Breast cancer

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  • Breast Cancer
    • Causes
      • It is not yet fully understood:  Age, started period early/menopause late, been exposed to radiation, first pregnancy after 30/ don't have children, eating high fat food/ drink more than 14 units alc a week, overweight and been through menopause, close family member had breast cancer, take contraceptive pill or hormone replacement therapy
    • Symptoms
      • Breast lump or change in overlying skin/nipple, change in shape or size, different shape to nipple, dimpled skin, rash on or around nipple, blood stained discharge from nipple, swelling or lump in armpit
    • Treatment
      • Surgery (Lumpectomy, masectomy, reconstruction, lymph node surgery), Radiothearpy, chemotherapy, hormonal therapy
    • Impacts (FPIES)
      • Financial: Missing work for appointments (self and family), reducing hrs worked, having to stop job, availability of sick pay, cost of travel to and from appointments
      • Physical: Loss of hair due to chemo, tiredness and weakness, nausea and vomiting, pain from surgery
      • Intellectual: increased knowledge of condition, poor concentration
      • Emotional: fear and anxiety, loss of control (daily life), denial, anger, guilt (impact on family), embarrassment (losing breast), confusion at beginning, nervous, frustration, sadness, detached feelings
      • Social: difficulty talking to friends and family (embarrassment), not taking part in social events or group activities, difficulty with sex and intimacy, change in friendships, altered role in fam (some men leave their wives), strained relationships
    • Patient centred care (HITLERD)
      • Heart of process:all decisions should involve patient, explain what care will involve, people will find masectomy embarrassing, social impacts of having no breast, coping with treatments (chemo)
      • Informed choices: explaining treatment w/out jargon, risks and benefits of different treatments, know consequences and have choice of no treatment
      • Take reponsibility: healthy diet during chemo, take care of masectomy scars, educating about signs of cancer coming back, side effects of chemo or radiotherapy
      • Lifestyle: diet, coping with hair loss during chemo, looking after general health
      • Empowering: have named specialist (breast surgeon, chemo, breast care nurse), local support groups, charities
      • Respecting: treated as equal partner, proffessionals show respect during examinations, maintain confidentiality, respect decisions to refuse treatment
      • Dignity: embarrassed and self conscious, staff should explain each procedure, be reassuring, talk about fears and concerns
    • Care pathway
      • Primary care: go to GP with symptoms, GP will: take a history, examine patient, refer to secondary care, prepare them. Screening programme: 50-70 yr olds every 3 years
      • Secondary care: blood tests (may have blood marker), mammorgram, ultrasound of breast, FNA of lump (fine needle aspiration) removes cells of cancer to send to pathology. Once diagnosed: send sample of tumour to pathology, CT scan to check if it has spread around the body
      • Treatments: meet specialist (breast cancer nurse, dietician, pallative care team, oncologists), discuss all treatments available, would think about social situation age and medical conditions, cancer team would plan carry out and monitor treatment
      • Practitioners involved: cancer specialist, counsellors, doctor, GP, occupational therapist, A&E, pharmacy
      • Ongoing support after diagnosis: providing support and practical advice (cancer specialist), come into home (occupational therapist), help through therapy (counsellor), encouraged to go for breast screening (GP), provide painkillers (doctor/ pharmacy), would go A&E if they felt a lump)

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