BREAST CANCERKarina Sanchez San Joaquin Valley College Abstract “According to the National Cancer Institute
BREAST CANCERKarina Sanchez
San Joaquin Valley College
“According to the National Cancer Institute, one in eight women who live to be age 80 will develop breast cancer in her lifetime. This makes the disease the second most commonly diagnosed cancer among American women, after skin cancer” ((n.d. Cancer Treatment Centers of America. (2018)). There are different types of mastectomies performed now a days to help treat breast cancer so that the cancer doesn’t keep spreading. A form of prevention for breast mastectomies is early self-breast exams and mammography’s so that if women have cancer, it doesn’t spread to other areas of the body. Cells in the breast become abnormal and uncontrollably multiply till they form a tumor. The malignant cells then spread to the rest of the body by metastasis. “The amount of tissue excised is determined by the extent, type and size of the malignancy and the elected procedure” (Goldman, Maxine A. (2008)). Breast cancer not only affects women, but it also affects men as well.
BREAST CANCERBreast cancer is a scary diagnosis for anyone to hear that they have. When they hear this, people are most likely in denial in the beginning because they don’t want to think about dying. In breast cancer, the abnormal cells will grow faster by dividing themselves and they will form a lump or a mass. The doctor may order a biopsy of the lump or mass to see if it’s cancer or not that the patient has. Once in the breast, cancer cells can spread to the lymph nodes, and finally to other parts of the body through the lymphatic system. Luckily, now a days, there are different treatments to help get rid of breast cancer. If detected early on, doctors will advise patients to do radiation or chemotherapy to help get rid of the cancer. The cancer is staged depending how much it has spread. Non-invasive cancer will be stage 0. Stage I and stage II happens when there is breast cancer, but the cancer hasn’t affected the lymph nodes. When the person has stage III already, they have a 50% chance of surviving at least five years. Stage IV is the final stage and that is when the patient has cancer that has spread to the lymph nodes and other organs in the body. The patient is less likely to live long at this stage. When these options don’t work, the doctor will recommend the patient to go through surgery. There are different types of surgeries the patient can undergo, but depending how much the cancer has spread, the doctor will do what is best for the patient.
“Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer” ((n.d.). Breast Cancer. (1998-2018)). Breast cancer can also be inherited, for example, when there is a history of breast cancer in the family, it is more likely for family members to get breast cancer. This happens when there is a mutation in the genes. When a person has had history of breast cancer, it is more likely to recur. Being a woman is also a risk factor with breast cancer because they are more likely to get breast cancer more than men. Also, increased age will increase the chances of getting breast cancer. Exposure to radiation can also increase the risk of breast cancer. Obesity also increases your risk of breast cancer. Another risk for breast cancer is girls starting their period at a younger age, or also when they start their menopause at an older age. Women who have their first child at an older age are also more likely to develop breast cancer. Likewise, women who have not conceived a child are at a higher risk for developing breast cancer than women who have had children already. The women who have hormone therapy treatment after they have menopause can also increase the development of breast cancer. Lastly, drinking alcohol is another risk factor for developing breast cancer.
Signs and Symptoms
“The first clinical sign for approximately 80% of women with breast cancer is a mass (lump) located in the breast” (Gulli, Laith Farid, MD, Mallory, Nicole, MS, PA-C. (2018)). People may see a change in the size of their breasts or their appearance. They may have dimpling as well in the skin of the breast. The nipples may invert also as a sign that there may be cancer in the breast. Skin around the nipples may be flaky, crusty or peeling as a sign as well. People may experience redness in the skin of their breasts.
Purpose and Expected Outcome Procedure
One of the types of mastectomies that may be performed will be a lumpectomy, where the surgeon will surgically remove a breast tumor with margins to see if the margins are clear of cancer, if not, they will excise more tissue until margins are clear. Another type of mastectomy is subcutaneous mastectomy. This procedure consists of removing all the breast tissue but leaving the skin and nipple intact. There is also another procedure called simple mastectomy, where the surgeon will remove the entire breast. Lastly, there is a procedure called modified radical mastectomy, where the surgeon will remove the whole breast with axillary lymph nodes. When this last procedure is done, the surgeon may use a skin graft to close the wound. This procedure is also the most common done procedure. This type of procedure leaved the pectoralis major muscle intact so that it provides a soft tissue cover in the chest wall. It allows for breast reconstruction if the patient decides to do that. The purpose of these different types of mastectomies is to get rid of the cancer the patient has in the breast. The expected outcome for the patients is to recover and be able to live their normal lives. Also, the surgeon tries their best to remove all the cancer so that the cancer is less likely to come back. They try to avoid loss of function, or any damage or injury to nerves. Vital structures are carefully protected so that if the patient wants, they can get breast reconstruction. The patient demonstrates that she understands the invasive procedure. They are expecting the patient to be free from signs and symptoms of infection as well.
My patient I chose to talk about who I saw that got one of these surgeries done was a 38-year-old woman. She is obese. This woman complained of a lump in the left axillary area. She got an ultrasound of the left breast done. The doctor was suspicious that it was breast cancer, so she then got a needle biopsy done on a lump. She had a 7mm lobulated nodule anterior of the breast, and they placed a clip there. In the ultrasound they could also see multiple solid looking hypoechoic nodules in the left breast which were also biopsied. The doctor did a breast exam and noticed an enlarged lymph node in the left axilla. With this test, they saw that she had infiltrating moderately differentiated ductal carcinoma that was staged II/III and axillary metastasis. The patient has no previous history of breast disease. Her grandmother had breast cancer. Both her parents had diabetes and hypertension. Her grandfather had a heart attack and stroke. Her father also had a heart attack. She has no hormone therapy either. The patient has diabetes, hypertension, anxiety and depression. The patient takes Xanax, Abilify, Paxil, and Norco. This patient has also had two cesarean sections and had a remote tubal ligation and tummy tuck. She has no known allergies. Patient says she quit smoking three days ago and denies using illicit drugs or drinking alcohol. The doctor talked to the patient about the plan he had for the procedure to get rid of her cancer. He discussed the risks of the procedure and well with the patient. The patient gave an informed consent for a left mastectomy and axillary dissection.
Preoperative Diagnosis/ Exams/ Testing
The preoperative diagnosis the doctor came up with for the patient was infiltrating ductal carcinoma of the left breast. The exams they took to come up with this diagnosis was a breast exam, an ultrasound, and an ultrasound guided biopsy. They also took blood work. The white blood cell count came out high. The body is trying to fight the cancer, while cancer cells are multiplying. The red blood cell count was a little lower. The neutrophil percent was high. The lymphocyte percent was low. The neutrophil absolute was high. The monocyte absolute was low. the sodium level was a little low. the chloride level was a little low. The glucose level was high. The BUN/creatine ratio was low. The osmolarity level was low and the calcium level was low as well. These values are affected because of the cancer. They also did a toxicology report and she was positive on benzodiazepines, cannabinoids, and opiates. My patient also got a pregnancy test done that came out negative. Her glucose was high because she is diabetic. Her toxicology report was positive on certain drugs because of the medications she takes as well.
During the procedure, the surgeon went through different anatomy so that he could get rid of the cancer of the patient. The surgeon went through the epidermis, dermis, and subcutaneous tissue first. Then the surgeon dissected through the mammary glands. He was also cutting though little blood vessels that are in the breast, so he had to cauterize it with the bovie, so it could stop bleeding. During this process, the surgeon also cuts through the lobules, ducts, and terminal ducts. Then the surgeon cut through the axillary lymph nodes, leaving the muscles and chest wall intact. The lobules inside the breast produce milk. The milk comes out through the nipples. Cancers normally arise from the cells that form the lobules and the terminal ducts. The lymphatic nodes, lymphatic vessels and arteries supply the breast with nutrients throughout the body. The pathophysiology of what went wrong with the anatomy was that there were cancer cells that arised in the breast and made a lump. It then spread to the lymph nodes that supply blood to the body.
The circulator put on sleeve sequential compression sleeve and pump, so it can help circulate the blood. Sponge laps were used to help stop and clean away blood. Normal saline was used in the procedure for cleaning the surgical site. The doctor used a skin stapler to staple the wound at the end. A suction yankauer bulb tip was used to suction blood. A control syringe was used to inject local in the breast where the incision was going to be made. A marking pen was also used to mark the areas where the surgeon was going to cut and where he was going to approximate the edges with suture when starting to close skin. The surgeon used Monocryl suture. Ligasure was used in the procedure to close up the little blood vessels that would bleed in the breast. Blue sterile towels were used to drape around the breast. Fluffs were used as dressing on the incision site. The circulator placed a grounding pad on the patient’s thigh because the bovie was going to be used. Two Jackson Pratt drains were used to collect the body fluids after the surgery. A sponge drain was used around the JP drain. A smoke evacuator was also used during the procedure so that we didn’t have to breathe the smoke plume of the bovie or electrosurgical unit.
Operative Preparation/ Anesthesia and Positioning
Skin Prep and Draping
Immediate Postoperative Care
Long Term Prognosis
There are several ways of preventing breast cancer so that people don’t have to go through with surgery. One of the ways for prevention is regular breast screenings like breast exams and mammograms. Women need to do a self-exam to get familiar with their breasts to know when they feel different like when they feel a lump, so they go to the doctor right away to get checked. Limiting alcohol intake is another way of preventing breast cancer. Exercising regularly at least thirty minutes a day will also help prevent breast cancer. This also goes hand in hand with maintaining a healthy weight and eating a healthier diet daily so that the chance of getting breast cancer is lower. Limiting hormone therapy treatment after menopause will also reduce the risk of developing breast cancer. Woman that are at a higher risk of developing breast cancer because of their family history can take preventative medications, though they do carry the risk of side effects like any other medications. Lastly, women that are at higher risk of breast cancer, may also opt for surgery of breast removal of their healthy breasts as a way of preventing breast cancer.
Goldman, Maxine A. (2008). Pocket Guide to the Operating Room (3rd ed.). F.A. Davis Company.
Gulli, Laith Farid, MD, Mallory, Nicole, MS, PA-C. (2018). Modified Radical Mastectomy. Retrieved from https://www.surgeryencyclopedia.com/La-Pa/Modified-Radical-Mastectomy.html#ixzz5XnsIKcROSelma Adventist Health Hospital. (2018) BIBLIOGRAPHY
(n.d.). Breast Cancer. (1998-2018). Mayo Foundation for Medical Education and Research (MFMER). Retrieved from https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470
(n.d.). Cancer Treatment Centers of America. (2018). Breast Cancer Information. Retrieved from https://www.cancercenter.com/breast-cancer/learning/?invsrc=non_branded_paid_
(n.d). Overview of the Breast. (2018). Johns Hopkins University. Retrieved from https://pathology.jhu.edu/breast/basics/overview