12b - Breast Cancer Flashcards
Incidence breast cancer
• Incidence of 1 in 8 women in Australia
diagnosed before 85yo
In‐Situ breast cancer
• Pre‐invasive cancer that has not breached the epithelial basement membrane • Marker for the later development of invasive carcinoma • Usually asymptomatic • Common due to breast cancer screening • Mastectomy is recommended
Invasive Breast Cancer
Invasive Ductal (IDC most common) and Lobular
Cancer cells have started to break through
ducts/lobules and invade surrounding areas
with ability to travel through the blood stream
and lymphatic system
Usual clinical presentation of breast
cancer
• Most frequently in the upper, outer quadrant
of the breast
• May present as a hard lump ‐ may be
associated with indrawing of the nipple or
discharge. May feel nothing
• May have skin involvement with puckering
skin appearance or frank ulceration and
fixation to the chest wall as the disease
advances locally
Types of Surgery Breast Cancer
- Wide local excision (WLE)/lumpectomy
- Axillary dissection or SNB
- Simple Mastectomy
- Modified Radical Mastectomy
Where breast drains
axilla
supraclavicular, cervical chain
Wide Local Excision
• Removal of the breast lump whilst conserving
the remaining tissue.
• May return for re‐excision 1 week later if
margins not clear
Sentinel Node Biopsy
• The first node that the tumour drains to
• Determined by injection of tumor with blue
dye and trace which node turns blue first then
remove it
• If + for tumour cells, further AD done
Simple Mastectomy
• Removal of breast but not the lymph nodes (for in situ carcinoma)
Modified Radical Mastectomy
• Removal of breast plus axillary lymph nodes
If it is large or multifocal
Radical Mastectomy
Removal of breast, axillary nodes and Pectoralis
Major – rarely done
If it has invaded through breastr and into the muscle
• Return to activity advice/posture aftter mastectomy
Go back to normal, light activites early - dressing, eating, picking up their phone with that hand
Exercises Mastectomy/WLE with AD
• Check op notes
• Level 1 exercises for 1 week plus encourage
light use of arm for normal activity
• Keep arm <90 degrees
• Level 2 exercises commenced after this, so
long as drain removed
• Gradual progression as pain allows
Exercises WLE/SNB
• Level 1 exercises for few days plus encourage
light use of arm for normal activity
• Level 2 exercises commenced after this, so
long as drain removed
• Gradual progression as pain allows
Posture and Activity Advice mastectomy
• Good posture in standing, sitting and walking
especially mastectomy
• Watch for protective postures – pillow support
• No heavy lifting/repetitive use/sustained
postures
Need yto keep circulation going - every 1/2 hour if doing something like computer or knitting, stop, stretch and move around
Why might women have poor posture after mawstectomy
pain
Body image
When does lymphoedema occur after mastectomy
• Can develop at any time even years ahead
Lymphoedema Prevention Mastectomy
• Avoidable risk factors – factors that challenge
immune system or impede flow of lymph
• Instruct patient to be aware of signs and
symptoms to identify early
• Avoid BP/cannulas/blood taken on the operated
side always (Armer 2013)
Possible Post‐op Complications Mastectomy
• Pain • Seroma • GH ROM/movement dysfunction • Soft tissue contracture/adhesions • Numbness/hypersensiti vity in arm/breast • AWS/Cording • Neural tension • Lymphoedema
What is Axillary Web Syndrome/Cording
A visible web of axillary skin overlying
palpable cords of tissue that are made taught
and painful by shoulder abduction
Aetiology Axillary Web Syndrome/Cording
• Lymphovenous injury, stasis and
hypercoagulability(tissue injury releases tissue
factor that causes hypercoagulability) as a
consequence of superficial venous stasis,
lymphatic disruption and tissue injury caused
by axillary clearance
Risk Factors / Onset axillary cording
- Slimmer women – BMI < 25
- Younger women – Age < 50yo
- Why?? Unknown
- Onset from 2‐8 weeks post‐op
Signs of AWS
• Shoulder abduction restricted
• Hardened palpable cords which are painful
but not erythematic
• Cords may extend down medial upper arm,
across cubital fossa into anterior forearm
Treatment axillary webbing
- Massage
- Stretches (need to push into some pain)
- LLLT trial – no research but good early results
