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... important consideration is the stage of the disease. The stage is based on the size of the tumor and whether the cancer has spread. The following is a brief description of the stages of breast cancer and the treatments often used at each stage according to (Dollinger, Rosenbaum and Cable, 1991): Stage 0 is sometimes called noninvasive carcinoma or carcinoma in situ. Lobular carcinoma in situ, or LCIS, refers to abnormal cells in the lining of the lobule These abnormal cells seldom become invasive cancer.
They mean there is an increased risk for developing breast cancer. The risk is increased for both breasts. Some women with LCIS may choose to take a medication called tamoxifen in an attempt to prevent cancer or may do nothing at all and have regular check ups. Ductal carcinoma in situ is called intra ductal carcinoma or DCIS. This refers to the cancer cells in an area of abnormal tissue in the lining of a duct that have not invaded the surrounding breast tissue. If DCIS lesions are left untreated, over time cancer cells may break through the duct and spread to nearby tissue.
Patient with DCIS may have a mastectomy or breast sparing surgery followed by radiation therapy. Underarm lymph nodes are not usually removed. Stage I, the cancer cells have not spread beyond the breast and the tumor is no more than an inch across. Stage II, the tumor in the breast is less than one inch across and the cancer has spread to the lymph nodes under the arms, the tumor is between 1 and 2 inches with or without spread to the lymph nodes under the arms or the tumor is larger than 2 inches but has not spread to the lymph nodes under the arm.
Stage III is called locally advanced cancer. The tumor is large, more than 2 inches across and the cancer is extensive in the underarm lymph nodes or it has spread to other lymph nodes or issues near the breast. Inflammatory breast cancer is this type. Usually local and systemic treatment are given to stop the disease from spreading.
Stage IV is metastatic cancer. The cancer has spread from the breast to other parts of the body. Chemotherapy and / or hormonal therapy is given to destroy the cancer cells and control the disease. Recurrent cancer means it has come back in spite of the initial treatment. Even when a tumor seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained in the area after treatment or the disease had already spread before treatment. Most recurrences appear within the first 2 to 3 years after treatment, but breast cancer can recur many years later.
Side effects of treatment The side effects are different for each person or even one treatment to the next. It is hard to limit the effects so that only the cancer cells are removed. Healthy cells and tissues are both damaged and the treatment can cause many side effects. The most common side effect of radiation is fatigue. Resting is important. The skin in the treated area becomes red, dry, tender and itchy.
Toward the end of treatment the skin may become moist and "weepy." Exposing the area to air helps aid healing. There may be a permanent change in the skin color (Dollinger, Rosenbaum and Cable, 1991). Chemotherapy has many side effects but vary from person to person. In general, anti- cancer drugs affect rapidly dividing cells. These include blood cells, which fight infection, cause the blood to clot and carry oxygen to all parts of the body. When these cells are affected the patient is more prone to infections, bruising and bleeding easily, and my have less energy during treatment.
Patients may lose their hair, have loss of appetite, nausea, vomiting, diarrhea or mouth sores. These side effects are generally short term problems and go away after treatment is over (Dollinger, Rosenbaum and Cable, 1991). Tamoxifen is a form of hormonal therapy. This drug blocks the body's use of estrogen but does not stop estrogen production. It may cause hot flashes, vaginal discharge and irritation, and irregular periods in some women. Serious side effects are rare but are noted to be blood clots in the veins, especially in the legs and sometimes causes cancer in the lining of the uterus (Mc Evilly and Hassey, 1998).
Surgery causes short term pain and tenderness in the area of the operation. Any surgery carries a risk of infection, poor wound healing, bleeding or reactions to medications and anesthesia according to Fraker and Edwards, (1998). Removal of a breast can cause a woman's weight to shift and be out of balance. This can cause discomfort in a woman's neck and back. The skin in the breast area may be tight and the muscles of the arm and shoulder may feel stiff. After a mastectomy, some women have some permanent loss of strength in these muscles, but for most, reduced strength and limited movement are temporary.
Exercises are of benefit to improve and maintain range of motion. Nerves may be injured or cut during surgery and they may be a numbness and tingling in the chest, underarm, shoulder and arm. These feelings usually go away within a few months but some women have permanent numbness (Fraker and Edwards, 1998). Loss of appetite can be a problem when feeling uncomfortable or tired. Nausea, vomiting and mouth sores can make it hard to eat.
However, good nutrition is important. Getting enough calories and protein helps to prevent weight loss, regain strength and rebuild normal tissues (Monson and Harwood, 1998). After mastectomy a woman may decide to wear a breast form (prosthesis). Others may prefer breast reconstruction. What is right for one woman may not be right for another.
There are many choices to be considered. Various procedures are used to reconstruct the breast. Some use implants or tissue moved from another part of the body. A woman's age, body and type of cancer treatment will all play a role in deciding what treatment would be best.
According to Fraker and Murray (1998), some women think the reconstructed breast may improve marital or sexual relations. It may make a woman feel more feminine and I described earlier, "whole again." There is more freedom in wearing clothing. The prosthesis is difficult to wear at times. Other factors play a role in choosing reconstruction or not. Such as, age, fear of more surgery, fear of the outcome, more pain and fear of not finding a local recurrence. Some reconstruction takes place right away, others are delayed because of the type of procedure.
The reconstruction process can be long and grueling according to my own experience but it can be one of the most important parts of the rehabilitation process if a woman chooses this option. Recovery will be different for every woman, depending on the extent of the disease, the type of treatment and other factors. Exercising after surgery helps to regain motion and strength in the arm and shoulder. It can also reduce pain and stiffness in the neck and back. Gradually, exercising can be more active and regular exercise should become part of the daily routine (Fraker and Edwards, 1998).
Often, lymphedema after surgery can be prevented or reduced with certain exercises and resting the arm on a pillow. An elastic sleeve can be worn, medication prescribed or manual lymph drainage (massage) can be tried. A physical therapist may be a helpful referral (Dollinger, Rosenbaum and Cable, 1991). Regular follow up care is important after breast cancer treatment.
A woman will have regular checkups to be sure that the cancer has not returned. This includes examinations of the breasts, chest, underarm and neck. From time to time there will be a complete physical examination and additional tests. Any unusual symptoms should be reported to the doctor such as pain, loss of appetite or weight changes, unusual vaginal bleeding or blurred vision. A woman should be alert to signs of dizziness, coughing or hoarseness, headaches, backaches or digestive problems that are unusual and do not go away. These symptoms may be a sign that cancer has returned but could be a lot of other things (Dollinger, Rosenbaum and Cable, 1991).
This diagnosis can change a woman's life and the lives of people close to her. These changes can be very hard to handle. There are feelings of fright, anger and depression. These are normal reactions when someone faces a serious health problem.
It helps to share thoughts and feelings with others. It can open the way for others to show their concern and offer support. Sometimes women who have had breast cancer are afraid that changes to their body affect not only how they look but how other people feel about them. They may be concerned that breast cancer and its treatment will affect their sexual relationships. It is helpful to seek counseling or a couple's support group (Monson and Harwood, 1998).
Cancer patients may worry about holding a job, caring for their families or starting new relationships. Worries about tests, treatments, hospital stays and medical bills are common. Doctors, nurses, members of the health care team and the rehabilitation counselor can help calm fears and ease confusion about these issues. The patient should be provided with information and resources (Monson and Harwood, 1998).
Employers must be educated to understand breast cancer and its treatment. Flexible work schedules, rest periods, time off for doctor appointments and treatments will be necessary. Depending on the extent of the disease, an employer may need to make reasonable accommodations for the returning employee. If the patient, for example is suffering from lymphedema, it may be necessary to adapt the work station or place the worker in a different position where no lifting is involved.
Since cancer is a disease outlined in the American Disabilities Act, it may be necessary for the rehabilitation counselor to discuss making reasonable accommodations and review the laws with the employer. In conclusion, it can be very helpful to talk with others who are facing similar problems. It is beneficial to get together in support groups and self help groups to share what has been learned about cancer, its treatment and coping with the disease. Several organizations have trained volunteers who have had breast cancer themselves, such as Kaiser Permanente's Breast Buddy program or The American Cancer Society's, Reach for Recovery program.
Volunteers may telephone or visit patients, provide information and lend emotional support before and after the treatment. Their own experiences are often shared with the patient which helps to put things into perspective during a very confusing, lonely and frightening time. Bibliography: References Ault, Susan R. , BSN, OCN and Ferrell, Betty R. , Ph. D. , FAAN (1999). From victim to victor: Taking control of breast cancer, The American Journal of Nursing, 46 - 51 Dollinger, Malin, M. D. , Rosenbaum, Ernest N. , M.
D. , and Cable, Greg (1991). Everyone's guide to breast cancer therapy, New York; Universal Press Fraker, Teresa R. , BSN, RN, OCN and Murray Edwards, Denise, MA, MED, RNCS, NTS (1998). After mastectomy: Restoring cosmetic via breast reconstruction, The American Journal of Nursing, (Suppl. 6), 40 - 45. Mc Evilly, Jan Marie, MS, RN and Hassey Dow, Karen, Ph.
D. , RN, FAAN (1998). Treating metastatic breast cancer; Principles on current practice, The American Journal of Nursing, (Suppl. 6), 26 - 29. Moffa Base, Patty, MSN, OACN, RN and Many, Agnes, MPH, MSN (1990). Adjacent therapy and breast cancer treatment, The American Journal of Nursing, (Suppl. 6), 21 - 25.
Monson, Mary Ann, MSN, RN and Harwood, Kerry, MSN, RN, (1998). Helping women select primary breast care treatment, The American Journal of Nursing, , 3 - 7. The National Cancer Institute, (1999). Understanding breast cancer treatment; A guide for patients, Chicago: Author.
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