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Principles of breast cancer care.

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* INTRODUCTION * ANATOMY AND PHYSIOLOGY OF THE BREAST. * AETIOLOGY AND RISK FACTORS. * PREVENTION. * BREAST CANCER SCREENING. * CLINICAL MANIFESTATIONS. * INVESTIGATIONS. * TREATMENT APPROACHES. * THE PSYCHOLOGICAL AND SOCIAL IMPACT OF BREAST CANCER. * PORTIFOLIO OF LEARNING EVIDENCE, CRITICAL INCIDENT ANALYSIS. * SUMMARY. INTRODUCTION Breast Cancer is the most is the most common malignancy and a leading cause of cancer deaths among women. It causes a threat to life, the treatment can involve such a degree of disfigurement that it is a potential threat to a woman's self image. Diseases of the breast do occur in men but much less frequently and these will not be discussed in detail. Before discussing breast cancer it is helpful to have some knowledge of the structure of the breast and it's development. THE FEMALE BREAST The breasts are a pair and are found on the anterior chest wall, extending from the second to the sixth ribs. They are made up of glandular, fatty and fibrous tissue covered by skin. In male's breasts do not develop but in females the breast develop during puberty in response to oestrogen. Natural changes also occur during menstruation, pregnancy and lactation. The full breast is dome shaped and contains a dark pigment called areola. Areola contains Montgomery tubules, which assist in moistening the nipples. The nipple has 15-20 openings called lactiferous sinuses where milk is stored during lactation. Lactiferous sinuses extend to lactiferous ducts and eventually ending into lobules called alveoli. The alveoli secrete milk during lactation. There are also blood vessels and lymph vessels in the breast. Lymph is a clear fluid waste product that gets drained out of the breast into lymph nodes. Lymph nodes are small pieces of tissue that filter and clean the lymph. Most lymph nodes are under the arm in what is called the axilla. Nerve supply is by the fourth fifth and sixth thoracic nerves. ...read more.


involves passing a thin needle into the breast lump and withdrawing tissue for examination. Some use a thicker needle known as Needle Core Biopsy. It is done under local anaesthesia and a thick needle is done to retrieve some tissue. The advantages are a greater accuracy in diagnosis and possibility of doing more tests on the samples, which cannot be done with FNA. Some require a SURGICAL BIOPSY, which is done under general or local anaesthesia and involves a small incision so that some tissue or a whole lump be removed and examined under microscope. Once the tissue is removed a pathologist reviews the specimen and can declare it cancerous or not. If it is cancerous the pathologist will characterise by what type of tissue it arose from, how abnormal it looks ( known as grading) and if the entire lamp was excised or cancer cells left at the borders. A test is also done for the presence of oestrogen and progesterone in order to guide treatment and offer insight into prognosis Carlson 1991. There is a strong evidence that triple assessment increases the accuracy and reduces overall cost of diagnosis when compared with selective use of component tests NHS Manual update, 2002. Accurate clinical staging is important because this helps in management and prognosis. The staging systems are based on clinical size and extent of invasion of the tumour Baum, M 1999. STAGE 0 ( called carcinoma in - situ) Lobular carcinoma in - situ refers to abnormal cells lining a gland in the breast. Ductal carcinoma in - situ (DCIS) refers to abnormal cells lining the duct.. STAGE 1 Early stage breast cancer where the tumour is less than 2cm across and has not spread beyond the breast. STAGE 2 Early stage breast cancer where the tumour is less than 2cm and has spread to the lymph nodes under the arm or the tumour is between 2 - 5cm (with or without spread to the lymph nodes under the arm) ...read more.


In more descriptive terms "body image" forms part of our total self-concept and as such can have enormous impact on psychological, sociocultural and physical concepts of self Blackmore citied in Alexander et al 1994. Problems with altered body image commonly present after all kinds of Brest surgery, which include biopsies, lumpectomies and mastectomies. Mastectomies causes the severe change Reaby 1998. Thus it would become quite clear that confronting an altered body image i.e. following mastectomy will be one of the primary post operative tasks of the patient. Individuals will of course deal this with differently and therefore nursing is dependent on patient reaction. Brenda had three drains which were removed on the second and third day post operatively. She did not want to look on her wound on hear the word "mastectomy". Although a woman knows her breast is gone it may take some time to assimilate Maguire and Faulkner 1998, Franklin and Smith 1994. Some acceptance in altered body image include when the patient starts to look at the area , takes over responsibility of care and begins to ask questions about caring for the area Costello 1990 O'Brien 1998 Moron et al 1985. The woman who delays in looking at her wound, is afraid to touch the area or sees no information about self care may develop problems in relation to altered body image Maguire 1998, Denton 1996. Body image disorders require physical and emotional attention. It is important to recognise that the patient is experiencing a loss with regard to her health and body image. Brenda was encouraged to discuss feelings with the partner who was very who was very supportive throughout her stay in hospital. She was also encouraged to express and explore feelings concerning cancer diagnosis and breast loss. CONCLUSION The diagnosis of cancer can be very traumatic and the response to such a diagnosis is varied and unpredictable. Mastectomy can cause a woman to experience some real difficulties in the area of self esteem and body image. The emphasis of nurses and patients working together, helps patients to cope better with breast surgery. ...read more.

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