I N T R O D U C T I O N

“We acquire the strength of what we have overcome.”

– Ralph Waldo Emerson

So many women you know may have had breast cancer —

friends and neighbors, coworkers, relatives. It seems as if
every time you turn around, breast cancer is being talked
about in the newspaper or on TV. You may be fearful of
developing breast cancer for the first time or of receiving a
diagnosis after a mammogram or other testing. If you’ve had
breast cancer, you may be fearful of a possible recurrence or
even of the possibility that breast cancer could take your
life.
Breast cancer is an uncontrolled growth of breast cells.
To better understand breast cancer, it helps to understand
how any cancer can develop.

Cancer develops when cells in a part of the body begin

to grow out of control. Although there are many kinds of
cancer, they all start because of out-of-control growth of
abnormal cells. Normal body cells grow, divide, and die in an
orderly fashion. During the early years of a person's life,
normal cells divide more rapidly until the person becomes an
adult. After that, cells in most parts of the body divide
only to replace worn-out or dying cells and to repair
injuries.

Because cancer cells continue to grow and divide, they

are different from normal cells. Instead of dying, they
outlive normal cells and continue to form new abnormal cells.
Cancer cells develop because of damage to DNA. This substance
is in every cell and directs all its activities. Most of the
time when DNA becomes damaged the body is able to repair it.
In cancer cells, the damaged DNA is not repaired. People can
inherit damaged DNA, which accounts for inherited cancers.
Many times though, a person’s DNA becomes damaged by exposure
to something in the environment, like smoking. Cancer cells
can invade nearby healthy breast tissue and make their way
into the underarm lymph nodes, small organs that filter out
foreign substances in the body. If cancer cells get into the
lymph nodes, they then have a pathway into other parts of the
body. The breast cancer’s stage refers to how far the cancer
cells have spread beyond the original tumor, A tumor can be
benign (not dangerous to health) or malignant (has the
potential to be dangerous).
The term “breast cancer” refers to a malignant tumor
that has developed from cells in the breast. Usually breast
cancer either begins in the cells of the lobules, which are
the milk-producing glands, or the ducts, the passages that
drain milk from the lobules to the nipple. Less commonly,
breast cancer can begin in the stromal tissues, which include
the fatty and fibrous connective tissues of the breast.
Breast cancer is always caused by a genetic abnormality
(a “mistake” in the genetic material). However, only 5-10% of
cancers are due to an abnormality inherited from your mother
or father. About 90% of breast cancers are due to genetic
abnormalities that happen as a result of the aging process
and the “wear and tear” of life in general.

1
 Breast cancer is the second leading cause of cancer
death in women, exceeded only by lung cancer. The chance that
breast cancer will be responsible for a woman's death is
about 1 in 35(about 3%). In 2008, about 40,480 women will die
from breast cancer in the United States. Death rates from
breast cancer have been declining since about 1990, with
larger decreases in women younger than 50. These decreases
are believed to be the result of earlier detection through
screening and increased awareness, as well as improved
treatment.
The risk of developing most types of cancer can be
reduced by changes in a person's lifestyle, for example, by
quitting smoking and eating a better diet. The sooner a
cancer is found and treatment begins, the better are the
chances for living for many years.

We have chosen the case because we want to broaden our

knowledge about Breast Cancer regarding to the nursing
interventions and medical management. Cancer is the second
leading cause of death and is a common case in the Surgical
Ward of Baguio General Hospital and medical Center (BGHMC)
that also prompted the group to research on the disease. The
risk of developing most types of cancer can be reduced by
changes in a person's lifestyle, for example, by quitting
smoking and eating a better diet. The sooner a cancer is
found and treatment begins, the better are the chances for
living for many years.

2
 P A T I E N T S P R O F I L E

Biographical Data

Patient X is 53 y/o, female, currently residing at

Urdaneta City, Pangasinan was born on May 28, 1956 at Dagupan
City, Benguet. She is married and was blessed with four
children. She is currently living with her sister and her
daughter here in Baguio due to her chemotherapy sessions at
Baguio General Hospital and Medical Center.

She is currently a housewife, managing the family and

her only daughter. At present, source of income comes from
her husband working as a Computer Technician on a company.

She was admitted last September 2008 at Baguio General

Hospital and Medical Center (BGHMC) form MRM (modified
Radical Mastectomy) with complaints of having pain in her
right breast last December 2007.

She attained a High school degree having the knowledge

and ability to read and write. As for hobbies and interests,
she certainly entertains herself by reading, cleaning and
doing household chores and taking care of her family. She
verbalized that the greatest gift from her is her only
children.

Present Illness

2 months Prior to Admission, patient complained, patient

noted a mass before the incision area of the right breast.
There was associated tenderness but no discharged.
Consultation was sought and surgery was scheduled, hence
admission.

Past Medical History

Patient X has no previous history of allergies. She had

stated that she had previous records of hospitalization and
operations. Last Operations were performed on September 2008.
She underwent MRM (Modified Radical Mastectomy) and Status
post a 6 cycle of Chemotherapy because of presence of tumor
on her right breast. She has also a history of Hypertension.

Family Medical History

Patient X verbalized that she is the only one in the

family that had cancer. She has stated that there were Family
Medical Diseases known in their neither family nor hereditary
sickness such as hypertension and most commonly in cancer.
She declared that she had cancer due to an unhealthy

3
lifestyle established during her younger years. Her aunt had
breast cancer and survived and her cousin died due to cancer.

Social/Environmental History

Patient X is married and with four children. They are

living in a bungalow type of house made of cement and wood
just. Purchase of mineral water is their source of drinking
water in the area. She also Garbage is collected on their
area daily. She is fond of eating vegetables and fruits, less
meat, and fish, and very selective on food. She dislikes and
avoids eating salty foods; she is not very fond of eating
sweets. She also stated that promotes drinking water,
hydrating herself by drinking lots of water approximately 8-
10 glasses a day, as she knows that it would be a benefit to
her health. She also stated that she is a non-alcoholic and
non-smoker.

Gynecological History

The patient was pregnant four times and delivered a

four healthy children via Normal Spontaneous Delivery. During
her pregnancy, she has a regular pre-natal check-up every
month. She has a normal menstrual cycle (ranging from 3 to 4
days every month). She has not undergone any abortion. She has
no history of reproductive abnormalities.

4
 P H Y S I C A L A S S E S S M E N T

13 AREAS OF ASSESSMENT

A. Psychosocial Status

Patient X is 53 y/o, female; currently residing at

Urdaneta City, Pangasinan was born on March 18, 1956 at
Baguio City, Benguet. She attained a High school degree
having the knowledge and ability to read and write.

As for now, she is currently a housewife, managing the

family and her only daughter. At present, source of income
comes from her husband working as a Computer Technician on a
company. As for hobbies and interests, she certainly
entertains herself by reading, cleaning and doing household
chores and taking care of her family. She verbalized that the
greatest gift from her is her only children.

Under Erik Erikson’s psychosocial development theory,

the patient is under the stage of Generativity Versus
Stagnation. She seems to have a good outlook in life.

She was attentive in conversing with the health team

members. She was cooperative to the nursing and medical
interventions. She deals well with her watcher and visitors.
They seem to have good relationship.

B. Mental Status and Emotional

Status

The patient was conversant and was slightly oriented to

date time, place, and people and to her present condition.

During the duty, there were no observed mood swings and

emotional changes. Her positive attitude was consistent all
throughout. She answers questions and follow instructions
appropriately.

C. Environmental Status

The patient was admitted to Baguio General Hospital and

Medical Center in Surgery East Ward of the Female Division on
Bed 16. The ward has adequate lighting, good ventilation and
warm temperature. It was maintained clean at all times by the
cooperation of the Hospital Janitor, Staff Nurses and
Watchers of each patient. The bed has no side rails. There
are clean blankets and pillows for the patient’s use. There
was a regular garbage collection in the hospital where in
there is proper regulation. The garbage bins are placed on

5
the hallway of the ward which is managed by the Hospital
Janitor.

D. Sensory Status

1. Visual Status

The patient’s pupils are equally rounded. There are no

reduced accommodation to light changes when the penlight was
directed to the eyes. Based on her age, she has diminished
visual acuity nor reduction in visual field. She does not
have difficulties in seeing far away objects and recognizing
people, and does wear corrective devices such as eye glasses
if needed. She has the capability to read due to good visual
acuity.

2. Auditory Status

She has no difficulties in hearing soft voices upon

seeing her conversing with her watcher in a whispering
manner. She was able to determine from what direction the
sound of the voices were coming from as observed when she
turned her head towards the direction of the person she was
talking to. There was no impacted cerumen upon inspection.
The ears are symmetrical and in lined with the outer cantus
of the eyes.

3. Olfactory Status

Air is felt in the nose when she exhaled. Nasal mucosa

is intact, smooth and moist pink upon inspection. She was
able to discriminate foul odor as noted when she complained
about the bad smell of the comfort room.

4. Gustatory Status

She is able to determine between different tastes such

as sour, sweet, bitter, and salty. She could also taste any
flavor or dish served to her.

5. Tactile Status

She was able to perceive hotness. She was also able to

perceive cold as noted when she asked the student nurse why
the thermometer is cold. Pain was noted when she grimaced
upon the administration of intravenous medications.

6
 6. Language Perception and Formation

The patient is fluent in Ilocano, Tagalog and in

English. She can understand Ilocano, Tagalog and English
language but fairly understandsother dialects. She verbalizes
her needs.

A. Motor Status

Patient can move all her extremities very well. She has
no limited movement from her bed and can barely stand on her
own. She could ambulate around the ward and walks to the
comfort room to refresh herself without no assistance.

B. Nutritional Status

During her hospitalization, The doctor advised her to

take in foods that would boost her immune system, eating a
balanced meal composing largely on fruits and vegetables and
small amount of meat. She has a good appetite. Upon
palpation, there is no abdominal tenderness.

C. Elimination Status

During hospitalization, her urination ranges from 3-4

times per day only. This must have been because she takes
water at all.

On the days that we handled her, she had not defecated

during our 3-11 shift. She described her stool as brownish
and depending on the foods colors that she intake in.

D. Fluid and Electrolyte status

Before the hospitalization, Mrs. X drinks large amounts

of water just about 8-10 glasses of water a day. She drinks
water every after meal, as she knows that it would be a
benefit to her health.

During her hospitalization, she did drink much water.

There was insertion of IV administration of D5LRS 1000 Liters
regulated at 21 drops per minute (gtts/min).

7
 E. Circulatory Status

Her pulse rate ranges from 62-95 beats per minute which
is within the normal limits. However, her blood pressure
ranges from 100/60- 130/70 which also her normal BP. She has
a history of hypertension. Her capillary refill is about 2-3
seconds which is normal.

F. Respiratory Status

Her respiration ranges from 16-22 breaths per minutes.

She has no episodes of difficulty in breathing.

G. Temperature Status

During her first day of hospitalization, she has no

fever. Her temperature ranges from 36.9 – 37.2 degrees
centigrade which is within normal range.

H. Integumentary Status

Skin was moist. Lips and buccal mucosa were not dry.
There is normal Skin turgor which goes back normally. There
were noted incision on the left breast due to her mastectomy
operation last 2008 at Cagayan de Oro.

I. Comfort and Rest Status

During our shift, she was comfortable in sleeping but

there are episodes where she cannot sleep due to ward
setting. The lights are on and the Noise surrounding the ward
could irritate her disturbance of sleeping.

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9
 L A B O R A T O R Y F I N D I N G S A N D I M P L I C A T I O N S

H e m a t o l o g y R e s u l t F o r m
N a m e : x A g e : 3 6 / f H o s p : 3 9 1 0 5 3
W a r d : s u r g T i m e : 9 : 1 5 a m L a b # : W H 1 2 2
R E F . R A N G E R E S U L T
l / l
Hemoglobin 1 0 2 F 1 2 0 - 1 6 0 7 8
Hematocrit 0 . 3 0 F 0 . 3 7 - 0 . 2 3
l / l
0 . 4 7
g / L
WBC Count 5 . 0 - 1 0 . 0 x 1 0 2 1 . 1
D I F F E R E N T I A L C O U N T
Neutrophils 0 . 5 0 - 0 . 7 0 0 . 8 4
Lymphocytes 0 . 2 0 - 0 . 4 0 0 . 1 5
Midcell 0 . 0 3 - 0 . 0 9
Eosinophil 0 . 0 0 - 0 . 0 7 0 . 0 1
Monocyte 0 . 0 0 - 0 . 0 7
10
Band 0 . 0 0 - 0 . 0 5 1 . 0 0
T O T A L 1 . 0 0
Red Cell Count F 4 . 0 4 - 5 . 4 8 x
1 2 / L
1 0
g / l
Platelet Count 1 5 0 - 4 0 0 x 1 0 M a r k e d l y
i n c r e a s e d
LE Cell Prep.
Malarial Smear
Bleeding Time 1 - 5 m i n u t e s
Clotting Time 2 - 6 m i n u t e s
Lee & white C.T 5 - 1 0 m i n u t e s
P R O T H R O M B I N T I M E ( P T )
Patient 1 0 - 1 4 s e c o n d s
Control 1 0 . 8 - 1 3 . 8
s e c o n d s
INR

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% Activity
P A R T I A L P R O T H R O M B I N T I M E ( P T T )
Patient 2 6 - 3 6 s e c o n d s
Control 2 9 . 6 - 3 7 . 6
s e c o n d s
E R Y T H R O C Y T E S E D I M E N T A T I O N R A T E
Wintrobe Method F 0 - 2 0 m m / H r
Westergren Method A d u l t 0 - 1 0 m m / H r
Retailocyte Count 0 . 5 - 1 . 5 %

R E M A R K S :
Midcells may include less frequently occurring and rare correlating to monotype, eosinophils, basophils,
blast and other precursor.

Blood Type: “O”

Rh: “Positive”

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I M P L I C A T I O N :
Chemotherapy affects production of white blood cells in the bone marrow. Normally white blood cells
help fight off infection. After chemotherapy, if your white blood cells are low, you are more likely to get
infections. Any infection can also worsen more quickly – a trivial infection could become life threatening
within hours if it isn’t treated.

When your white blood cell count is at its lowest you can feel very tired (fatigued). Some people also
say they feel depressed. This can be really hard to deal with and make you wonder if you really want to go
on with your treatment. Try to hang in there. Things should improve and you will start to feel better again
before your next treatment, as your blood counts rise. Unfortunately, they'll go down again after each
treatment. But once your treatment is finished your blood cell counts will remain at normal levels.

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 A N A T O M Y A N D P H Y S I O L O G Y

T h e B r e a s t s

In order to understand breast cancer, it helps to have

some basic knowledge about the normal structure of the
breasts. 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).

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.

T h e L y m p h a t i c s y s t e m

The lymph system is important to understand because it

is one of the ways in which breast cancers can spread. This
system has several parts. 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. Most lymphatic vessels in the
breast connect to lymph nodes under the arm (axillary nodes).
Some lymphatic vessels connect to lymph nodes inside the
chest (internal mammary nodes) and those either above or
below the collarbone (supraclavicular or infraclavicular
nodes).

14
 Knowing if the cancer cells have spread to lymph nodes
is important because if it has, 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, the more
likely it is that the cancer may be found in other organs as
well. This is important to know because it could affect your
treatment plan. Still, not all women with cancer cells in
their lymph nodes develop metastases, and in some cases a
woman can have negative lymph nodes and later develop
metastases.

F i b r o c y s t i c c h a n g e s
Most lumps turn out to be fibrocystic changes. The term
"fibrocystic" refers to fibrosis and cysts. Fibrosis is the
formation of fibrous (scar-like) tissue, and cysts are fluid-
filled sacs.

Fibrocystic changes can cause breast swelling and pain.

This often happens just before a woman's menstrual period is
about to begin. Her breasts may feel lumpy and, sometimes, she
may notice a clear or slightly cloudy nipple discharge.

B e n i g n B r e a s t L u m p s
Benign breast tumors such as fibroadenomas or
intraductal papillomas are abnormal growths, but they are not
cancerous and do not spread outside of the breast to other
organs.They are not life threatening. Still, some benign
breast conditions are important because women with these
conditions have a higher risk of developing breast cancer.

15
16
 P A T H O P H Y S I O L O G Y O F T H E D I S E A S E

Predisposing ETIOLOGY: Precipitating Factors:

Factors:
Unknown ✔ exposure to
Age radiation and
certain chemicals
Gender ✔ having a sibling
Somatic mutations in with leukemia
✔ HTLV-1 virus
the DNA
✔ genetic
abnormalities
✔ chromosomal
Activate oncogene/
deactivate tumor-
supppresor gene

Malignant transformation
of lymphoid stem cells

s/sx:
Uncontrolled proliferation Treatment:
of lymphoblast in the bone bone pain
marrow Analgesic
joint pain
Diagnostic Treatment:
Lymphoblast replace the
Test:
normal marrow elements ✔ Remission
BM aspiration Induction
Therapy
Decreased production ✔ Consolidation
and
of normal blood cells
Maintenance
Therapy
✔ BM
17
18
 P A T H O P H Y S I O L O G Y O F T H E
D I S E A S E

Breast cancer may be classified pathologically as

noninvasive (in situ) or invasive (infiltrating). The
noninvasive carcinomas are generally thought to be
antecedents of invasive carcinoma.
Intraductal carcinoma (ductal carcinoma in situ) is the
most common noninvasive carcinoma among elderly women. It is
generally multicentric, and <= 20% recur locally after
partial mastectomy. Axillary lymph nodes are involved in < 2%
of cases. Lobular carcinoma in situ, often multicentric and
involving both breasts, is rare after menopause.
Of the invasive carcinomas, invasive ductal carcinoma is
the most common among women of all ages, comprising about 70%
of all cases. The incidence of mucinous (colloid) carcinoma,
a slow-growing tumor in elderly women, increases with age.
The incidence of medullary carcinoma, which is often
bilateral, decreases with age. Inflammatory carcinoma of the
breast, a very aggressive tumor, is equally prevalent among
premenopausal and postmenopausal women.
Paget's disease of the nipple represents spread of a
ductal carcinoma to the skin of the nipple; it is usually
associated with intraductal carcinoma and less so with
invasive carcinoma. A palpable breast lump is present in 50%
of cases.
Although many risk factors may increase your chance of
developing breast cancer, 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.

Certain changes in DNA can cause normal breast cells to

become cancerous. DNA is the chemical in each of our cells
that makes up our genes -- the instructions for how our cells
function. We usually resemble our parents because they are
the source of our DNA. However, DNA affects more than how we
look. Some genes contain instructions for controlling when
our cells grow, divide, and die. Certain 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. Cancers can be caused by DNA
mutations (changes) that "turn on" oncogenes or "turn off"
tumor suppressor genes.

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. 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. Women have already begun to benefit from advances in
understanding the genetic basis of breast cancer. 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.

19
Acquired gene mutations
Most DNA mutations related to breast cancer, however,
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, such as radiation or cancer(22 of 121) causing
chemicals. But so far, the causes of most acquired mutations
that could lead to breast cancer remain unknown. Most breast
cancers have several gene mutations that are acquired.

20
 N U R S I N G C A R E A N D
M A N A G E M E N T

LIST OF IDENTIFIED PROBLEMS

ACTUAL PROBLEMS

1. hair loss leading to disturbed body image

2. easy bruising or bleeding (due to low blood platelet
counts)
3. fatigue (due to low red blood cell counts and other
reasons)
4. loss of appetite

POTENTIAL PROBLEMS

1. nausea and vomiting

2. increased chance of infections (due to low white blood
cell counts)
3. mouth sores

PRIORITIZED PROBLEMS
1. Fatigue (due to low red blood cell counts and other
reasons)
Fatigue is a common health complaint. It is, however,
one of the hardest terms to define, and a symptom of
many different conditions.
Fatigue, also known as weariness, tiredness, exhaustion,
or lethargy, is generally defined as a feeling of lack
of energy. Fatigue is not the same as drowsiness, but
the desire to sleep may accompany fatigue. Apathy is a
feeling of indifference that may accompany fatigue or
exist independently.
2. Hair Loss Leading Disturbed Body Image

Some medicines can cause hair loss. This type of hair

loss improves when you stop taking the medicine.
Medicines that can cause hair loss include blood
thinners (also called anticoagulants), medicines used
for gout, medicines used in chemotherapy to treat
cancer, vitamin A (if too much is taken), birth control
pills and antidepressants.

Body image is the attitude a person has about the actual

or perceived structure or function of all or part of his
or her body. This attitude is dynamic and is altered
through interaction with other persons and situations

21
 and influenced by age and developmental level. As an
important part of one’s self-concept, body image
disturbance can have profound impact on how individuals
view their overall selves.

3. loss of appetite

A decreased appetite is when you have a reduced desire

to eat. This occurs despite the body's basic caloric
(energy) needs.

Any illness can affect a previously hearty appetite. If

the illness is treatable, the appetite should return
when the condition is cured.
Loss of appetite can cause unintentional weight loss.
Depression in the elderly is a common cause of weight
loss that is not explained by other factors.

22
23
 N U R S I N G C A R E P L A N S

ACTUAL
ASSESSMENT EXPLANATION OF PLANNING IMPLEMENATION RATIONALE EVALUATION
THE PROBLEM
S> “Medyo The length of STO> After 8 hours DX> Monitor Vital ➢ For baseline STO> Goal is met
nanghihina pa ako” Chemotherapy of Nursing Signs and Record data. if the patient
treatment depends Intervention the ➢ To determine will be able to
O> Appears weak on whether the patient will be ➢ Assess activity identify
cancer shrinks, able to identify Ability to intolerance techniques to
➢ Slow ambulate
Movements how much it techniques to ➢ To determine enhance activity
shrinks, and how a enhance activity ➢ Assess circulatory tolerance such as:
noted capillary
➢ Good Skin woman tolerates tolerance such as: problems.
length of Refill ➢ To determine - gradual increase
Turgor - gradual increase ➢ Assess skin in activity level
➢ Coherent and treatment. Some of hydration.
the most common in activity level turgor. ➢ To enhance as tolerated
Conversant as tolerated TX> Promote
➢ Needs possible side ability to - rest in between
effect is fatigue Adequate Rest participate
assistance in - rest in between activities
performing (due to low red activities with
ADL’s blood cell counts activities
A> Activity and other reasons) ➢ To protect
➢ Assist with LTO> Goal is met
Intolerance client from
LTO> After 8 days activities if the patient
Related to injury
of Nursing will be able to
Weakness ➢ To promote
Intervention, the ➢ Anticipate report an increase
24
patient will be Needs wellness in activity
able to report an EDX> Encourage ➢ To determine intolerance.
increase in expression of contributing
activity feelings factors
intolerance. ➢ Suggest Use ➢ To Enhance
of Relaxation Ability to
Techniques participate
such as in activities
visualization
and guided
imagery.

25
26
 ASSESSMENT EXPLANATION PLANNING IMPLEMENATION RATIONALE EVALUATION
OF THE
PROBLEM
S> “Nakakahiya The length of STO> After 8 DX> Monitor vital ➢ For baseline STO> Goal is met
makakalbo ako” Chemotherapy hours of Nursing signs and record data if patient will
treatment depends Intervention the ➢ Aids in be able to
O> on whether the patient will be ➢ Determine identification verbalize
cancer shrinks, able to verbalize patient’s of ideas, understanding of
➢ Coherent and perception of
Conversant how much it understanding of attitudes and body changes.
shrinks, and how a body changes cancer and fears,
➢ Submits self cancer
to Nursing woman tolerates misconception
length of treatments. ➢ Misconceptions
Procedure and TX> Ask for LTO> Goal is met
Care done treatment. Some of LTO> After 1 day about cancer may if patient will
the most common patient for verbal be more
A> Disturbed of Nursing feedback, and be able to
Body Image possible side Intervention, the disturbing than verbalize
effect is hair correct facts and can
realted to patient will be misconception acceptance of
illness loss. able to verbalize interfere with self in situation
about individual’s treatments/
treatment. acceptance of type of cancer and in the effects of
self in situation delay healing. therapeutic
treatment. ➢ Accurate and
in the effects of ➢ Provide regimen.
therapeutic concise
anticipatory information
regimen. guidance with helps dispel
patient fears and
regarding anxiety, helps
treatment clarify the
Protocol, expected
27 length of routine.
28
29
 ASSESSMENT EXPLANATION PLANNING IMPLEMENATION RATIONALE EVALUATION
OF THE
PROBLEM
S> This can often STO> After 8 DX> Monitor Vital ➢ For baseline STO> Goal is met
have a major hours of Nursing Signs and record. Data. if patient will
O> Coherent and effect on the Intervention the ➢ Temperature be able to
Conversant immune system and patient will be ➢ Monitor elevation may verbalize
may reduce the able to verbalize Temperature occur because understanding of
➢ Submits self
to Nursing body's defenses understanding of of various Having cancer or
against infection Having cancer or factors such treatment for cancer
Procedure and
for some months, treatment for cancer as can weaken your
Care done
both during and can weaken your chemotherapy immune system. This
A> Risk for makes it more likely
after treatment. immune system. This side effects.
Infection makes it more likely that you will pick
related to This is because ➢ Early
that you will pick up an infection and
inadequate chemotherapy recognition develop a fever.
up an infection and
secondary reduces the develop a fever. and
defenses and production of intervention
immunosuppress white blood cells may prevent
TX> Assess all LTO> Goal is met
ion secondary by the bone progression
LTO> After 1 day systems for signs if patient will be
to dose- marrow. People to more
of Nursing and symptoms of able to
limiting side having serious
Intervention, the infection on a demonstrate proper
effect of chemotherapy are situation.
patient will be continual basis. aseptic techniques
chemotherapy. particularly at ➢ Limits
able to preventing further
risk of picking up fatigue, yet
demonstrate proper infection such as
infections between encourages
aseptic techniques proper hand
7–14 days after sufficient
preventing further washing.
the chemotherapy, movement to
infection such as 30 ➢ Promote
when the level of prevent
31
D R U G S T U D Y

32
Generic name/brand name/ Action and Indication Route/Dosage/Date prescribe Nursing consideration
classification

Dosage • Take the drug

twice a day, in
tamoxifen citrate Therapeutic actions
the morning and
(ta mox' i fen) Available Forms: Tablets--10,
evening.
Apo-Tamox (CAN), Potent antiestrogenic effects: 20 mg
Nolvadex, Novo-Tamoxifen • The following
competes with estrogen for binding Adult side effects may
(CAN), Tamofen (CAN), sites in target tissues, such as occur: bone pain;
Tamone (CAN) the breast. Breast cancer: hot flashes
20---40 mg/d PO for 5 y. (staying in cool
Pregnancy Category D Indications temperatures may
➢ Adjunct with cytotoxic Reduction in breast cancer
Drug class help); nausea,
incidence:
chemotherapy following radical vomiting (small,
• Antiestrogen 20 mg/d PO for 5 y.
or modified radical mastectomy frequent meals
to delay recurrence of Pharmacokinetics may help); weight
surgically curable breast gain; menstrual
Ro On Pe irregularities;
cancer in postmenopausal women ut se ak dizziness,
or women >50 y with positive Or
e Va
t 4- headache, light-
axillary nodes al ri -- headedness (use
➢ Treatment of advanced,
Metabolism:
es Hepatic,
7 T1/2: caution if
7---14 d h
metastatic breast cancer in driving or
women and men; alternative to Distribution: Crosses performing tasks
placenta; enters breast that require
oophorectomy or ovarian
milk alertness).
radiation in premenopausal
women Excretion: Feces • This drug can
cause serious
➢ Preventative therapy for women
fetal harm and
at high risk for breast cancer must not be taken
➢ Unlabeled uses: treatment of during pregnancy.
33
34
35
 S U M M A R Y O F F I N D I N G S

Vital Signs were assessed and properly documented. The

patient was on IVF of D5NSS 1L, it was regulated and
monitored. IVF flow rate and patency on site were checked.
The significant others was encouraged to converse with the
patient and instructed to maintain bed rest. The significant
others was endorsed to increase fluid intake. The diet as
tolerated was encouraged promoting vegetables and fruits in
giving vitamins and minerals that could support the body’s
defenses. Medications were prepared to the patient Treatment
for these symptoms are a standard fluid rehydration therapy
in order to maintain blood pressure. If circulatory failure
is not reversed, death may follow. Rapport was established
and integrated with the significant others. Safety was
ensured with the close monitoring on the patient.

36
 C O N C L U S I O N

If a newly diagnosed Breast cancer patient asked you to

define cancer, could you tell her that she has still hope? We
all have heard the word "cancer" many times, however very few
people understand the disease and how it develops.
Cancer is a complex group of over 100 different types of
cancer. Cancer can affect just about every organ in the human
body.
All cancers are different, and require different
treatment. What may be effective for prostate cancer,
probably will not be for bladder cancer. Diagnosing cancer
will vary as well, depending on the organ affected.
End-of-Life Issues
Palliative care, which provides physical, emotional, and
spiritual relief, must be provided with attempts for curative
therapy and becomes the exclusive goal when cure cannot be
expected at all stages of breast cancer, treatment needs to
be modified for life expectancy. For patients with metastatic
disease for which cure is not attainable, the physician
should clarify the goals of care through frequent, clear
discussions with the patient and, when appropriate, the
family.

All should recognize that cognitive impairment alone

does not exclude the patient from participating in decision
making, because some patients with impaired cognition are
able to understand, explain the consequences of, and voice an
opinion about certain treatment options. Pain from bony
metastases should be treated as described above with
nonsteroidal anti-inflammatory drugs, pamidronate, local
radiation, and strontium 89 rather than with opioids if
possible. Palliative chemotherapy may be useful when the
tumor invades vital organs.

37
 R E C O M M E N D A T I O N

Health care providers should:

a. Should continuously monitor the vital signs of the

patient.
b. Observe the patient to avoid development of
complications.
c. Promote safety of the patient.
d. Educate patient and significant others about the
disease, and
e. Explain the procedure done to the patient. The
evaluation and diagnosis of Breast Cancer is based on
the presenting symptoms and history combined with a
focused physical assessment, imaging studies, and
possibly a functional study of the breast.

Significant others should:

a. Actively cooperate in the rendering of care for the

patient.
b. Be sensitive to the needs.
c. In addition, every effort is made to retrieve and
analyze breast has passed spontaneously or retrieved
through aggressive interventions.
d. Cooperate with the health care providers in the
implementation of her Health Care programs.

38
 A P P E N D I C E S

S t a g e s o f B r e a s t C a n c e r
Stage Definition
Stage Cancer cells remain inside the breast duct, without
0 invasion into normal adjacent breast tissue.
Stage Cancer is 2 centimeters or less and is confined to the
I breast (lymph nodes are clear).
No tumor can be found in the breast, but cancer cells
are found in the axillary lymph nodes (the lymph nodes
under the arm)
OR
Stage the tumor measures 2 centimeters or smaller and has
IIA spread to the axillary lymph nodes
OR
the tumor is larger than 2 but no larger than 5
centimeters and has not spread to the axillary lymph
nodes.
The tumor is larger than 2 but no larger than 5
centimeters and has spread to the axillary lymph nodes
Stage
OR
IIB
the tumor is larger than 5 centimeters but has not
spread to the axillary lymph nodes.
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 breastbone
Stage
OR
IIIA
the 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.
The tumor may be any size and has spread to the chest
wall and/or skin of the breast
AND
may have spread to axillary lymph nodes that are
Stage clumped together or sticking to other structures, or
IIIB cancer may have spread to lymph nodes near the
breastbone.

Inflammatory breast cancer is considered at least stage

IIIB.
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 breast
AND
Stage
the cancer has spread to lymph nodes either above or
IIIC
below the collarbone
AND
the cancer may have spread to axillary lymph nodes or
to lymph nodes near the breastbone.
Stage The cancer has spread — or metastasized — to other
IV parts of the body.

39
 B r e a s t C a n c e r R i s k F a c t o r s
A “risk factor” is anything that increases your risk of
developing breast cancer. Many of the most important risk
factors for breast cancer are beyond your control, such as
age, family history, and medical history. However, there are
some risk factors you can control, such as weight, physical
activity, and alcohol consumption.
Be sure to talk with your doctor about all of your
possible risk factors for breast cancer. There may be steps
you can take to lower your risk of breast cancer, and your
doctor can help you come up with a plan. Your doctor also
needs to be aware of any other risk factors beyond your
control, so that he or she has an accurate understanding of
your level of breast cancer risk. This can influence
recommendations about breast cancer screening — what tests to
have and when to start having them.
I. Risk factors you can control
Weight. Being overweight is associated with increased risk of
breast cancer, especially for women after menopause. Fat
tissue is the body’s main source of estrogen after menopause,
when the ovaries stop producing the hormone. Having more fat
tissue means having higher estrogen levels, which can
increase breast cancer risk.
Diet. Diet is a suspected risk factor for many types of
cancer, including breast cancer, but studies have yet to show
for sure which types of foods increase risk. It’s a good idea
to restrict sources of red meat and other animal fats
(including dairy fat in cheese, milk, and ice cream), because
they may contain hormones, other growth factors, antibiotics,
and pesticides. Some researchers believe that eating too much
cholesterol and other fats are risk factors for cancer, and
studies show that eating a lot of red and/or processed meats
is associated with a higher risk of breast cancer. A low-fat
diet rich in fruits and vegetables is generally recommended.
For more information, visit our page on healthy eating to
reduce cancer risk in the Nutrition section.
Exercise. Evidence is growing that exercise can reduce breast
cancer risk. The American Cancer Society recommends engaging
in 45-60 minutes of physical exercise 5 or more days a week.
Alcohol consumption. Studies have shown that breast cancer
risk increases with the amount of alcohol a woman drinks.
Alcohol can limit your liver’s ability to control blood
levels of the hormone estrogen, which in turn can increase
risk.
Smoking. Smoking is associated with a small increase in
breast cancer risk.
Exposure to estrogen. Because the female hormone estrogen
stimulates breast cell growth, exposure to estrogen over long
periods of time, without any breaks, can increase the risk of
breast cancer. Some of these risk factors are under your
control, such as:
• taking combined hormone replacement therapy (estrogen
and progesterone; HRT) for several years or more, or
taking estrogen alone for more than 10 years
• being overweight
• regularly drinking alcohol
Recent oral contraceptive use. Using oral contraceptives
(birth control pills) appears to slightly increase a woman’s

40
risk for breast cancer, but only for a limited period of
time. Women who stopped using oral contraceptives more than
10 years ago do not appear to have any increased breast
cancer risk.
Stress and anxiety. There is no clear proof that stress and
anxiety can increase breast cancer risk. However, anything
you can do to reduce your stress and to enhance your comfort,
joy, and satisfaction can have a major effect on your quality
of life. So-called “mindful measures” (such as meditation,
yoga, visualization exercises, and prayer) may be valuable
additions to your daily or weekly routine. Some research
suggests that these practices can strengthen the immune
system.
I . R i s k f a c t o r s y o u c a n ’ t
c o n t r o l
Gender. Being a woman is the most significant risk factor for
developing breast cancer. Although men can get breast cancer,
too, women’s breast cells are constantly changing and
growing, mainly due to the activity of the female hormones
estrogen and progesterone. This activity puts them at much
greater risk for breast cancer.
Age. Simply growing older is the second biggest risk factor
for breast cancer. From age 30 to 39, the risk is 1 in 233,
or .43%. That jumps to 1 in 27, or almost 4%, by the time you
are in your 60s.
Family history of breast cancer. If you have a first-degree
relative (mother, daughter, sister) who has had breast
cancer, or you have multiple relatives affected by breast or
ovarian cancer (especially before they turned age 50), you
could be at higher risk of getting breast cancer.
Personal history of breast cancer. If you have already been
diagnosed with breast cancer, your risk of developing it
again, either in the same breast or the other breast, is
higher than if you never had the disease.
Race. White women are slightly more likely to develop breast
cancer than are African American women. Asian, Hispanic, and
Native American women have a lower risk of developing and
dying from breast cancer.
Radiation therapy to the chest. Having radiation therapy to
the chest area as a child or young adult as treatment for
another cancer significantly increases breast cancer risk.
The increase in risk seems to be highest if the radiation was
given while the breasts were still developing (during the
teen years).
Breast cellular changes. Unusual changes in breast cells
found during a breast biopsy (removal of suspicious tissue
for examination under a microscope) can be a risk factor for
developing breast cancer. These changes include overgrowth of
cells (called hyperplasia) or abnormal (atypical) appearance.
Exposure to estrogen. Because the female hormone estrogen
stimulates breast cell growth, exposure to estrogen over long
periods of time, without any breaks, can increase the risk of
breast cancer. Some of these risk factors are not under your
control, such as:
• starting menstruation (monthly periods) at a young age
(before age 12)
• going through menopause (end of monthly cycles) at a
late age (after 55)

41
 • exposure to estrogens in the environment (such as
hormones in meat or pesticides such as DDT, which
produce estrogen-like substances when broken down by the
body)
Pregnancy and breastfeeding. Pregnancy and breastfeeding
reduce the overall number of menstrual cycles in a woman’s
lifetime, and this appears to reduce future breast cancer
risk. Women who have never had a full-term pregnancy, or had
their first full-term pregnancy after age 30, have an
increased risk of breast cancer. For women who do have
children, breastfeeding may slightly lower their breast
cancer risk, especially if they continue breastfeeding for 1
1/2 to 2 years. For many women, however, breastfeeding for
this long is neither possible nor practical.
DES exposure. Women who took a medication called
diethylstilbestrol (DES), used to prevent miscarriage from
the 1940s through the 1960s, have a slightly increased risk
of breast cancer. Women whose mothers took DES during
pregnancy may have a higher risk of breast cancer as well.
For more detailed information about risk factors for breast
cancer, visit our Lower Your Risk section.

S y m p t o m s & D i a g n o s i s
Breast cancer symptoms vary widely — from lumps to
swelling to skin changes — and many breast cancers have no
obvious symptoms at all. Symptoms that are similar to those
of breast cancer may be the result of non-cancerous
conditions like infection or a cyst.
Breast self-exam should be part of your monthly health care
routine, and you should visit your doctor if you experience
breast changes.

Mammogram. If you're over 40 or at a high risk for the

disease, you should also have an annual mammogram.
Physical Exam by a doctor. The earlier breast cancer is found
and diagnosed, the better your chances of beating it.
The actual process of diagnosis can take weeks and involve
many different kinds of tests. Waiting for results can feel
like a lifetime. The uncertainty stinks. But once you
understand your own unique “big picture,” you can make better
decisions. You and your doctors can formulate a treatment
plan tailored just for you.

R i s k o f D e v e l o p i n g B r e a s t
C a n c e r
The term “risk” is used to refer to a number or
percentage that describes how likely a certain event is to
occur. When we talk about factors that can increase or
decrease the risk of developing breast cancer, either for the
first time or as a recurrence, we often talk about two
different types of risk: absolute risk and relative risk.

42
 I . A b s o l u t e r i s k
Absolute risk is used to describe an individual’s
likelihood of developing breast cancer. It is based on the
number of people who will develop breast cancer within a
certain time period. Absolute risk also can be stated as a
percentage.
The absolute risk of developing breast cancer during a
particular decade of life is lower than 1 in 8. The younger
you are, the lower the risk. For example:
• From age 30 to 39, absolute risk is 1 in 233, or 0.43%. This
means that 1 in 233 women in this age group can expect to
develop breast cancer. Put another way, your odds of
developing breast cancer if you are in this age range are 1 in
233.
• From age 40 to 49, absolute risk is 1 in 69, or 1.4%.
• From age 50 to 59, absolute risk is 1 in 38, or 2.6%.
• From age 60 to 69, absolute risk is 1 in 27, or 3.7%.

I . R e l a t i v e r i s k
Relative risk is a number or percentage that compares
one group’s risk of developing breast cancer to another’s.
This is the type of risk frequently reported by research
studies, which often compare groups of women with different
characteristics or behaviors to determine whether one group
has a higher or lower risk of breast cancer than the other
(either as a first-time diagnosis or recurrence).
E n d - o f - L i f e I s s u e s
Palliative care, which provides physical, emotional, and
spiritual relief, must be provided with attempts for curative
therapy and becomes the exclusive goal when cure cannot be
expected. At all stages of breast cancer, treatment needs to
be modified for life expectancy.

For patients with metastatic disease for which cure is

not attainable, the physician should clarify the goals of
care through frequent, clear discussions with the patient
and, when appropriate, the family. All should recognize that
cognitive impairment alone does not exclude the patient from
participating in decision making, because some patients with
impaired cognition are able to understand, explain the
consequences of, and voice an opinion about certain treatment
options.

Pain from bony metastases should be treated as described

above with nonsteroidal anti-inflammatory drugs, pamidronate,
local radiation, and strontium 89 rather than with opioids if
possible. Palliative chemotherapy may be useful when the
tumor invades vital organs.

Chemotherapy
Chemotherapy is treatment with cancer-killing drugs that may
be given intravenously (injected into a vein) or by mouth.
The drugs travel through the bloodstream to reach cancer
cells in most parts of the body. The chemotherapy is given in

43
cycles, with each period of treatment followed by a recovery
period. Treatment usually lasts for several months.

When is chemotherapy used?

There are several situations in which chemotherapy may be
recommended.

Adjuvant chemotherapy: Systemic therapy given to patients

after surgery who have no evidence of cancer spread is called
adjuvant therapy. When used as adjuvant therapy after
breast-conserving surgery or mastectomy, chemotherapy reduces
the risk of breast cancer coming back. Even in the early
stages of the disease, cancer cells may break away from the
primary breast tumor and spread through the bloodstream.
These cells don't cause symptoms, they don't show up on
imaging tests, and they can't be felt during a physical exam.
But if they are allowed to grow, they can establish new
tumors in other places in the body. The goal of adjuvant
chemotherapy is to kill undetected cells that have traveled
from the breast.

Neoadjuvant chemotherapy: Chemotherapy given before surgery

is called neoadjuvant therapy. The major benefit of
neoadjuvant chemotherapy is that it can shrink large cancers
so that they are small enough to be removed by lumpectomy
instead of mastectomy. Another possible advantage of
neoadjuvant chemotherapy is that doctors can see how the
cancer responds to chemotherapy. If the tumor does not
shrink, your doctor may try different chemotherapy drugs.
So far, it's not clear that neoadjuvant chemotherapy improves
survival, but it seems to be at least as effective as
adjuvant therapy after surgery.

Chemotherapy for advanced breast cancer: Chemotherapy can

also be used as the main treatment for women whose cancer has
already spread outside the breast and underarm area at the
time it is diagnosed, or if it spreads after initial
treatments. The length of treatment depends on whether the
cancer shrinks, how much it shrinks, and how a woman tolerates
length of treatment. Some of the most common possible side
effects include:
• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infections (due to low white blood cell
counts)
• easy bruising or bleeding (due to low blood platelet counts)
• fatigue (due to low red blood cell counts and other reasons)

44
 D E F I N I T I O N O F T E R M S
Breast cancer general terms
It is important to understand some of the key words used to
describe breast cancer.

Carcinoma
This is a term used to describe a cancer that begins in
the lining layer (epithelial cells) of
organs such as the breast. Nearly all breast cancers are
carcinomas (either ductal carcinomas or lobular carcinomas).

Adenocarcinoma
Is a type of carcinoma that starts in glandular tissue
(tissue that makes and secretes a substance). The ducts and
lobules of the breast are glandular tissue (they make breast
milk), so cancers starting in these areas are sometimes
called adenocarcinomas.

Carcinoma in situ
This term is used for the early stage of cancer, when it
is confined to the layer of cells where it began. In breast
cancer, in situ means that the cancer cells remain confined
to ducts (ductal carcinoma in situ) or lobules (lobular
carcinoma in situ). They have not invaded into deeper
tissues in the breast or spread to other organs in the body,
and are sometimes referred to as non-invasive breast cancers.

Invasive (infiltrating) carcinoma

An invasive cancer is one that has already grown beyond
the layer of cells where it started(as opposed to carcinoma
in situ). Most breast cancers are invasive carcinomas – either
invasive ductal carcinoma or invasive lobular carcinoma.

Sarcoma
Sarcomas are cancers that start from connective tissues
such as muscle tissue, fat tissue, or blood vessels. Sarcomas
of the breast are rare.

Triple-negative breast cancer

This term is used to describe breast cancers (usually
invasive ductal carcinomas) whose cells lack estrogen
receptors and progesterone receptors. Breast cancers with
these characteristics tend to occur more often in younger
women and in African-American women, and they tend to grow
and spread more quickly than most other types of breast
cancer. Because the tumor cells lack these receptors, neither
hormone therapy nor drugs that target HER2 are effective
against these cancers (although chemotherapy may be useful if
needed).

Mixed tumors
Mixed tumors are those that contain a variety of cell
types, such as invasive ductal cancer combined with invasive
lobular breast cancer. In this situation, the tumor is
treated as if it were an invasive ductal cancer.

Medullary carcinoma
This special type of infiltrating breast cancer has a
rather well defined boundary between tumor tissue and normal
tissue. It also has some other special features, including

45
the large size of the cancer cells and the presence of immune
system cells at the edges of the tumor. Medullary carcinoma
accounts for about 3% to 5% of breast cancers. The outlook
(prognosis) for this kind of breast cancer is generally
better than for the more common types of invasive breast
cancer. Most cancer specialists think that true medullary
cancer is very rare, and that cancers that are called
medullary cancer should be treated as the usual invasive
ductal breast cancer.

Metaplastic carcinoma
Is a very rare type of invasive ductal cancer. These
tumors include cells that are normally not found in the
breast, such as cells that look like skin cells (squamous
cells) or cells that make bone. These tumors are treated like
invasive ductal cancer.

Mucinous carcinoma
Also known as colloid carcinoma, this rare type of
invasive breast cancer is formed by mucus-producing cancer
cells. The prognosis for mucinous carcinoma is usually better
than for the more common types of invasive breast cancer.

Paget disease of the nipple

This type of breast cancer starts in the breast ducts
and spreads to the skin of the nipple and then to the areola,
the dark circle around the nipple. It is rare, accounting for
only about 1% of all cases of breast cancer. The skin of the
nipple and areola often appears crusted, scaly, and red, with
areas of bleeding or oozing. The woman may notice burning or
itching.

Paget disease is almost always associated with either

ductal carcinoma in situ (DCIS) or, more often, with
infiltrating ductal carcinoma. If no lump can be felt in the
breast tissue and the biopsy shows DCIS but no invasive
cancer, the prognosis is excellent.

Tubular carcinoma
Tubular carcinomas are another special type of invasive
ductal breast carcinoma. They are called tubular because of
the way the cells are arranged when seen under the
microscope. Tubular carcinomas account for about 2% of all
breast cancers and tend to have a better prognosis than most
other infiltrating ductal or lobular carcinomas.

Papillary carcinoma
The cells of these cancers tend to be arranged in small,
finger-like projections when viewed under the microscope.
These cancers are most often considered to be a subtype of
ductal carcinoma in situ (DCIS), and are treated as such. In
rare cases they are invasive, in which case they are treated
like invasive ductal carcinoma, although the outlook is
likely to be better. These cancers tend to be diagnosed in
older women, and they make up no more than 1% or 2% of all
breast cancers.

Adenoid cystic carcinoma (adenocystic carcinoma)

These cancers have both glandular (adenoid) and
cylinder-like (cystic) features when seen under the
microscope. They make up less than 1% of breast cancers. They
rarely spread to the lymph nodes or distant areas, and
they tend to have a very good prognosis.

46
Phyllodes tumor
This very rare breast tumor develops in the stroma
(connective tissue) of the breast, in contrast to carcinomas,
which develop in the ducts or lobules. Other names for these
tumors include phylloides tumor and cystosarcoma phyllodes.
These tumors are usually benign but on rare occasions may be
malignant. Benign phyllodes tumors are treated by removing
the mass along with a margin of normal breast tissue. A
malignant phyllodes tumor is treated by removing it along
with a wider margin of normal tissue, or by mastectomy. While
surgery is often all that is needed, these cancers may not
respond as well to the other treatments used for invasive
ductal or lobular breast cancer.

Angiosarcoma
This is a form of cancer that starts from cells that
line blood vessels or lymph vessels. It rarely occurs in the
breasts. When it does, it is usually seen as a complication
of radiation to the breast. It tends to develop about 5 to 10
years after radiation treatment. However, this is an
extremely rare complication of breast radiation therapy.
Angiosarcoma can also occur in the arm of women who develop
lymphedema as a result of lymph node surgery or radiation
therapy to treat breast cancer. These cancers tend to grow
and spread quickly. Treatment is generally the same as for
other sarcomas.

47
 B I B L I O G R A P H Y

Huether, S.E., McCance K.L., (2004). Understanding Pathophysiology

3rd edition. USA: Mosby

Doenges, M E., Moorehouse, M.F., (2002). Nursing Care Plans:

Guidelines for individualizing patient cares 6th edition.
Philadelphia USA: Davis company

Lee, E.C., Banasik, J., (2005). Pathophysiology 3rd edition.

Philippines: Elsevier Saunders

Lemone, P., Burke, K., (2004). Medical-surgical Nursing: Critical

Thinking in Client Care 3rd edition. USA: Pearson

Schilling, J.A., Kelly, W.J., et al (2007). Nursing Drug Handbook

27th edition. Philippines: Lippincott William and Wilkins.

Smeltzer, S.C., Bare, B.G., Hinkle, J.L., and Cheever, K.H. (2008).
Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11th
edition. Philippines: Lippincott Williams and Wilkins.

48