10.4 Breast and Ovarian Cancer

Question 1

Breast Cancer

Answer 1

Ductal Carcinoma
- Most common type, where it starts in cells that line the ducts of tubes that carry milk from the gland to the nipple.

Lobular Carcinoma
- Start in the glands that make the milk
- Can spread to lymph nodes under the armpits.
- Can travel to brain, bone, lungs, and liver

Risk Factors
- Increased Age
- Family History
- Obesity/ETOH intake (alcohol)
- Radiation exposure
- 30+ pregnancy
- Early menarche (first menses)
- Late menopause
- Hormone replacement therapy

Other Facts
- Too much sugar will not cause breast cancer
- Cell phone in bra is not researched well enough to know if it causes cancer
- Mammograms do not guarantee breast cancer will be found early.
- Breast cancer does not always have lumps (especially when it first develops)

Manifestations
- Painless lump
- Thickening of breast tissue
- Edema of affected arm
- Changes in shape/size of breast
- Sudden inversion of nipples
- Clear, milky or bloody discharge
- Skin changes

Question 2

Ductal Carcinoma

Answer 2

• Firm lump felt on the breast
• Remains there and does not change in size. May be tender but not painful

Question 3

Lobular Carcinoma

Answer 3

• Feels like thick or hard tissue (not a lump)

Question 4

Lymphedema

Answer 4

• Accumulation of lymph in soft tissue because axillary nodes cannot return lymph fluid into circulation.
• This causes obstructive pressure on veins and decreased venous return
• May feel heaviness in arm, pain, impaired motor function and cellulitis

Question 5

Diagnosis/Treatment Breast Cancer

Answer 5

Diagnosis
- Health history
- Mammogram
- Biopsy
- Chest x-ray
- Carcinoembryonic Antigen (CEA)

Treatment
- Lumpectomy (removal of tumor and little bits of surrounding tissue)
- Mastectomy (removal of breast. Modified Radical Mastectomy can preserve the pectoralis)
- Axillary node dissection (removal of 12-20 nodes around the tumor)
- Radiation therapy
- Chemotherapy (usually before radiation therapy because this can cause adverse side effects with chemotherapy medication)
- Hormone therapy - Blocks estrogen

Question 6

Nursing Care Breast Cancer

Answer 6

• Assess skin
• IV fluids for dehydration
• Semi-fowler
• Pain management
• Surgical teachings
• Post-mastectomy exercises
• Patients are often discharged with surgical drains still in place. Arm function should be restored and no VS/IV/LABS should be done on the affected side FOR LIFE.
• This means the affected arm SHOULD NOT BE PLACED IN DEPENDENT POSITION.

Question 7

Ovarian Cancer

Answer 7

• Mainly affects 63+ white women.
• Most common type is serous carcinoma which originates in epithelial cells

Risks
- Age, history
- BRCA gene mutation
- Lynch syndrome
- Nulliparity
- Gynecological Surgery
- Exposure to asbestos
- Obesity
- Hormone replacement therapy

Manifestations
- Abdominal discomfort
- Pelvic heaviness (pressure in pelvis)
- Irregular bleeding between menopause
- Decreased appetite
- Changes in bowel habits
- Frequent discharge from vagina
- Bowel dysfunction
- Menstrual irregularities
- Pain/ascites

Question 8

Diagnosis/Treatment

Answer 8

• No routine screening (annual bimanual pelvic exam)
• Transvaginal/abdominal ultrasound
• CA-125 TUMOR MARKER (elevated levels does not mean cancer, and blood test not recommended for people with only average risk). Elevated levels means inflammation in pelvic area.
• Average CA-125 is 0-35 units
• Ovarian cancer increases risk of breast cancer.

Treatment
Stage 1 - Chemotherapy/Radioisotopes
Stage 2 - Second look surgery (determines effectiveness of treatment)
Stage 3/4 - Debulking (remove as much of the tumor as possible) followed by chemotherapy.

Surgery
- Total abdominal hysterectomy (TAH)
- Laparoscopic Assisted vaginal hysterectomy
- Brachytherapy (internal radiation) - Requires hospital stay and complete bed rest. (also requires foley catheter)

Question 9

External Radiation

Answer 9

• Coordinated care (no more than 30 minutes a day)
• Stay at doorway or foot of bed
• Limit visitors (less than 3 hours a day standing 6 feet away from bed at all times)

Question 10

Pre/Post-Op Care

Answer 10

Pre
- Vaginal douche
- Enema
- Foley

Post
- VS/Lung Sounds/BP
- I&O
- Pain management
- Dressing change
- DVT prevention
- No sex for 4-6 weeks, will not have menstruation, no heavy lifting for 2 months, low intensity exercise.