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Selected Topics > BCRL > Flashcards

BCRL Flashcards

1
Q

What is the most common cancer in women within the US?

A

breast cancer (30% of all new female cancers)

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2
Q

The median age for breast cancer diagnoses is ___ y/o.

A

62 y/o

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3
Q

Incidence rates of breast cancer has increased by ___% per year.

A

0.5%

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4
Q

What is the second leading cause of cancer death in women?

A

breast cancer

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5
Q

What is the first leading cause of cancer death in women?

A

lung cancer

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6
Q

What demographic group has the highest death rate and development of breast cancer before the age of 40?

A

Black women

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7
Q

What demographic group has the lowest death rate from breast cancer?

A

asian/pacific islanders

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8
Q

What demographic group has the lowest rate of developing breast cancer?

A

american indian/alaska natives

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9
Q

What are risk factors that contribute to the development of breast cancer?

A
  • age
  • genetic mutations
  • reproductive history: menstruation before the age of 12 and menopause after age 55, giving birth after age 30, not breast-feeding, and having a full term pregnancy
  • dense breast tissue
  • PMH of breast cancer or breast disease
  • Family history of breast and/or ovarian cancer
  • radiation therapy treatments
  • physical inactivity
  • obesity
  • hormones
  • alcohol
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10
Q

definition: tumors that start in the epithelial cells in the lining of the organs and tissue

A

ductal/lobular carcinoma (Adenocarcinomas)

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11
Q

Invasive ductal carcinoma makes up about ___-__% of call breast cancers

A

70-80%

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12
Q

definition: cancer cells that block the lymph vessels in the skin

1-5% of breast cancers

A

inflammatory breast cancer

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13
Q

What type of breast cancer is very aggressive? Why is this?

A

triple negative… the cells do not have estrogen, progesterone or protein HER2

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14
Q

What are BRCA genes?

A

Tumor suppressor genes that can lead to abnormal growths/cancer if there is a mutation.

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15
Q

_____ of women in the world with BRCA gene mutation will get breast cancer by ___ y/o

A

1/2, 70 y/o

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16
Q

(true/false) All women have the BRCA gene

A

true

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17
Q

___ out of 100 women in the general US population has BRCA gene mutation

A

7 out of 100

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18
Q

How is pathologic/surgical stage of breast cancer determined?

A

examining the tissue removed

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19
Q

How is the clinical stage of breast cancer determined?

A

based on results of physical exam, biopsy, and imaging

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20
Q

T (Tumor) Followed by the numbers 0-4 indicate the ________ and if it has spread to the skin or the chest wall below the breast.

A

Indicates the primary tumor size

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21
Q

A patient with breast cancer will be staged T__ if their tumor is 2-5 cm across

A

T2

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22
Q

A patient with breast cancer will be staged T__ if their tumor is <2 cm across

A

T1

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23
Q

A patient with breast cancer will be staged T__ if their tumor is >5 cm across

A

T3

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24
Q

When will a patient with breast cancer be classified as a T4?

A

When there is a tumor of any size growing into the chest wall or skin (this also includes inflammatory breast cancer

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25
Q

N (nodes) Followed by the numbers 0-3 indicates ______.

A

Indicates whether the cancer has spread to the lymph nodes and how many nodes are involved.

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26
Q

A patient with breast cancer will be staged N__ if there are 1-3 axillary lymph nodes involved AND/OR cancer is found in the internal mammary lymph node

A

N1

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27
Q

A patient with breast cancer will be staged N__ if there are 4-9 lymph nodes involved

A

N2

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28
Q

A patient with breast cancer will be staged N__ if there are 10 or more lymph nodes involved or the cancer has spread to the lymph nodes under the clavicle

A

N3

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29
Q

What are the 4 most common cancers to metastasize in order?

A
  1. bones
  2. lung
  3. brain
  4. liver
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30
Q

definition: surgeon injects a dye under the arm and then removes the lymph node(s) that have taken up the dye

A

sentinel node biopsy

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31
Q

definition: Surgeon removes many nodes (usually less than 20) from under the arm

A

axillary node biopsy

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32
Q

What type of biopsy increases the risk of lymphedema?

A

axillary node biopsy

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33
Q

(true/false) surgery does not increase the risk of lymphedema

A

FALSE (it does)

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34
Q

What is the standard schedule of radiation for patients with breast cancer?

A

5 days/ week for 6-7 weeks

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35
Q

definition: Surgery to remove the cancer as well as some of the surrounding normal tissue (margins)

–> patient will most likely need radiation therapy

A

breast conservation (lumpectomy/partial mastectomy)

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36
Q

definition: Mastectomy that removes all breast tissue INCLUDING the nipple, areola, and some overlying skin.

Muscle beneath the breast is NOT removed.

A

simple total mastectomy

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37
Q

definition: Mastectomy that removes all breast tissue but leaves as much healthy breast skin as possible.

This procedure is done when the plan is for immediate reconstruction of the breast, nipple, and areola.

A

skin sparing mastectomy

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38
Q

What type of mastectomy is not a safe option if there is a possibility of tumor cells close to the skin?

A

skin-sparing mastectomy

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39
Q

definition: Mastectomy that removes all breast tissue but leaves the nipple, areola, and overlying skin.

This is not recommended if the cancer includes the nipple or Paget’s disease or if cancer is detected in the margins.

A

Nipple-sparing mastectomy

40
Q

What type of mastectomy option allows for a more “natural” look?

A

nipple-sparing mastectomy

41
Q

definition: Mastectomy that removes all breast tissue INCLUDING the nipple, areola, and axillary lymph nodes.

Chest wall muscle is left INTACT

A

modified radical mastectomy

42
Q

Axillary web syndrome will occur __-__ weeks after surgery and the patient will feel cording in the tissue

A

1-5 weeks

43
Q

What is the most common type of radiation?

A

external beam radiation

44
Q

If you had a mastectomy and NO lymph nodes had cancer cells, the external beam radiation will be focused on what?

A

the chest wall, the mastectomy scar, and the places where the drains exited the body after surgery

45
Q

If you had breast-conserving surgery, external beam radiation will be focused on __________, with a boost to the area in the breast where the cancer was removed

A

focused on the whole breast

46
Q

When is external beam radiation started after surgery?

A

Usually not started until after surgical sites have healed and after any chemotherapy treatments

47
Q

External beam radiation is measured in ___.

A

grays

48
Q

definition: Irreversible condition where there is an excess formation of Fibrous connective tissue which causes structural and functional changes

A

radiation fibrosis

49
Q

What are potential side effects of external beam radiation?

A
  • swelling of the breast
  • skin changes
  • fatigue
  • radiation fibrosis
  • change in the size of breasts
  • inability to breastfeed
  • brachial plexus damage
  • weak ribs
  • lymphedema
50
Q

What is considered as the gold standard for measuring lymphedema volume?

A

water displacement

51
Q

__-__% of patients during active treatments will have cancer-related fatigue

A

60-90%

52
Q

Hemoglobin levels will be ___ in men and ___ for women with chemotherapy treatment.

A

Men: < 13.2

Women: < 11.6

53
Q

1 in ___ women who are diagnosed with breast cancer will develop lymphedema.

A

1 in 5

54
Q

definition: Long term, chronic condition in which there is an abnormal accumulation of water and proteins in the interstitium and subcutaneous tissues that leads to inflammation and reactive fibrosis of the affected tissues.

A

lymphedema

55
Q

definition: vertical structures that assists fluid traveling from blood capillaries to lymph capillaries

A

pre-lymphatic channel

56
Q

Where is the location of lymph capillaries?

A

directly under epidermis

57
Q

Lymph vessels (do/do not) contain valves.

A

do not

58
Q

Lymph capillaries are overlapping _____ cells.

A

endothelial

59
Q

definition: Channels that move fluid to larger vessels and may absorb some fluid (like capillaries)

A

pre-collectors

60
Q

Pre-collector channels contain ___.

A

smooth muscle

61
Q

Perforating pre-collector connects superficial and deep lymphatics through the ____.

A

fascia

62
Q

lymph collectors have (one/two)-way valves

A

one-way

63
Q

What is the smallest functional unit of lymph collector?

A

lymphangion

64
Q

lymphangions are innervated by the ____.

A

autonomic system

65
Q

(true/false) lymph collectors absorb fluid.

A

FALSE (transports only)

66
Q

definition: collects lymph fluid from organs, extremities, and trunk

A

lymph trunk

67
Q

definition: transports lymph fluid into VENOUS circulation

A

lymph ducts

68
Q

What duct in the lymphatic system empties 3/4 of all lymph fluid?

A

Thoracic duct

69
Q

Where does lymph fluid enter the venous system?

A

Left subclavian vein

70
Q

What duct empties the other 1/4 of lymph fluid that the thoracic duct is not responsible for?

A

right lymphatic duct

71
Q

definition: Separate lymphatic regions associated with specific groups of lymph nodes

A

lymphatic watersheds

72
Q

Lymph transport is regulated by what?

A

Intrinsic contractions of the Lymphangions

extrinsic contractions of:
- muscles
- arterial pulse
- breathing
- negative pressure in central veins
- external compression

73
Q

What connects lymph collectors?

A

watersheds (anastomoses)

74
Q

How can lymphatic load increase?

A
  • active hyperemia (inflammation, heat, massage)
  • passive hyperemia (CHF, DVT, CVI)
  • hypoproteinemia (renal/liver disease)
75
Q

definition: Damage to actual lymphatic system

A

mechanical insufficiency

76
Q

What is the difference between edema and lymphedema?

A

Edema:
-symptom
- LOW protein
- dynamic insufficiency
- hemodynamic insufficiency
- dependent on gravity

Lymphedema:
- disease/disorder
- HIGH protein
- caused by lymphatic system drainage
- mechanical insufficiency
- NOT dependent on gravity

77
Q

What is considered as the gold standard of care for lymphedema?

A

Complete decongestive therapy (CDT)

78
Q

What does the active phase (phase I) of complete decongestive theory involve?

A
  • skin care
  • bandaging
  • exercise
  • manual lymph drainage
79
Q

What does the maintenance phase (phase II) of complete decongestive theory involve?

A

compression garments
self-care
HEP

80
Q

definition: dried skin

A

skin plaques

81
Q

definition: overhanging skin

A

skin lobules

82
Q

definition: have a wart like appearance

A

papillomas

83
Q

definition: dimpling of the skin

A

peau d-orange

84
Q

When should strengthening exercises be initiated after surgery for lymphedema?

A

4-6 weeks post op

85
Q

definition: treatment of lymphedema that increases the uptake and transport of the lymphatic loads by raising intravascular pressures and peristalsis of the lymph collectors, ducts, and trunks

A

manual lymph drainage

86
Q

definition: accumulation of interstitial fluid caused by tumor infiltration or compression of lymphatic vessels

A

malignant lymphedema

87
Q

Manual lymph drainage is (contraindicated/indicated) for those with malignant lymphedema

A

CONTRAINDICATED

88
Q

What are contraindications for manual lymph drainage?

A
  • malignant lymphedema
  • recent irradiated skin
  • low cardiac function
  • acute, untreated DVT
89
Q

Short stretch compression bandages stretch ___% of their original length.

A

60%

90
Q

definition: A federal law that passed on 12/23/22 that will go into effect on 1/1/24 to improve insurance coverage for the medically necessary, doctor-prescribed compression supplies that are the cornerstone of Lymphedema treatment.
Medicare

A

lymphedema treatment act

91
Q

What kind of device mimics manual lymph drainage that can be used independently when at home?

A

pneumatic compression pump

92
Q

What is a good option of treatment for patients who refuse to wear compression garments every day to treat lymphedema?

A

pneumatic compression pump

93
Q

definition: minimally invasive surgery for lymphedema that directly connects lymphatic vessels to veins to re-route lymph fluid directly into circulatory system

A

Lymphaticovenous Anastomosis (LVA)

94
Q

definition: surgery that involves a vascularized lymph node transfer of functional lymph nodes with micro-anastomsis to area of removed or damaged node beds

A

lymph node transplant

95
Q

defintion: surgery that removes excess solids from areas of lymphedema

A

suction-assisted protein lipectomy (SAPL)

96
Q

What procedure is used for debulking lymphedema in the event of an extreme case?

A

Charles procedure

Selected Topics (8 decks)

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