Breast Cancer: Pathogenesis, Diagnosis, Treatment

Introduction

Breast cancer is one of the most widespread cancers in the United States, resulting in over 240,000 diagnoses and 41,000 deaths each year (Centers for Disease Control and Prevention, 2015). It can affect all women, but factors such as age and genetics can play a role. Researchers have been actively attempting to determine the role of the immune system in breast cancer development and treatment, potentially using it for targeted therapy. This case study investigates the pathophysiology of breast cancer and explores the most recent standards of care.

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Pathophysiology and Diagnostic Testing

The pathophysiology of breast cancer is currently understood to be based on molecular alterations that occur at the cell level. Molecular disruptions or influential factors lead to breast epithelial cells which retain uncontrolled growth forming a tumor. The genomic profiling of the condition revealed that there are four distinct subtypes of breast cancer, each associated with a specific receptor-based on epigenetic aberrations.

These include the presence or lack of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (Chalasani, 2018). Visible signs and symptoms include the appearance of lumps or deformations on the breast tissue, abnormal changes in skin color or texture, and inversion or discharge from the nipple.

Risk factors for developing breast cancer increase with age, particularly in post-menopausal women. The family history of the disease or other genetic conditions increases the risk as well. Genetics has been strongly associated with the disease. Hormonal abnormalities linked to early menarche, pregnancy, breastfeeding, and menopause are associated with an increased risk of developing breast cancer. Lifestyle factors such as obesity and alcohol consumption are a factor as well (Shah, Rosso, & Nathanson, 2014). Currently, it is unknown how the immune system plays a role in the origins of aggressive cancerous tumors. However, some immune cells have been proven to contribute to metastasis once affected by neutrophils, causing the tumor to spread more rapidly (Leiden Universiteit, 2017).

Screening and diagnosing breast cancer begin with breast self-examination. Women are encouraged to perform monthly examinations for any abnormalities in their breasts. If symptoms are discovered, a physician can perform a physical examination as well. One of the most popularized diagnostic imaging techniques is mammography, which utilizes X-rays to locate tumor tissue in the breast. This provides an initial overview by visualizing the breast from two different planes and a focal compression. Further detailed imaging can be ordered via magnetic resonance imaging (MRI) and ultrasound. Finally, a biopsy and bloodwork are reliable methods of diagnosis for breast cancer (Shah et al., 2014).

Evidence-Based Treatment Modalities

Treatment modalities of breast cancer greatly depend on the epidermal factor and stage of progress of the disease. The National Comprehensive Cancer Network suggests in its guidelines that radiation therapy to the breast and chest wall and internal mammary nodes are recommended as a basis for the treatment of initial stages of breast cancer. Radiation therapy consists of highly concentrated x-rays which attempt to control malignant cancer cells (Gradishar et al., 2017).

An adjuvant system treatment for hormone receptor-positive breast cancer instances is recommended through endocrine therapy or chemotherapy. The American Society of Clinical Oncology recommends HER-2 targeted endocrine therapy which is a type of hormonal therapy specifically designed for oncological purposes to manipulate the endocrine system to eliminate hormones that aid cancer cell growth (steroids) and produce those that inhabit it. Endocrine therapy is commonly used in conjunction with chemotherapy that introduces powerful drugs into the system that inhibit mitosis and slow cancer growth (Giordano et al., 2018).

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Nurse Applicability

Information about the case can impact a nurse’s practice by providing an evidence-based quality improvement to healthcare provision. Using recommendations from guidelines and modern treatments, a nurse can respond adequately and provide valuable contributions to any initiatives that focus on disease prevention and education (Stevens, 2013). A patient education session for someone with breast cancer is a difficult concept, as the patient must be instructed in both, the emotional impact as well as the medical expertise of a highly complex disease. The information will help to develop an informative, updated curriculum with the latest information and provide the patient with available options for further treatments.

The most important information presented in the case is the pathophysiology of the disease and its diagnosis. One of the biggest concerns in medical research is the formation of cancerous tumors and how they can be prevented. Knowledge about these concepts can be vital in ordering appropriate diagnostic tests for an early identification of a tumor, which significantly increases the chances of survival.

The challenging concept was the discussion of relating breast cancer to the immune system since the disease is not commonly associated with immune defects. Therefore, treatments using immune functions are still in initial development. Patient safety for consideration in individuals with breast cancer is an infection. Numerous treatments include potential sites of infection. For example, chemotherapy drugs are delivered through central venous catheters, which are one of the primary locations for hospital-acquired infections.

Conclusion

Breast cancer is a highly complex and fatal disease. Significant progress has been made in the 21st century on the diagnosis and treatment of cancer, with innovative approaches such as using the immune response. However, there continues to be much unknown about the disease. A nurse can use the information about breast cancer to provide guidance and better-informed practice for patients.

References

Centers for Disease Control and Prevention. (2015). United States cancer statistics. Web.

Chalasani, P. (2018). Breast cancer. Web.

Giordano, S. H., Temin, S., Chandarlapaty, S., Crews, J. R., Esteva, F. J., Kirshner, J. J.,… Davidson, N. E. (2018). Systemic therapy for patients with advanced human epidermal growth factor receptor 2–positive breast cancer: ASCO clinical practice guideline update. Journal of Clinical Oncology, 36(26), 2736-2740. Web.

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Breast Cancer: Pathogenesis, Diagnosis, Treatment
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Gradishar, W. J., Anderson, B. O., Balassanian, R., Blair, S. L., Burstein, H. J., Cyr, A.,… Kumar, R. (2017). NCCN guidelines insights: breast cancer, Version 1.2017. Journal of the National Comprehensive Cancer Network, 15(4), 433-451. Web.

Leiden Universiteit. (2017). Immune system plays dual role in breast cancer. ScienceDaily. Web.

Shah, R., Rosso, K., & Nathanson, S. D. (2014). Pathogenesis, prevention, diagnosis and treatment of breast cancer. World Journal of Clinical Oncology, 5(3), 283–298. Web.

Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2), 4. Web.

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