BREAST CANCER

Breast cancer is cancer that forms in the cells of the breasts.

After skin cancer, breast cancer is the most common cancer diagnosed in women in the
United States. Breast cancer can occur in both men and women, but it's far more common
in women.

Substantial support for breast cancer awareness and research funding has helped improve
the screening and diagnosis and advances in the treatment of breast cancer. Breast cancer
survival rates have increased, and the number of deaths steadily has been declining,
which is largely due to a number of factors such as earlier detection, a new personalized
approach to treatment and a better understanding of the disease.
SYMPTOMS

Signs and symptoms of breast cancer may include:

 A breast lump or thickening that feels different from the surrounding tissue
 Change in the size, shape or appearance of a breast
 Changes to the skin over the breast, such as dimpling
 A newly inverted nipple
 Peeling, scaling or flaking of the pigmented area of skin surrounding the nipple
(areola) or breast skin
 Redness or pitting of the skin over your breast, like the skin of an orange

CAUSES
Doctors know that breast cancer occurs when some breast cells begin growing
abnormally. These cells divide more rapidly than healthy cells do and continue to
accumulate, forming a lump or mass. The cells may spread (metastasize) through your
breast to your lymph nodes or to other parts of your body.

Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal
carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive
lobular carcinoma) or in other cells or tissue within the breast.

Researchers have identified hormonal, lifestyle and environmental factors that may
increase your risk of breast cancer. But it's not clear why some people who have no risk
factors develop cancer, yet other people with risk factors never do. It's likely that breast
cancer is caused by a complex interaction of your genetic makeup and your environment.

RISK FACTOR

 Being female. Women are much more likely than men are to develop breast cancer.

 Increasing age. Your risk of breast cancer increases as you age.

 A personal history of breast cancer. If you've had breast cancer in one breast, you have an
increased risk of developing cancer in the other breast.
 A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast
cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of
people diagnosed with breast cancer have no family history of the disease.
 Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of
breast cancer can be passed from parents to children. The most common gene mutations are
referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer
and other cancers, but they don't make cancer inevitable.
 Radiation exposure. If you received radiation treatments to your chest as a child or young adult,
your risk of breast cancer is increased.
 Obesity. Being obese increases your risk of breast cancer.
 Beginning your period at a younger age. Beginning your period before age 12 increases your
risk of breast cancer.
 Beginning menopause at an older age. If you began menopause at an older age, you're more
likely to develop breast cancer.
 Having your first child at an older age. Women who give birth to their first child after age 30
may have an increased risk of breast cancer.
 Having never been pregnant. Women who have never been pregnant have a greater risk of
breast cancer than do women who have had one or more pregnancies.
 Postmenopausal hormone therapy. Women who take hormone therapy medications that
combine estrogen and progesterone to treat the signs and symptoms of menopause have an
increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these
medications.
 Drinking alcohol. Drinking alcohol increases the risk of breast cancer.

PREVENTION

 Ask your doctor about breast cancer screening. Discuss with your doctor when to
begin breast cancer screening exams and tests, such as clinical breast exams and
mammograms.

 Talk to your doctor about the benefits and risks of screening. Together, you can
decide what breast cancer screening strategies are right for you.
 Become familiar with your breasts through breast self-exam for breast awareness.
Women may choose to become familiar with their breasts by occasionally inspecting
their breasts during a breast self-exam for breast awareness. If there is a new change,
lumps or other unusual signs in your breasts, talk to your doctor promptly.

Breast awareness can't prevent breast cancer, but it may help you to better understand
the normal changes that your breasts undergo and identify any unusual signs and
symptoms.

 Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to less
than one drink a day, if you choose to drink.

 Exercise most days of the week. Aim for at least 30 minutes of exercise on most days
of the week. If you haven't been active lately, ask your doctor whether it's OK and
start slowly.

 Limit postmenopausal hormone therapy. Combination hormone therapy may increase

the risk of breast cancer. Talk with your doctor about the benefits and risks of
hormone therapy.

 Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If
you need to lose weight, ask your doctor about healthy strategies to accomplish this.
Reduce the number of calories you eat each day and slowly increase the amount of
exercise.

 Choose a healthy diet. Women who eat a Mediterranean diet supplemented with
extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer. The
Mediterranean diet focuses mostly on plant-based foods, such as fruits and
 vegetables, whole grains, legumes, and nuts. People who follow the Mediterranean
diet choose healthy fats, such as olive oil, over butter and fish instead of red meat.

DIAGNOSIS

 Breast exam. Your doctor will check both of your breasts and lymph nodes in the armpit, feeling
for any lumps or other abnormalities.

 Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to

screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor
may recommend a diagnostic mammogram to further evaluate that abnormality.
 Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within
the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a
fluid-filled cyst.
 Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to
make a diagnosis of breast cancer. Biopsy samples are sent to a laboratory for analysis where
experts determine whether the cells are cancerous. A biopsy sample is also analyzed to determine
the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and
whether the cancer cells have hormone receptors or other receptors that may influence your
treatment options.
 Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves
to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of
dye.

TREATMENT

Breast Cancer Surgery

 Removing the breast cancer (lumpectomy). During lumpectomy, which may be referred to as
breast-sparing surgery or wide local excision, the surgeon removes the tumor and a small margin
of surrounding healthy tissue. Lumpectomy is typically reserved for smaller tumors.

 Removing the entire breast (mastectomy). Mastectomy is an operation to remove all of your
breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts,
fatty tissue and some skin, including the nipple and areola (simple mastectomy).
 Removing a limited number of lymph nodes (sentinel node biopsy). To determine
whether cancer has spread to your lymph nodes, your surgeon will discuss with you
 the role of removing the lymph nodes that are the first to receive the lymph drainage
from your tumor.

 Removing several lymph nodes (axillary lymph node dissection). If cancer is

found in the sentinel lymph nodes, your surgeon will discuss with you the role of
removing additional lymph nodes in your armpit.

 Removing both breasts. Some women with cancer in one breast may choose to have
their other (healthy) breast removed (contralateral prophylactic mastectomy) if they
have a very increased risk of cancer in the other breast because of a genetic
predisposition or strong family history.

RADIATION THERAPHY

Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high risk of
returning or spreading to another part of your body, your doctor may recommend
chemotherapy to decrease the chance that the cancer will recur. This is known as adjuvant
chemotherapy.

HORMONE THERAPHY

Treatments that can be used in hormone therapy include:

 Medications that block hormones from attaching to cancer cells. Selective

estrogen receptor modulator (SERM) medications act by blocking estrogen from
attaching to the estrogen receptor on the cancer cells, slowing the growth of tumors
and killing tumor cells.

SERMs include tamoxifen, raloxifene (Evista) and toremifene (Fareston).

 Medications that stop the body from making estrogen after menopause. Called
aromatase inhibitors, these drugs block the action of an enzyme that converts
androgens in the body into estrogen. These drugs are effective only in
postmenopausal women.

Aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara) and

exemestane (Aromasin).

HEALTH EDUCATION

Taking aspirin

In particular, those taking two or more ibuprofen tablets a week reduced their chances of developing
the disease by 50 per cent.

No/limit alcohol

Alcohol can increase the levels of estrogens in the body, which might increase the risk for breast
cancer recurrence. But there is no strong evidence from studies to support this. In people who have
already been diagnosed with cancer,alcohol intake could also affect the risk of developing a
new cancer.

Maintain a healthy weight

Overweight and obese women -- defined as having a BMI (body mass index) over 25 -- have a higher
risk of being diagnosed with breast cancer compared to women who maintain a healthy weight,
especially after menopause. ... Still, the link between extra weight and breast cancer is complicated
and affected by other factors.

Avoid a long term hormone theraphy

Estrogen-only HRT increases the risk of breast cancer, but only when used for more than 10 years.
Estrogen-only HRT also can increase the risk of ovariancancer. The higher breast cancer risk from
using HRT is the same for so-called "bioidentical" and "natural" hormones as it is for
synthetic hormones.

Stay physically active

Regular physical activity can help maintain or improve your health during and after
treatment, and can:
 help avoid or reduce some side effects of cancer treatment – such as fatigue, weight gain,
osteoporosis and lymphoedema
 improve your long-term health, reducing the risk of heart attacks and strokes, and may reduce
the risk of the cancer coming back
 help your mental wellbeing by reducing anxiety, stress, depression and improving your
overall mood
 prevent or reduce the loss of muscle tone and aerobic fitness that can happen during
treatment.

Eats food high in fiber

Eating healthily is important for everyone, but when you’ve had breast cancer you may
become even more aware of what you eat and drink. A balanced diet has been shown to
have a range of health benefits.
However, even though we’ve included a lot of information about following a healthy
lifestyle, it’s important to not feel guilty if you don’t stick to it all the time – especially
while you’re coping with the other physical and emotional effects of breast cancer and its
treatment. It’s just about getting the balance right.

Emphasize olive oil

In the five-year trial that randomly assigned women to different kinds of diets, those instructed to eat a
Mediterranean-style diet with four tablespoons of extra virgin olive oil per day had about half as many
breast cancer diagnoses as those on a low-fat diet.

Avoid exposure to pesticide

According to recent research, you can reduce your risk of breast cancer by avoiding certain chemicals
found in common, everyday products. An estimated 90 percent of Americans have flame-retardant
chemicals in their bodies, and many studies have linked them to human health risks, including liver,
kidney, testicular, and breast cancers. Previous studies have shown that all parabens have estrogenic
activity in human breast cancer cells. In one study, 99 percent of cancerous tissue samples were found
to contain parabens.
CASE STUDY

PATIENTS PARTICULAR:
1. Medical Records
2. Name:MRS.Wong Kiou
3. Gender:Female
4. Age:51 years old
5. Ethnic:Chinese
6. Occupation:Officer cleaner and Funeral Services agent
7. Weight:74.2kg Height:162cm

CHIEF COMPLAINT
- Mrs Wong Kiou is 51y/o, Chinese, Female was coming at Emergency Deparment
HTAR with complaint have small lump at Left Breast for 6/12.

HISTORY OF CHIEF COMPLAINT

- Left breast swelling for 6/12
- Pain upon touch and discomfort
- No skin changes
- No discharge
- Nipple retraction (t) since long ago

Otherwise: No vomiting
No tachypnic
No fever
Minimal pain at operation site
Comfortable under room air
Low axillary drain
O/E: Alert, conciouses
BP:120/70
PR:60
RR:20
Temp:37

HISTORY OF PATIENT

Past Medical History

- Hypertension for 7 years on T.atenolol 25mg OD
-Dyslipidemia on T.Simvastatin 40mg OD
- Follow up at KK pandamaran

Past surgical History

- L Breast surgery - lumpectomy in 1995 (claimed non-cancerous)

Past Antenatal Histor

y
- 3x giving birth- all boys/ SVD

Family History

-Mother has Breast Ca

-Sister has Breast Ca

Drug History

- Hypertension - T.atenolol 25mg OD

- Cholestrol- T.simvastatin 40mg OD

Social History

- Married with 3 children

-Non smoking
-Non alcoholic
-Stay in Perlabuhan Klang
Menstrual History

-Last Menstrual Period(LMP): 31/8/2017

-Normal cycle; 5-7 days
-Changes 3-4 pads in 2 days

Occupational History

- Work as Officer cleaner and Funeral Services Agent

Physical Examination

Head to Toe (oral, throat, ear, eye and nasal):

No pain, tenderness, swelling and redness
No any lumps or bump
No discoloration
No bruising or trauma

Neck:
No any lumps or bump
No swelling around thyroid gland
No tenderness
No pain and redness

Chest region;

Heart:
PR ranges from 62-95 beats per minutes which is within the normal limits.
BP also ranges from 100/60 - 130/70 which is normal BP.
Has history of HPT, capillary refill is 2-3 seconds which is normal.
Heart beats murmur normal.

Lungs:
Lungs clears and symmetrical movements/sound.
No swallow breathing.
No shortness of breath.
Respiration rates from 16-22 breaths per minutes.

Abdomen/Thoracix
Left breast Ca
No active bleeding seen at operation sites.
2 radivac drain - size 10 (insite at axillary)
 -size 12 (insite at breast)

Nervous system:
No seizures, loss of consciousness, anesthesia
No paresthesia (numbness and tingling)

Upper and Lower Limbs:

No pain and tenderness at both of arm and legs.
Muscles movement normal.
Able to ambulate byself.

Others:
(inclusive genital and rectum)
Bowel open see normal
3x per day
Past urine also normal.

INVESTIGATION

Blood investigation
Fbc: Hb 11.7, Twbc 11.27, Plt 262, Pcv 37.5, Pt/Ptt 12.4/32.5, Inr 0.96
Rp: Na 139, Urea 4.1, K 4.3, Ci 102, Creat 59.
Lft: Tp 65, A/b 37, Alt 14, Alp 61, Tb 10.8

UFEME: Negative
AXR:fecal loaded,no dilated bowel
CXR AP sitting::no air under diaphragm
PR:Brownish stool,no impacted stool
CT abdomen:Perforated@pylorus
Scan finding:no mass,no free fluid

MANAGEMENT PLAN

1. Ca + Analgesic - T.PCM 1g QID

- C.Celebrex 200mg BD x 3/7
- C.Tramal 50mg QID
2. E orally
3. Drain charting
4. Upper lymp physio
 RAMSAY SIME DARBY HEALTHCARE COLLEGE

DIPLOMA IN MEDICAL ASSISSTANT

SEMESTER 4

INDIVIDUAL ASSIGNMENT

INTAKE: DMA SEPT 2015

SUBJECT CODE:
SUBJECT NAME: SURGICAL

NAME: HASBULLAH ROSLI

ID: SD01-201704-002560

ACADEMIC FACILATOR: Ms. ROSMARINA BT SEKOF