Saturday, January 14, 2006

cancer, breast

In American women, the breast is the most common site of cancer. The disease can occur at any age, but it is most common during and after menopause. The longer a women lives the greater her chance of developing breast cancer. However, if it is discovered and treated early, the five-year level of cure for small lesions is about 80 percent.
In order to discover carcinoma of the breast early, it is necessary that a woman examine her breasts on a regular, monthly basis, reporting any unusual signs or lumps immediately to her physician. A lump may be a cyst, a benign tumor, or a malignancy. Characteristically, malignant lumps are painless in their early stages. Other symptoms of breast cancer are nipple discharge, pain, and a change in the appearance of the breast.
A mammogram, a soft tissue X-ray examination, is an excellent diagnostic tool. On these films, it is possible for the radiologist and the surgeon to distinguish with considerable accuracy a benign lump from a malignant one and to discover lesions too small to feel. Each woman over the age of 40 should have a mammogram annually. When a malignancy is suspected a biopsy is usually taken to confirm the diagnosis. If the results are positive, a lumpectomy or some type of mastectomy is performed. There is continuing medical debate and controversy about which surgical procedure offers the most favorable prognosis. The various procedures are: lumpectomy-removal of the tumor only; partial mastectomy-the tumor and small amount of breast tissue are removed; simple mastectomy-the breast is removed; subcutaneous mastectomy-all breast tissue is removed but the skin and nipple are left intact; modified radical mastectomy- the breast and axillary lymph nodes are removed; and radical mastectomy-the breast, axillary lymph nodes, and pectoral muscles are removed. Frequently, surgery will be followed by radiation therapy or chemotherapy.
Exercises are an important part of a patient's postoperative care, enabling her to again become independent and self-sufficient. When the wound is sufficiently healed a prosthesis may be fitted. Reconstruction is also a possibility depending upon the extent of the cancer and preference of the patient. Unfortunately, metastases of breast cancer occurs in many patients. Lymph nodes are most commonly affected followed by bone and pulmonary involvement, though many organs can be affected. The methods of treatment for metastatic cancer include hormonal therapy, radiation therapy, and chemotherapy. All forms of treatment carry the possibility of unpleasant side effects and complications. At present, metastatic carcinoma of the breast is incurable. The goal of treatment is to prolong the patient's life and make her more comfortable.
Breast amputation is a devastating experience, irrevocably altering a woman's body and her self-image. The emotional comfort of the postmastectomy patient is as great a necessity as her physical comfort. Often she feels isolated with no one to help her face her worries about social acceptance and her concerns about death. The patient needs a great deal of support from members of her health-care team as well as her family and friends. Volunteer agencies can be contacted through the American Cancer Society to help patients, spouses, and other family members through this traumatic experience.
Rossman, I. Clinical Geriatrics, 3rd ed. Philadelphia: J. B. Lippincott Co., 1986.
Scherer, J. C. Introductory Medical-Surgical Nursing, 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.

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