The term cancer is derived from the Latin translation for the Greek word for crab (Huether, McCance, Brashers & Rote, 2017). Breast cancer is a general term for a group of solid tumor malignancies that arise in the tissues of the breast (Crawford & Alder, 2013). Breast cancer can affect the breasts, cells, glands, and lymphatic system. It is the second leading cause of deaths related to cancer in women and the most common invasive cancer among women.
Pathophysiology of the Disease Process
To understand the pathophysiology of breast cancer, one must first understand the pathophysiology of cancer. According to the National Cancer Institute (NCI) of the National Institutes of Health (NIH), cancer is “diseases in which abnormal cells divide without control are able to invade other tissues” (2015). Cancer is a collection of over 100 different diseases that are caused by a specific and unique age-related accumulation of genetic alterations (Huether et al., 2017). Mutation generally means an alteration in the DNA sequence which in turn affects the expression or function of a gene. The genes are found in a cell’s nucleus which can be considered the “control center” of the cell. Typically, healthy new cells take over and the old cells die. Mutations can cause a cell to keep dividing without control which can lead to the formation of a tumor.
Many cancers can form solid tumors that are masses of tissue. Carcinomas, the most common type of cancer, are formed by epithelial cells (NCI, 2015). Epithelial cells are cells that cover the outside and inside surfaces of the body. Adenocarcinoma is cancer that forms in the epithelial cells that produce mucus or fluids, which include cancers of the breast. There are two types of tumors: benign and malignant. Benign tumors are usually encapsulated with connective tissue (NCI, 2015). They do not invade beyond their capsule, spread into nearby tissue, or spread into regional lymph nodes. They can be large and usually do not grow back after they are removed. Benign tumors are named according to the tissues that they come from using the suffix “-oma.” For instance, a benign tumor that is found in fat cells is a lipoma. Some benign tumors can progress and develop into a malignant tumor. A malignant tumor is cancerous and more rapid growth rates. They have can spread into nearby tissues, blood vessels, and lymph nodes. Cancer cells can break off from a malignant tumor, travel to another part of the body and form new tumors. When a malignant tumor is removed, it can possibly grow back. The term breast cancer refers to a malignant tumor that has developed from cells found in the breast (breastcancer.org, 2018). Breast cancer is the uncontrolled growth of breast cells. Sex hormones, such as estrogen and progesterone, control the growth and development of breast tissue beginning at puberty. Breast tissue is made up of functional and fatty tissue. The functional tissue includes the lobes and ducts which are involved in the secretion and production of breastmilk. For many cancers, the presence of the female sex hormones stimulates the sustained growth of the abnormal tissue.
Nonetheless, cancer cells can invade healthy tissue nearby and lymph nodes in the underarm. Lymph nodes can act as a pathway for the cancer cells to spread to other parts of the body. The most common noninvasive breast cancer is called ductal carcinoma in situ (DCIS) (Haelle & Cascetta, 2018). DCIS occurs when cancer develops in the ducts but does not spread outside the ducts. Similarly, lobular carcinoma in situ develops in the lobes and does not spread beyond the lobes. The most common form of invasive breast cancer is known as invasive ductal carcinoma (IDC) (Haelle & Cascetta, 2018). IDC begins in the ducts then spreads to the nearby ducts. The cancer then metastasizes into the lymph nodes then the bloodstream.
Breast cancers are classified using the TNM system which is supervised by the American Joint Committee (AJCC) (breastcancer.org, 2018). The stages were previously determined by whether it was noninvasive or invasive, the size of the tumor, which lymph nodes the cancer spread to, and where the cancer had metastasized. The AJCC updated the breast cancer staging guidelines in 2018. The guidelines now include a tumor grade, estrogen-and-progesterone-receptor status, HER2 status, and an Oncotype DX score. The tumors are graded on a scale of 1 to 3 determined by how abnormal the cells look under a microscope (Haelle & Cascetta, 2018). Grade 1 cells look normal and spread and grow slowly. Grade 2 cells fall between 1 and 3. Grade 3 cells are abnormal and grow the fastest. The estrogen-and-progesterone-receptor status determines if the cancer cells have receptors for the hormones progesterone and estrogen. The HER2 status determines if the cancer cells are making too much HER2 protein. The Oncotype DX score tells if the cancer is HER2 negative, estrogen-receptor positive, and if there is cancer in the lymph nodes. Cancer that has not metastasized outside of the breast is considered local. Regional cancer has only spread to the skin of the breast, structures of the chest, and lymph nodes. Distant cancer is cancer that has spread from the breast to other parts of the body. Breast cancer stages are graded on a scale of zero to four. Stage 0 means that there are abnormal cells that have not spread into the lobes or ducts. Stage 1 is invasive and is spreading past where the cancer originated. Stage 1 is divided into two subcategories. Stage 1A means that the cancer is less than or equal to 2cm and has not spread beyond the breasts or into the lymph nodes. Stage 1B means that there are small clumps of cancer cells that range from 0.2 to 2 mm that have been found in the lymph nodes. If a tumor is present during this stage, it will not be bigger than 2 cm. Stage 2 refers to a tumor that is 2 to 5 cm with 1 to 3 cancerous axillary lymph nodes. Stage 3 breast cancer is broken down into 3 subcategories. Stage 3A means that 4 to 9 lymph nodes that are in the axilla or close to the breastbone are cancerous. Stage 3B means that cancer cells have spread to up to 9 lymph nodes in the axilla or close to the breastbone and to the skin of the breasts. Stage 3C means that 10 or more lymph nodes in the axilla, above and/or below the collarbone are affected. Stage 4 breast cancer means that the cancer has metastasized beyond the lymph nodes and breasts and into other parts of the body. In stage 4, the cancer can spread to the lungs, liver, bones, and brain (Lange, 2015).
All women are at risk for developing breast cancer. It can also occur in men, but it is rare. Age is the biggest risk factor for developing the cancer. Four out of five breast cancers are found in women over the age of fifty (Lange, 2015). Another risk factor that influence the risk include a positive family history. A positive family history means that one has had a mother, sister, or daughter who had breast cancer. Frequent alcohol intake may also increase one’s chances. Interruptions in the levels of estrogen can decrease the risks of developing breast cancer. These interruptions can occur during pregnancy and lactation. Essentially, fewer menstrual periods decrease the risk. A low-fat diet and exercising may also decrease the risk of developing breast cancer. The exact cause of breast cancer is not known but researchers do know that it is not caused by physical injury and it is not contagious.
Evidence-Based Nursing Care
Education is a very important role for nurses. Educating people on their potential risks can aid in the prevention of breast cancer. Raising awareness is the first step in breast care prevention. A nurse should teach women how to conduct routine self-examinations. They should be educated on what is and what is not a normal finding during the exam. Recommending breast screening is also crucial in preventing breast cancer. The American Cancer society recommends that women should receive annual mammograms after the age 45 (Seal, 2017). Educating people about leading a healthy lifestyle and offering ample information about breast cancer are two of the greatest contributions nurses can add to the prevention of breast cancer.
Due to the gravity of breast cancer, it may be very difficult for many people to cope with their diagnosis. The inability to cope with the diagnosis can cause patients to experience anxiety or depression. It is important for nurses to help these patients through their journey. A study was done by researchers at Zhengzhou People’s Hospital in Zhengzhou, China to evaluate the influence of nursing interventions on the mental health of patients diagnosed with breast cancer (Xia Kang, Yu Fang, & Yu Kong, 2017). In this study, 200 patients with breast cancer were randomly divided into two groups to compare the effect of clinical treatment of different nursing care. The participants in the group did not have significant differences in gender, age, educational level, marital status, disease course, or grade of cancer. The first group, group C, received routine nursing interventions such as health propaganda, education and general nursing care. The second group, group I, received the same interventions with the addition of psychological nursing, life and behavior interventions, health education, social intervention and music therapy. The participants were evaluated after one and two months. They were evaluated on their life quality with the European Organization for Research and Treatment of Cancer quality of life questionnaire. The Self-Rating Depression Scale (SDS) was used for the assessment of depression and Self-Rating Anxiety Scale (SAS) was applied to the evaluation of anxiety. Pittsburgh Sleep Quality Index was used to measure the sleep quality the participants received. After the final evaluation, the participants in group I showed the greatest increase in quality of life and quality of sleep. They also showed the lowest levels of depression and anxiety. These findings show that comprehensive nursing care is more effective in improving the overall health status of people diagnosed with breast cancer.
It is imperative for nurses to be culturally sensitive and use educational and interpersonal skills to treat people with breast cancer. Culture is defined as the customary beliefs, social forms, and material traits of racial, religious, or social group (Culture, n.d). Culture plays a huge part in one’s cancer experience. It influences one’s level of trust, priorities, behavior, and perceptions in a healthcare setting (Ott, 2015). Each culture has unique beliefs and customs that should be taken into consideration while providing care. African-Americans may have a fatalistic view of cancer, have a strong reliance on spiritual and religious practices, and generally respect and turn to elders of their community and extended family members for support. Asian-Americans may believe that illness results from bad behavior within the family or because of fate. Members of this culture may practice self-healing holistic approaches such as acupuncture and may believe that medial intervention may interfere with one’s spirit. Latino/Hispanic-Americans often use folk healers, place a high value on extended family members, and prefer action-oriented treatments. Native-American customs vary among tribes. Native Americans commonly believe that illness originates as a disharmony with supernatural causes and approach life with respect for the natural world. While these customs are found frequently within these cultures, it is important to not generalize patients.