PATHOPHYSIOLOGY

Predisposing Factors Precipitating Factors

Genetics
and Family Gender Nulliparity Contraceptive Alcohol
History use consumption

Inherits a Ovaries Decrease in Exogenous Ethanol in the

BRCA1 or produce and progesterone estrogen body is broken
BRCA2 gene secrete level intake in the down by liver
mutation estrogen in form of oral enzyme alcohol
from 1st breast contraceptive dehydrogenase
Increase
degree development pill (estrogen- (ADH)
number of
relative based)
estrogen
Immature receptors Ethanol
and highly Addition of transforms into
active exogenous a toxic
Increase estrogen in
breast cells compound
target organs endogenous
present called
response to estrogen that acetaldehyde
estrogen is already (CH3CHO)
Highly present in the
responsive system
Estrogen
to estrogen Acetaldehyde
binds to
binds to
estrogen Increase in proteins and
receptors estrogen DNA
concentration
levels
Prolonged
Downregulating
estrogen
the tumor
exposure
suppressor
gene BRCA1
Stimulates
proliferation
Increase activity
of mammary
of estrogen
or breast cells
receptor

Increase in target
cell number within
the breast tissue

Increase in cell
division and DNA
synthesis
 Increased cell
regeneration

Increase in breast
cell replication
errors

DNA damage

Failure of DNA repair

Genetic mutation of the cellular DNA

(BRCA1, BRCA2 genes) on chromosome 17

Activation Inactivation Alteration in

of growth- of tumor genes that
promoting suppressor regulate
oncogenes genes apoptosis

Unregulated proliferation of cancer Decreased

cells in the milk duct apoptosis

Tumor
growth
Some cells are
Activation of abnormal in
immunologic B lymphocytes produce size and shape
mechanism autoantibodies and
tumor growth factors
Moderately
Release of B- differentiated
lymphocytes, T- Clonal expansion
breast cancer
lymphocytes, & cells
Natural Killer Cells

Immunity Angiogenesis
Inhibit tumor escape
development

Death of some Tumor progression

cancer cells
 Breast Malignant tumor grows rapidly
asymmetry

Cancer cell infiltrated

Rupture of milk
beyond the basement
duct
membrane of breast
ducts
Transient
Present in surrounding vasoconstriction
tissues including
lobules and some
lymph vessels Inflammatory
response

Invasion of cancer
cells in skin dermal Release of chemical
lymphatics mediators: Bradykinins
& Prostaglandins

Obstructed lymph Increased blood

channels in breast Vasodilation flow to the Erythema
skin covering affected area

Increase
Mammary duct Vascular
obstuction permeability

Plasma fluid
leaks into the Swelling
tissue

Compression
of nerve Pain
endings
 MODERATELY DIFFERENTIATED
INFILTRATING DUCTAL
CARCINOMA
Nursing Interventions

1. Administer analgesics as
prescribed.
2. Advise to relax on bed.
Pain 3. Encourage to have adequate
periods of rest and sleep.

1. Elevate arm on pillow to make

the hand or elbow higher than
shoulder.
2. Apply warm, moist compresses
Swelling & redness to the swelling breast every few
hours or take a warm shower.
3. Avoid high-sodium (salt) foods
and liquids.
4. Administer non-steroidal, anti-
inflammatory medication, as
ordered.

Diagnostic Procedures and Imaging Studies Rationale Results

The process of using low- Category 6; mostly fatty

Mammogram energy X-rays to examine
the human breast for
diagnosis and screening.
Used for early detection of
breast cancer, typically
through detection of
characteristic masses or
microcalcifications.

Core Needle Biopsy A diagnostic procedure B5; Positive Margin-

which removes a piece of
tissue from lesion or mass. spreading to lymph nodes.
This is used to have a more
definitive diagnosis of the
breast cancer type.

An imaging test used to Cells not in normal shape.

Magnetic Resonance Imaging Grows and divides rapidly. Mass
better examine an
abnormality found on present in the duct of the right
breast invading neighboring
mammography if they can’t
lymph nodes.
find it with other tests or if 6 cm infiltrating ductal + 10
results are unclear. nodes
 Tumor markers are CA 15-3 --- 38 U/ml (High)
Tumor Marker Test substances found in the
blood, tissues or fluids CA 27-29 --- 45 U/ml (High)
removed from the body. CEA --- 3.5 ng/ml (High)
They use the levels of
cancer antigen 15-3 (CA15-
30), cancer antigen (CA 27-
29), and carcinoembryonic
antigen (CEA) to check
response to treatment.

IF TREATED IF NOT TREATED

Medical Management Nursing Management

Medication Surgery Independent Dependent

Parenteral: Modified radical 1. Monitor 1. Administer

1. Methotrexate 40 mastectomy – patient’s vital analgesics,
mg/m2; days 1 and 8
every 4 weeks in procedure in signs. antibiotic, and
combination with which the entire 2. Slightly elevate antineoplastic
cyclophosphamide breast is removed affected arm of medications as
and fluorouracil for 6- including the skin, the patient. ordered by the
12 cycles areola, nipple, and 4. All IV access physician.
2. Fluorouracil 500 or
600 mg/m2 on days 1 most axillary sites or 2. Change wound
and 8 q28Days for 6 lymph nodes. venipuncture dressing as
cycles Thus, removing must be managed ordered by
3. Cyclophosphamide the tumor in the in non-operative physician.
600 mg/m2
breast. side.
4. Goserilin 3.6 mg
implant SC q28days 5. Monitor wound
5. paclitaxel for inflammation,
175mg/m2 IV over 3 tenderness,
hr every 3 wk for 4 swelling, or
courses 1 purulent drainage.
7. Put the patient
Per Orem:
5. Tamoxifen 20 mg on bed rest, rails
qday for 5 years up, and call light
6. Lapatinib 1250 mg of reach in case of
qDay on days 1-21 emergency.
continuously in
combination with
capecitabine
7. Everolimus 10 mg
qDay
8. Capecitabine 1250
mg/m2 BID for 2
weeks q3weeks
 Tumor removed
successfully

Recovery from
treatment pain

Monitored vital signs

are stable

GOOD PROGNOSIS

Increase pressure in surrounding tissues

Cancer cells leak in surrounding tissue, lobules, and lymph nodes

Fluid from areas Malignant neoplasm

surrounding the
lymph nodes drain
into the lymph Permeable to enter
nodes itself blood vessels

Adhere to a nearby Blood vessels

lymph node cannot contain
increasing number
of cancer cells
Cancer cells break
away
Travel across blood
circulation
Cancer cells travel (hematogenous
through the spread)
lymphatic system
(lymphatic spread)
Systemic circulation
of cancer cells

Lodge/adhere to
other tissues
 Another tumor
formation

Metastasis

Bone pain Stage IV or advance

in areas: breast cancer Liver:
hips, Jaundice,
spine, fever,
pelvis, Continuous spread edema,
arms, of cancer cells all swelling,
shoulders, over the system extreme
legs, ribs, weight
skull loss
Most often bones,
lungs, liver, and
Lungs: brain Brain:
shortness balance
of breath, issues,
difficulty visual
breathing, change,
Metastasis tends Prolonged
chronic headache,
to block or antigen
cough dizziness,
squeeze organs stimulation
weakness

Disrupt normal Progressive loss

organ system of effector
function function

Organ system T-cell exhaustion

deterioration

Immune system
Organ system is weak enough
failure to fight cancer
cells

Immune system
shutdown

DEATH