
dairy products and spicy foods, can help
reduce symptoms. Medications, such as
loperamide (Imodium) and diphenoxylate
(Lomotil), can be used to treat diarrhea.

Constipation

Constipation is a less common side effect of

hormone therapy. Daily exercise, eating foods
high in fiber (such as uncooked fruits and
vegetables and whole grain breads and
cereals) and drinking lots of liquids--6 to 8
glasses a day--can help ease symptoms. If
these measures do not work, medicines, such
as a stool softener or laxative, may be needed.

Weight gain

A daily exercise routine of 20 to 30 minutes

per day and a weight management program
can be helpful. Eating foods low in fat, such as
fruits and vegetables, is a good idea.

Mood swings

Nervousness, depression, and anxiety are some of

the symptoms that women may experience. It is
natural to experience strong emotions in response
to a diagnosis of breast cancer. These may become
stronger when a woman receives hormonal therapy.
Relaxation, meditation, and yoga may be useful in
controlling mood swings. Exercise may help boost
mood and relieve anxiety. Support groups and
professional counselors may be helpful for some
women. Antidepressants may be prescribed.

CONT.

Pain, including pain in joints, back, and bones

For mild to moderate pain, over-the-counter

pain medication can help alleviate pain in
various parts of the body, such as the joints or
back. Pain felt at an injection site can be
treated with warm or cold compresses. A
topical anesthetic cream may also be used.

Cough

Certain hormonal therapies, such as the

aromatase inhibitor anastrozole, can increase
coughing symptoms. Women should try to
drink at least 8 glasses of fluid a day to keep
the lining of the breathing tube moist. Using a
humidifier to increase the moisture in the air
is also a good idea. Medicines, such as
dextromethorphan,
benzonatate,
and
guaifenesin, may be used to stop or control
coughing.

Osteoporosis

Some hormone therapies, such as tamoxifen

in some case, may lower bone loss in
postmenopausal women. Other hormone
therapies may not prevent or modify a
woman's risk of getting osteoporosis. For this
reason, postmenopausal women with breast
cancer should have a bone mineral analysis to
determine if a preventive therapy should be
used.

The following suggestions are recommended

for people at risk:
Take calcium and vitamin D supplements

Get regular physical activity, including weightbearing exercises that put stress on bones,
such as jogging, stair climbing, dancing, and
resistance exercises, such as weight lifting.

Quit smoking

Reference:http://www.cancer.gov/cancertopics/factsheet/Therapy/adjuvant-brea

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