DIAGNOSTIC EVALUATION Mammography (most accurate method of detecting non-palpable lesions) shows lesions and cancerous changes, such

h as microcalcification. Ultrasonography may be used to distinguish cysts from solid masses. Biopsy or aspiration confirms diagnosis and determines the type of breast cancer. Estrogen or progesterone receptor assays, proliferation or S phase study (tumor aggressive), and other test of tumor cells determine appropriate treatment and prognosis. Blood testing detects metastasis; this includes liver function tests to detect liver metastasis and calcium and alkaline phosphatase levels to detect bony metastasis. Chest x-rays, bone scans, or possible brain and chest CT scans detect matastasis. PHARMACOLOGIC INTERVENTIONS 1. Chemotherapy is the primary used as adjuvant treatment postoperatively ; usually begins 4 weeks after surgery (very stressful for a patient who just finished major surgery). Treatments are given every 3 to 4 weeks for 6 to 9 months. Because the drugs differ in their mechanisms of action, various combinations are used to treat cancer. Principal breast cancer drugs include cyclosphosphamide, methotrexate, fluorouracil, doxorubicin, and paclitaxel. Additional agents for advanced breast cancer include docetaxel, vinorelbine, mitoxantrone, and fluorouracil. Herceptin is a monoclonal antibody directed against Her-2/neu oncogene; may be effective for patients who express this gene 2. Indications for chemotherapy include large tumors, positive lymph nodes, premenopausal women, and poor prognostic factors. 3. Chemotheraphy is also used as primary treatment in inflammatory breast cancer and as palliative treatment in metastatic disease or recurrence. 4. Anti-estrogens, such as tamoxifen, are used as adjuvant systemic therapy after surgery. 5. Hormonal agents may be used in advanced disease to induce remissions that last for months to several years. SURGICAL INTERVENTIONS 1. Surgeries include lumpectomy (breast-preventing procedure), mastectomy (breast removal), and mammoplasty (reconstructive surgery). 2. Endocrine related surgeries to reduce endogenous estrogen as a palliative measure. 3. Bone marrow transplantation may be combined with chemotherapy.

NURSING INTERVENTIONS 1. Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. 2. Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression. 3. Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. Provide psychological support to the patient throughout the diagnostic and treatment process. 4. Involve the patient in planning and treatment. 5. Describe surgical procedures to alleviate fear. 6. Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue. 7. Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy. 8. Administer I.V. fluids and hyperalimentation as indicated. 9. Help patient identify and use support persons or family or community. 10. Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. 11. Teach all women the recommended cancer-screening procedures.