Breast Cancer UK

UK a diagnosis of cancer could be expected by 1 in 3 people. For women, breast cancer is the most common type of cancer, figures being 1 in 9. There are about 41,000 new female cases diagnosed each year but only 42 deaths in 100,000 cases per year.

There is personal reason for this particular choice of subject as it has touched a wide cross section of friends and family in a number of ways. According to World Health Organisation (WHO, 2011) around 30% of cancers deaths can be avoided. Hence the NHS implementation taken as part of WHO 58th World Health Assembly, approved resolutions on cancer prevention and control of breast screening as this type of cancer has overtaken lung cancer in the recent years.

In order to understand the condition, the normal anatomy of the organ that is parts of the reproductive system the breast and its tissues will be examined, how the cancer will impact on the tissue.  What cancer is will be discussed, together with where and how it starts within the breast, signs and symptoms of the condition, with what factors may contribute to the risks such as life style, familial, environment. Determinates as to what health practice is in place for clinical observations and results found for treatment and rehabilitation will also be examined.

This assignment is based on a female x whose signs and symptoms are fictitious and therefore, within the context of Data Protection 1998, no prior permission is required. This law provides protection for the individual whose data is used or stored. No sensitive data of a personal nature as to sexual orientation, religion, criminal record and political beliefs the clients mental and physical condition should be kept without permission. The personal information will be regulated and covered for written and electronic form (i.e. Internet, intranet and email) the client would have had the right to request what information is held about them. Teesside School of Health and Social Care (as a student of this institution disclosure is to protect both the student and the organisation) together with Department of Health protocols would otherwise have to be followed in respect of data obtained and used. Otherwise one would have to have a signed consent from the client for the information to be used in this assignment. Practice professional code of conduct followed and data must be used in a confidential and sensitive manner regarding information about its clients.

To conclude how complementary therapies through reflective practice can provide the appropriate targeted support treatment for future clients with this type of diagnosis.

Female x hypothetical case is aged 41, she is a house wife with 3 children aged 12 boy, 14 girl and 16 boy. This brings with it extra stress of running a family home. For her life style, she does a reasonable amount of dog walking, cooking, cleaning and washing. The family mainly has a vegetarian diet apart from the husband and the youngest son, who has the occasional meat and poultry.  Female x has a below normal intake of water at around 3-5 glasses a day, with approx. 1 to 4 units of alcohol consumed each week. Munk, BA, (2010) states massage therapy(MT) would be a beneficial route to preventative and supportive care if stress levels are very high throughout together with a disturbed sleep pattern. She has had to come to terms with a loss of very close member of the family recently through lung cancer, Cancerhelp. (2010) there seems to be no connection of lung cancer being passed on as a transmuted form to breast cancer to first line family members however, the lung cancer gene itself has the potential of being passed down.  On discovering a certain amount of discomfort in the left breast female x did a gentle breast self examination(BSE) as per Van De Graaff et al (2001)on both breasts and found tenderness and a number of lumps there together with a slight dimple effect under the left nipple. Although breast cancer can be a hereditary condition, female x does not have any family history of breast cancer according to (Lewis J, 2008, p6) faulty cancer genes (BRAC1, BRAC2, TP53) are known to increase risks.

In children, puberty can start from the ages of 10 to 15. With reference to (Smith T,ed. 1982, p841) for both genders. It was believed the main endocrine gland responsible in triggering the onset of puberty was the pituitary gland, sending out a hormone called Gonadotropins(GnRh), however (Carter D, ed, 2001, p291) with the technical and scientific advances that we have now, indicated the hypothalamus triggers the Gonadotrophins(GnRh) which in turn trigger the ovaries in releasing oestrogen in girls. The pituitary gland initiates the follicle stimulating hormone(FSH) encouraging the production of a sex cell, the Luteinizing Hormone (LH)releases the eggs, oestrogen and progesterone. Start of a regular menstrual cycle and underarm and pubic hair growth. Puberty for boys on the other hand triggers the maturity of the testes in producing testosterone and the start of hormone production. The function of the female breasts is mainly for the nursing of a new born baby. With reference to (Tortora G J, 2004,p576) normal breast structure in made up of altered sudoriferous sweat glands that yield milk. The word breast comes from mamma and is medically known as mammary glands. Breasts are positioned over the pectoral major serratus anterior with a layer of connective tissue as attachment for these glands within the tissue, there are approximately 20 lobes protected by adipose tissue. The lobes are directed into finer ducts called lobules then milk secreting glands the alveoli that open out into the nipple also termed as lactation. As stated in Van De Graaff et al (2001) approximately 75% of the lymph is drained into the auxiliary nodes, this in itself has a major impact on breast cancer to spread (metastases).

Female breasts are part of the reproduction system connected with pregnancy and child birth (Tortora G 2004). Prolactin instigated by the anterior pituitary together with progesterone and estrogens from the ovaries. During pregnancy although prolactin is being secreted by the pituitary gland. Only after delivery the amounts of estrogens and progresterone in mothers blood circulation decreases,  its ability to produce milk (lactation) in the mammary glands is no longer suppressed by progresterone. With the onset of the new born infant sucking this stimulates nerves of the stretch receptors in nipples triggering the hypothalamus to release increased amounts of prolactin from the pituitary and oxytocin from the posterior pituitary. Therefore, as female x has had three children and breast fed them all, the function of the breast tissue would have been normal up until now. However, with reference to Henk B. Kal. (2008) Radiography in pregnancy would not be contra indicated to diagnosing breast cancer if female x was pregnant and discovered a cancerous lump. According to Women’s Health. (2010) Females between 20s and 30s may develop lumps known as fibro adenomas, these are glandular growths which usually heal by themselves or may be surgically removed. The more common signs of lumps in breast tissue are usually fibrocystic lumps that are usually fluid filled sacs these tend to occur in females between 30 and 50 and are the effects of hormones which have an impact due to the menstrual cycle. It was confirmed from the manual palpation of the breast tissue by the G.P. that there were a number of lumps in the left mammary gland. As per the NHS. (2007). Female x will be a priority case classed as a high risk due to her age and a slight skin disorientation under the left nipple (Nice 2002) in an expedited assessment of the lumps, with the collaboration of oncology and all related departments. European directive according to Osborn G D et al. (2010) to reducing doctors’ working times allowing nurses to do a clinical breast examination(CBE),The subsequent visit to the hospital resulted in a nurse palpating the area and using ultra sound and completed on female x Fine Needle Aspirations (FNA) which reduced the abscess of these two lumps and the fluid would be sent for cytological examination to ensure floating cells are not cancerous (Lewis J 2008), Dr Rutherford D (2003). Female x was then referred to have an x-ray on the third lump under the nipple. According to Lewis J (2008). There are a number of different types of lumps and the most common type of cancer Invasive ductal carcinoma with grading system used 1 to 3 grade, the third being worst outcome. Clinician will assess how the tumour looks, how quickly the cells divide. Lobular carcinoma is the second most frequent type found after invasive ductal carcinoma and can be difficult to manually palpate as the cells grow inside and along the duct and appear as multifocal (many tumours). Another type is the inflammatory breast carcinoma this takes up space in the lymphatic space of the dermis and shows signs of erythema, swelling and discomfort. Types such as non-invasive carcinoma referred to as ‘in-situ’ contained within the wall of the breast duct. The group is termed as duct carcinoma in situ (DSIC), lobular carcinoma in situ restricted to the lobes of the breast.

Before one can understand what causes breast cancer normal cell function needs to be understood, with reference to Zimmerman, Barbara T. (2004, p9) all living things including our bodies are made up from the most basic fully functional unit known as cells, each containing a nucleus in the centre and enclosed by a cytoplasm within this are a number organelle that have specific functions, the nucleus however, holds the genetic code in form of molecules of deoxyribonucleic acid or (DNA) once a human egg is fertilized by a sperm cell, term as the zygote this contains the full forty-six chromosomes, that’s twenty three chromosomes from the male and twenty three chromosomes from the females and the DNA of the new human being, thus the ability of the zygote to divide and copy the genetic code the all new reproduced cells. Specialized cell begin to form called differentiation. Therefore, a blood cell code will mean it never become a nerve cell. As a function cells die and new ones are created. Cancerous cells usually are triggered when error occurs (mutations) in function and replication as instructed by the DNA. Causing the cell to divide uncontrollably amassing in the tissue, taking over the nutrients and blood supply to feed its own growth.This growth may stay confined to one area (benign) If the cancerous cells travel via the blood or lymph system (matastes) this may be a more serious problem of treatment the prognosis will be looked at later.

External factor that may cause of breast cancer according to MacMahon B. (2006) ionizing radiation, as an example breast cancer risk had doubled amoung teenager girls during the war exposed to radiation Dr Rutherford D (2003).  exogenous ovarian hormones from aging beverage alcohol, however a drinks company according to Bateman, M (2010) suggests otherwise that alcohol does not have and effect on breast cancer, other cause that are known to impact as stated by Jeffrey, G et al (2010) are diet (department of Health 2004) exercise can reduce illness by 50% in cancer, diabetes, heart disease and strokes. Further to this state’s Lewis J (2008. P3-6) totally random occurrence and change of the gene in the cell that triggers cancer (sporadic), one in ten of breast cancers can be attributed familial passing down of the faulty gene cell from parent to child. BRAC1 and BRAC2 have been identified as been inherited by women and as such have a higher life time risk as mention previously female x does not have a family history of breast cancer therefore is most like not to have the faulty gene, however if the G.P. directs a test can be suggested to rule this out.

Clinical observations by the National Health Service provide the following, mammography Lewis J (2008, p48) found that female x had a lump that had to be examined further. Triple assessment provides clinician on overall picture of the size, shape type of cancer that is found according to Dr Rutherford D (2003). Other tests may be conducted are Magnetic Resonance Imaging scan (MRI) particularly useful if there are multifocal tumors. Methoxy IsoButyl Isonitrial (MIBI) or Sesta Scans these are classed as nuclear medicine scans (known as scintimammogaphy) using radioactive dye where a gamma camera to pick up the image from the radioactive path of the dye in the vein.  At this stage the primary care team would instigate a core biopsy this is a fast effective method of excising a small amount of tissue for oncology assessment to ascertain what the tissues cell structure is and how fast it is growing. A hand-held device with a spring loaded needle, with the area of the skin injected with a local anaesthetic. This procedure is carried out inconjunction with a mammography or ultrasound (stereotactic guidance) sent to pathology laboratory for investigation by a pathologist. The core biopsy to effectively target the appropriate treatment, a staging system is used from zero from slow growing to 4 fast growing, to identify and assess tumours, nodes and metastases (TNM).

According to Lewis (2008,p60-136) non-invasive breast cancer (caricinoma in situ) also called a ‘pre-cancerous’ disease. These cancers tend not spread beyond breast tissue therefore, treatments are concentrated in local area (local control) the same for ductal in situ carcinoma (DCIS) this cancer also tends to be confined to the ducts. The most important aspect for the client is to converse the breast (adjuvant radiotherapy) from surgery and mastestomy. The author notes the lowest risks or recurrence from mastectomy for DCIS. Cancer drug Tamoxifen post surgery (primary surgery) and radiograghy does not reduce the rate of recurring. However, Tamoxifen has shown to reduce cancer starting in the other breast. Lobule carcinoma in situ (LCIS) is recognised as risk for the breast cancer rather disease as it is localised and generally does not spread, where as invasive are more aggressive in growth and metastases through lymph and blood circulation. Female x had a small low grade LCIS just below the nipple, most effect surgery for this as stated in. Known as quadrantectomy. Therefore, there will be no need for any major breast reconstructive surgery of skin and muscles, mastectomy or silicone gel implants, as the tumour is benign and has not matastasis through blood and lymph to other areas with cancer

 

(http://www.timesonline.co.uk/tol/life_and_style/health/article6816597.ece) accessed 14/12/10, age, HRT(hormone Replacement Therapy)(http://info.cancerresearchuk.org/cancerstats/types/breast/screening/hrt/ ) accessed 14/12/10 and exposure to carcinogens

(http://www.nomorebreastcancer.org.uk/common_carcinogens.html accessed 14/12/10, these will be discussed at a later stage.

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