Clinical Case: Breast Cancer
Pathophysiology of Breast Cancer
Breast cancer is an invasive cancer that occurs after a sequence of molecular changes at the cell level. It manifests as a malignant tumour in breast epithelial cells which possess immortal features and undergo uncontrolled growth. Like other cancers, there is no definite cause of breast cancer. However, some of the causes include damage to the DNA and genetic mutations both of which can be inherited. Also, people with a family history of ovarian and breast cancer are likely to develop breast cancer in their life. There exists a wide variety of breast cancer subtypes and molecular alterations classified depending on the presence or absence of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) (Chalasani, 2020). Signs and symptoms of breast cancer include a new lump in breast or underarm, swelling of a section of the breast, dimpling of breast skin, pain in breast, changes in breast shape and size, nipple discharge, redness or flaky skin in any part of the breast, nipple pain or pulling in the nipple regions. The symptoms can either occur individually or as a combination of any of the symptoms.
Diagnosis of Breast Cancer
Breast cancer can be diagnosed in a number of ways including breast exams, mammograms, breast ultrasound and biopsy (Center for Disease Control and Prevention, 2017). In a breast exam, the doctor physical checks for lumps or abnormalities on both breasts and on armpit lymph nodes. Second, the mammogram is a breast x-ray which is essential in screening for abnormalities in the breast. If an initial x-ray indicates an abnormality, the patient can be scheduled for a diagnostic mammogram for further assessment of the abnormality. Third, a breast ultrasound produces images of structures deep within the breasts. For example, it is used to examine whether an identified lump is a solid mass or a fluid-filled cyst. Fourth, a biopsy involves the removal and testing of a sample of breast cells. It is the most conclusive testing method through which doctors can derive important information such as the type of cell involved, the aggressiveness of cancer, and the present receptors which will influence the treatment options. Lastly, the breast magnetic resonance imaging (MRI) offers a non-radiation approach in creating images from the interior of the breast. It uses magnet and radio waves and points out any abnormalities in the breast.
Treatment Modalities
Recommended treatments for breast cancer are surgery, radiation therapy (RT), chemotherapy (CT), endocrine (hormonal) therapy (ET) and targeted therapy. Surgery is mostly applied in localized breast cancer, and especially where mastectomy is necessary. It is preceded by neoadjuvant therapy and followed by adjuvant therapy. Neoadjuvant therapy increases the operability of the breast by shrinking the tumour while adjuvant therapy enhances full recovery and reduces the risk of metastases (Nounou, et al., 2015). As for radiation therapy, the cancerous cells are directly exposed to high levels of radiation shrinking the tumour. It can be used together with chemotherapy as adjuvant therapy after surgery. Chemotherapy is completed by the use of special drugs designed to shrink or kill the cancer cells. The medicine is either oral, intravenous or both. On the other hand, endocrine therapy prevents cancer cells from accessing the hormones they require for growth while targeted therapy boosts the body’s immune system to fight cancer cells and to minimize side effects of other treatments. Adjuvant therapy is selected depending on predicted sensitivity to a treatment method and risk of relapse after treatment and can be used after any of the selected treatments. Adjuvant therapy options include endocrine therapy, chemotherapy, HER2-directed therapy, Cycline-dependent kinases (CDKs) targeting, and Bisphosphonates.
Nursing Practice Implications
A master’s prepared nurse can use the above information on breast cancer to device care patterns and practices that benefit and help the patients. By understanding the treatment processes, for example, the nurse can offer case-specific care depending on the necessary preparations before treatment and identified side-effects after treatment. Also, they can design an education session for patients with breast cancer where they include all necessary information such as the probable causes, the effects on the body and the treatment options. The nurse can also help the patient arrive at their desired treatment option based on the aggressiveness of cancer, predicted reaction to different treatments and individual preferences.
The most important information presented in the case is the diagnosis methods because this is where the largest information gap is. Many people are aware of the treatment options once they have been diagnosed but have no idea how the diagnosis is done and that there are different diagnosis approaches. On the other hand, the information on treatment methods is the most challenging. This is because while the options are many, all of them have their side effects and none of them guarantees full healing. Patients need to undergo adjuvant therapy after treatment and even then, there is a risk of relapsing. Patients also may not be fully convinced of the safety of some procedures such as radiation therapy. Many people are convinced that radiation therapy increases their chances of getting another type of cancer. The nurse should discuss with the patient that radiation is carried out safely by oncologists by targeting only the cancer cells. Although radiation may result in side effects, they are either very few or none where the therapy is carried out precisely.
References
Center for Disease Control and Prevention. (2017). Breast Cancer. Retrieved from CDC: https://www.cdc.gov/cancer/breast/index.htm
Chalasani, P. (2020). What is the pathophysiology of breast cancer? Medscape.
Nounou, M. I., ElAmrawy, F., Ahmed, N., Abdelraouf, K., Goda, S., & Qhattal, H. (2015). Breast Cancer: Conventional Diagnosis and Treatment Modalities and Recent Patents and Technologies. NCBI.