Unit 15 wound careBreast CancerBreast cancer is the most common type of cancer among women. Breast cancer affects one in eight women during their lives. Men can have breast cancer too, but the number of cases is small. Breast cancer is the leading cause of death from all causes in women 40-44 years of age and is frequent in women of all ages over 30. No one knows why some women get breast cancer, but there are a number of risk factors. The women whose family members with breast or ovarian cancer are more likely to develop the disease. Risk is increased when when breast cancer has occurred before menopause, was bilateral, or was present in 2 or more first-degree relatives. Early menarche and late natural menopause are associated with a slight increase in risk of developing breast cancers. Other risks include being overweight, using hormone replacement therapy, taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.The earlier breast cancer is found and diagnosed, the better the chances of beating it. Women 20-40 years of age should have a breast examination as part of routine medical care every 2-3 years . If women are over 40 or at a high risk for the disease,they should have an annual radiography with molybdenum target tube and physical exam by a doctor.They may perform monthly breast self-exams to check for any change in their breasts. It is important to remember that changes can occur because of aging, your menstrual cycle,pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for the breasts to be swollen and tender right before or during their menstrual period. Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.The patient with breast cancer usually presents with a lump in the breast. The diagnosis of breast cancer is confirmed by biopsy. The presenting complaint in about 70% of patients with breast cancer is a lump (usually painless ) in the breast. About 90% of breast masses are discovered by the patient herself.Less frequent symptoms are breast pain,nipple discharge, erosion,retraction,enlargement, or itching of the nipple; and redness, generalized hardness, enlargement ,or shrinking of the breast.Inspection of the breast is the first step in physical examination and should be carried out with the patient sitting,arms at sides and then overhead.Palpation of the breast for masses or other changes should be performed with the patient both seated and supine with the arm abducted. Breast cancer usually consists of anon-tender, firm or hard lump with poorly delineated margins. Slight skin or nipple retraction is an important sign. Women with breast cancer have many treatment options. These include surgery, radiation therapy, chemotherapy, hormone therapy,and biological therapy. Treatment by segmental mastectomy plus axillary dissection and radiation therapy or by total mastectomy plus axillary dissection (modified radical mastectomy) is the best initial treatment for most patients with potentially curable carcinoma of the breast.Full discussion with the patient regarding the rationality for mastectomy and the manner of coping with the cosmetic and psychological effects of the operation is essential.Breast reconstruction should be discussed with the patient if this is a realistic possibility. Time spent preoperatively in educating the patient and her family is well spent.Post-operative care for the patient with mastectomy includes:(1) wound care and observation for bleeding.(2) promoting comfort by placing the patient in semi-Fowlers position and elevating the operated arm.(3)providing the patient with a protein-rich diet.(4) giving the patient some advice on activity and exercises, such as climbing the wall or arm swinging.(5) observing and recording any change of the patients physiologic and psychological conditions. New words ovarian uvrin adj. 卵巢的；子房的menopause menup:z n. 更年期；活动终止期bilateral balt()r()l adj. 双边的；有两边的menarche menk n. 初潮（少女的第一次月经来潮）hormone h:mun n. 激素，荷尔蒙radiography ,reidirfi n. 放射线照相术；X 光线照相术molybdenum mlbdnm n. 化学 钼（金属元素，符号 Mo，原子序号 42）menstrual menstrul adj. 月经的；每月的；一月一次的pregnancy prennsi n. 怀孕；丰富，多产；意义深长lumpy lmpi adj. 粗笨的；波浪起伏的；多块状物的uneven ,ni:vn adj. 不均匀的；不平坦的；奇数的swollen swuln adj. 肿胀的，浮肿的；浮夸的；激动兴奋的lump lmp n. 块，块状；肿块；瘤；很多；笨人 vt. 混在一起；使成块状；忍耐；笨重地移动biopsy bai,psi n. 活组织检查；活组织切片检查；切片检查法mass ms n. 块，团；群众，民众；大量，众多 adj. 群众的，民众的；大规模的，集中的nipple nipl n. 乳头，奶头；奶嘴erosion irun n. 侵蚀，腐蚀retraction ritrkn n. 撤回，撤销；收回enlargement inl:dmnt n. 放大；放大的照片；增补物itch it n. 痒；渴望； vi. 发痒；渴望shrink rik vi. 收缩；畏缩 vt. 使缩小，使收缩margin m:din n. 边缘；利润，余裕；页边的空白 vt. 加边于；加旁注于segmental segmental