Introduction
In the recent past, cancer has been considered a menace; it is the cause of high mortality rates. Following a 2020 study, 1 806,590 current cancer patients and 606, 520 mortality of cancer were predicted in the United States (Siegel et al. 2020). There are different types of cancer, and the persistent type is breast cancer. It is most prevalent in women and less in men. Globally, approximately 1.5 million women, which is 25% of all females with cancer, are recognized to have breast tumors annually (Sun et al., 2017). The majority of patients present with late-stage and locally advanced diseases resulting in high mortality rates. Diagnosis and medication of breast cancer depend on various factors. It is, therefore, important for both medical practitioners and patients to understand these factors.
Pathophysiology of Disease Process
Breast cancer is the formation of abnormal cells in the breast. It is a cancerous tumor that begins in the breast cells and might spread to other parts of the body depending on the type. The growth and spread of the malignant cells are uninhibited in the body and rapidly spreading. The pathophysiology of breast cancer varies between individuals.
The categories of breast cancer include inflammatory breast cancer, metastatic breast cancer, Paget’s disease of the nipple, invasive lobular carcinoma, ductal carcinoma, locally advanced breast cancer, and phyllodes tumors of the breast. Depending on an individual, the risk factors vary such as genetic, irregular menstrual cycles, obesity, radiation exposure, and oral contraceptives. The case study aims at an individual diagnosed with breast cancer and will discuss her history, assessment, diagnosis, and care management.
Metastatic Breast Cancer
The cancerous cells in this type spread to other body parts beyond the breast, such as the liver and bones. About 12% of patients diagnosed with breast cancer eventually develop metastatic disease (Peart, 2017). These cells move to other body parts through the vast network of nodes and vessels such as the bloodstreams and lymphatic system. The bloodstream and lymphatic system omit bacteria, viruses, and cellular waste products in the body. This type of tumor occurs with early stage of breast cancer diagnosis or later when it reoccurs after the original diagnosis and treatment. Only a few women can be diagnosed at an early stage before it spreads to other body parts.
The tumor formed in the other body parts constitutes the cancer cells and not the cells of that body part; it is a metastatic tumor. The treatment of metastatic breast cancer varies among individuals and the stage, for instance, the medication can be controlled through chemotherapy and radiotherapy. However, there is no specific medicine to cure it fully hence the 5-year survival rate is 26% (Peart, 2017). The signs and symptoms of these types vary depending on the body part that it has spread to. The most common signs and symptoms are include pain, weight loss, discomfort, and retraction.
Inflammatory Breast Cancer
It is the hardest to diagnose and scarce type of breast cancer. The risk factors are young women and obesity. It is quick in spreading and often diagnosed when it is at stage 3 of cancer. Since the diagnosis is at the last stages, treatment might be unyielding. The signs and symptoms are; retraction, breast swelling, swollen lymph node above the collar bone, pain in the breast, redness in the breast, and itchy breast.
Ductal Carcinoma
Ductal carcinoma is a regular category of breast cancer among women. It comprises four subtypes; Medullary Ductal Carcinoma, Papillary Carcinoma, Mucinous Ductal Carcinoma, and Tubular Ductal Carcinoma. Occurrences of these subtypes are very scarce types of breast cancer among women. The signs and symptoms of invasive ductal carcinoma are; creation of a lump in the breast, retraction, swollen breast, breast pain, nipple pain and discharge, breast redness, and bump in the armpit.
Invasive Lobular Carcinoma
It starts in the breast lobules through mutation of the DNA, and generally, the occurrence in women is low. The risk factors include inherited genetic cancer syndromes, older age, and postmenopausal hormone use. The signs and symptoms concerning lobular carcinoma are; breast swelling, breast thickening, and inverted breasts. The diagnosis of invasive lobular happens when the cancer cells are at the breast lobules; the spread of the cancer cells is slow. The recommended treatment is hormonal therapy since the growth of the cancer cells is slow.
Paget’s Disease of the Nipple
Paget’s disease affects both men and women, but the occurrence is rare. It begins in the nipple and can continue to the areola. The signs and symptoms are; itchiness, burning sensation around the affected area, skin flaking at the nipple, bloody discharge from the nipple, and redness. The risk factors are; prior diagnosis of breast cancer, old age, overweight, excessive drinking of alcohol, and genetic inheritance. The recommended treatment for Paget’s disease of the nipple is breast surgery by removing the affected breast and radiotherapy afterward. Depending on the extent of the spread, other parts such as the arm can be tested for Paget’s disease of the nipple.
Phyllodes Tumors of the Breast
It can be cancerous, non-cancerous, or occurs at the borderline. The diagnosis is through a microscope to prevent the wrong diagnosis. It rarely occurs, and its tumors are quick in growth. They begin at the stromal tissues of the breast of women. The most common symptom is the formation of a breast lump. The doctors mostly recommend surgery and either chemotherapy or radiotherapy after the surgery. The surgery aims at removing the affected breast and prevents reoccurring. Radiotherapy and chemotherapy help in preventing the further spread of the cancerous cells in the body.
Locally Advanced Breast Cancer
It is the extreme stage of breast cancer diagnosis. The signs and symptoms are; lump formation in the breast, nipple discharge, retraction, pain in the breast, redness of the nipple, breast swelling, and skin irritation. Since it is the most advanced stage of cancer, the recommended treatment is through surgery, radiotherapy, and chemotherapy. It requires advanced treatment strategies to prevent adverse effects such as death.
History and Physical
Charity is a 45 years old woman diagnosed with metastatic cancer. She has two children and lives at home with her family. The medical history is hypertension and a preceding history of excessive alcohol drinking.
Assessment
Upon breastfeeding her last born son, 22 years ago, Charity notices a lump on her breast. The lump was still growing, and years later, it had rapidly grown. Late last week, she developed some coughs and visited the hospital. She was diagnosed with pneumonia and started her medication for pneumonia. She noticed that the lump was still growing, and it is more visible than before. Charity went back to the hospital, and the test was done.
The results were out days later, but the cancer cells had not been detected. She also noticed that her breast had swollen; itchy nipples, pain, and her nipples were retracting. The doctor recommended a mammogram screening to determine the chances of breast cancer. Her hypertension was managed, and she was not on daily medications. She developed hypertension when she was 30 years old.
The important signs detected for charity was; retracted nipples, itchy breasts, swollen breasts, pain, and a lump. All these signs are evidence of cancer, but a mammogram was needed to ascertain. Before the mammogram, the doctor had done a physical examination test of her breasts. Physical examination was done to identify the changes in the breast, nipple retraction, and swollen breasts besides the formation of the lump in the breast. It was the first stage to determine the next assessment and prediction as well.
Diagnostics
After the physical examination and mammogram, the results were out. Charity was confirmed to have breast cancer stage 2 although the type of tumor was undetected. She was advised to carry on with breast cancer medications. The doctor advised her to take surgery since the stage is not her advanced or beginning chemotherapy. Both of these medications required admission to the hospital. She was left to decide which of the medications she will take. More lab tests were done to identify the level of spread of the disease in her body. Initial-stage cancer disclosure could moderate breast cancer mortalities persistently (Wang, 2017).
Additionally, lab tests were done to determine other diseases that might be present in her body. The progress of the cancer stage was critically assessed to determine if there is a rapid spread of the cancer cells in her body. Moreover, her stage 2 breast cancer greatly aided in the doctor’s decision in carrying out the right medication. Charity occasionally had computerized tomography (CT) scan and ultrasound.
Medical Management
Upon knowing the stage of breast cancer, medication was easy. Charity decided on taking chemotherapy instead of surgery. However, the doctors preferred surgery because it was at an early stage hence easily manageable. They believed the surgery would help cure the disease and prevent any reoccurrence and its quick medication. Chemotherapy is done in circles and can take time; besides, it is expensive. Charity was afraid of surgery since there were myths of it as a cancer treatment method. She was sensitized to chemotherapy and given daily medication. Since she had a previous history of excessive alcohol drinking, she was advised not to embark since it will affect her chemotherapy treatment.
Alcohol is known to dilute all the chemotherapy and is also a risk factor for cancer. In charity’s case, it was recognized that she had a genetic inheritance since there was a history of cancer in her family. Although it was not a conclusive result, it was recognized among the causes. The surgery aimed to remove the lump and a breast section since the lump was only on her left breast. With the surgery, Charity would undergo Systemic Treatment. In this case, chemotherapy was to be administered after surgery. Chemotherapy is done to prevent further multiplication of the cancer cells in the body. Immediate medication of her diagnosis was vital to prevent the advancing of the disease.
Chemotherapy
Charity began her chemotherapy treatment a week later after her diagnosis. She was on and off at the hospital for the chemotherapy. The treatment was done monthly and not weekly; however, she had daily medication. Her hypertension disease was also managed. After she finished her first cycle, Charity went back home to stage with her family and unfortunately resumed drinking. She was in denial of being diagnosed with breast cancer and opted for alcohol.
Although she was aware of the impact, she decided on it. Her limps got weak, and she was not stable to stand and walk alone. She decided on using a stool for support and walking rather than going back to the hospital. Upon discussing with her, she said she felt her limbs growing weak every day. One day when she was drunk, she missed getting her support and fell to the ground. She was then unable to walk again and was forced to be carried. Her husband called for an ambulance, and she was taken back to the hospital.
In the hospital, her medical history was made, and it was confirmed that she had earlier been diagnosed with stage 2 breast cancer. An x-ray was done, and the results showed that her pelvic bone had broken and needed to be connected.
After the surgery, a biopsy was done to determine the impact of chemotherapy and the stage of the disease. Several lab tests were also carried out and the results showed that her hypertension level was high, and she had developed diabetes; the breast cancer stage had also advanced. It was at this time that she was diagnosed with metastatic breast cancer. The lump in her breast had overgrown and became a wound, therefore, making surgery less applicable. She was advised to take the second circle of chemotherapy but under strict conditions. The chemotherapy was meant to prevent further spread. Also, with the biopsy, it was detected that the cancer cells had spread to her bones. Her limps were weak because the cancer cells had already invaded.
The second circle of chemotherapy had adverse side effects. Immediately after taking chemotherapy, Charity got weak, and her appetite was low. She had diarrhea, and her hair often fell off, in addition to vomiting. The doctor confirmed these side effects as normal and that it varies with individuals. Charity kept on going for the chemotherapy twice per week this time. However, it was expensive, and her medical insurance was used to settle the huge medical bills.
Medical Management Recommendations
Cancer patients need thorough canceling before undergoing the treatment. For instance, in Charity’s case, she was depressed and stressed sorting for alcohol. The doctors should also be able to find the most suitable medication for a patient. Considering the types of cancer treatment, they should advance it and ensure it works for every individual. Also, there should be follow-ups of patients when they take cancer medications. The doctors should aim to have a strong relationship with their patients. Over the years, cancer is considered to be incurable; therefore, more research needs to be done, especially for advanced cancer stages.
Nursing Management
Upon admission in hospitals, the nurse has to take care of the patients. The nurse and breast cancer patient’s relationship should be strong. The nurses perform in the management, responsibility of a patient also responsible for prioritizing the patient’s quality of life. During chemotherapy, they administer the drugs to the patients; therefore, they should be canceling patients on the side effects after being administered. Breast cancer patients may display psychological reactions among psychological distress, depression, and anxiety that range up to 77%, 26%, and 17%, respectively, including higher sickness truancy (Mertz, 2017).
The nurse can greatly help reduce these effects by being close to the patients. According to (Mertz, 2017), proficient nurses are known to be suitable navigators due to the skills they possess. Nurses perform the most significant role in managing patient care. They can help the patient cancers cope with the disease. In charity’s case, despite having adverse side effects after chemotherapy, the nurses helped her navigate through. She made friends with the nurses, and her cancer journey was fewer burdens and even had a positive attitude on improving her health.
Plan of Care and Interventions
Cancer patients require great care and interventions to manage the disease. Once diagnosed, most patients feel like it is a death sentence since it has no curable medications. They require immense care within their environment to build a positive attitude and acceptance. Nurses are responsible for caring for breast cancer patients; they can often get asses, support the chemotherapies and radiation, ease pain and, provide any relevant support such as emotional support. They are obliged to make the patients feel comfortable and positive about their health status. Also, they can help patients in reducing the anxiety and fear when taking the radiations and chemotherapies. Considering patient preferences in the older patient with cancer is vital because a disease-centered approach can disregard other complications (Shahrokni, 2017). Apparently, breast cancer patients deserve quality plan care to encourage them emotionally.
Interventions can be done to help in improving the care of breast cancer patients. People should be aware of the cancer screening methods and consequences. Additionally, cancer treatment can be made affordable to expand treatment to more people. Sensitization and education on the importance of screening for everybody are critical to managing breast cancer treatment. Early diagnosis of the disease will help in treatment strategies. Charity managed her breast cancer journey because of the quality care she received and interventions from the hospital.
Discussion
Apparently, Charity’s breast cancer cells traveled rapidly in her body. Since it was metastatic breast cancer, it moved to the liver. She frequently vomited, and upon seeking treatment, tests were done, and it was recognized that the disease was on other parts. He continued with more circles of chemotherapy and was positive about her health because of her environment and the interactions she had. Her family and the nurses, in addition to the doctors, have her full support. The disease advanced to stage 4 after some time, and the other diseases immensely developed. However, the doctors were able to manage it in the ways they could to ensure she is stable.
Conclusion
The case study has been vital in providing knowledge concerning breast cancer. It helps one understand the diagnosis, treatment, and management of the disease. In addition, the interaction with Charity provides knowledge of patient care and managing all stages of cancer. The case study is therefore aimed at expanding other people’s knowledge as well. Breast cancer is curable if diagnosed at early stages; therefore, people should normalize doing the screening occasionally.
References
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