BCRL Flashcards
What is the most common cancer in women within the US?
breast cancer (30% of all new female cancers)
The median age for breast cancer diagnoses is ___ y/o.
62 y/o
Incidence rates of breast cancer has increased by ___% per year.
0.5%
What is the second leading cause of cancer death in women?
breast cancer
What is the first leading cause of cancer death in women?
lung cancer
What demographic group has the highest death rate and development of breast cancer before the age of 40?
Black women
What demographic group has the lowest death rate from breast cancer?
asian/pacific islanders
What demographic group has the lowest rate of developing breast cancer?
american indian/alaska natives
What are risk factors that contribute to the development of breast cancer?
- 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
definition: tumors that start in the epithelial cells in the lining of the organs and tissue
ductal/lobular carcinoma (Adenocarcinomas)
Invasive ductal carcinoma makes up about ___-__% of call breast cancers
70-80%
definition: cancer cells that block the lymph vessels in the skin
1-5% of breast cancers
inflammatory breast cancer
What type of breast cancer is very aggressive? Why is this?
triple negative… the cells do not have estrogen, progesterone or protein HER2
What are BRCA genes?
Tumor suppressor genes that can lead to abnormal growths/cancer if there is a mutation.
_____ of women in the world with BRCA gene mutation will get breast cancer by ___ y/o
1/2, 70 y/o
(true/false) All women have the BRCA gene
true
___ out of 100 women in the general US population has BRCA gene mutation
7 out of 100
How is pathologic/surgical stage of breast cancer determined?
examining the tissue removed
How is the clinical stage of breast cancer determined?
based on results of physical exam, biopsy, and imaging
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.
Indicates the primary tumor size
A patient with breast cancer will be staged T__ if their tumor is 2-5 cm across
T2
A patient with breast cancer will be staged T__ if their tumor is <2 cm across
T1
A patient with breast cancer will be staged T__ if their tumor is >5 cm across
T3
When will a patient with breast cancer be classified as a T4?
When there is a tumor of any size growing into the chest wall or skin (this also includes inflammatory breast cancer
N (nodes) Followed by the numbers 0-3 indicates ______.
Indicates whether the cancer has spread to the lymph nodes and how many nodes are involved.
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
N1
A patient with breast cancer will be staged N__ if there are 4-9 lymph nodes involved
N2
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
N3
What are the 4 most common cancers to metastasize in order?
- bones
- lung
- brain
- liver
definition: surgeon injects a dye under the arm and then removes the lymph node(s) that have taken up the dye
sentinel node biopsy
definition: Surgeon removes many nodes (usually less than 20) from under the arm
axillary node biopsy
What type of biopsy increases the risk of lymphedema?
axillary node biopsy
(true/false) surgery does not increase the risk of lymphedema
FALSE (it does)
What is the standard schedule of radiation for patients with breast cancer?
5 days/ week for 6-7 weeks
definition: Surgery to remove the cancer as well as some of the surrounding normal tissue (margins)
–> patient will most likely need radiation therapy
breast conservation (lumpectomy/partial mastectomy)
definition: Mastectomy that removes all breast tissue INCLUDING the nipple, areola, and some overlying skin.
Muscle beneath the breast is NOT removed.
simple total mastectomy
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.
skin sparing mastectomy
What type of mastectomy is not a safe option if there is a possibility of tumor cells close to the skin?
skin-sparing mastectomy
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.
Nipple-sparing mastectomy
What type of mastectomy option allows for a more “natural” look?
nipple-sparing mastectomy
definition: Mastectomy that removes all breast tissue INCLUDING the nipple, areola, and axillary lymph nodes.
Chest wall muscle is left INTACT
modified radical mastectomy
Axillary web syndrome will occur __-__ weeks after surgery and the patient will feel cording in the tissue
1-5 weeks
What is the most common type of radiation?
external beam radiation
If you had a mastectomy and NO lymph nodes had cancer cells, the external beam radiation will be focused on what?
the chest wall, the mastectomy scar, and the places where the drains exited the body after surgery
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
focused on the whole breast
When is external beam radiation started after surgery?
Usually not started until after surgical sites have healed and after any chemotherapy treatments
External beam radiation is measured in ___.
grays
definition: Irreversible condition where there is an excess formation of Fibrous connective tissue which causes structural and functional changes
radiation fibrosis
What are potential side effects of external beam radiation?
- swelling of the breast
- skin changes
- fatigue
- radiation fibrosis
- change in the size of breasts
- inability to breastfeed
- brachial plexus damage
- weak ribs
- lymphedema
What is considered as the gold standard for measuring lymphedema volume?
water displacement
__-__% of patients during active treatments will have cancer-related fatigue
60-90%
Hemoglobin levels will be ___ in men and ___ for women with chemotherapy treatment.
Men: < 13.2
Women: < 11.6
1 in ___ women who are diagnosed with breast cancer will develop lymphedema.
1 in 5
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.
lymphedema
definition: vertical structures that assists fluid traveling from blood capillaries to lymph capillaries
pre-lymphatic channel
Where is the location of lymph capillaries?
directly under epidermis
Lymph vessels (do/do not) contain valves.
do not
Lymph capillaries are overlapping _____ cells.
endothelial
definition: Channels that move fluid to larger vessels and may absorb some fluid (like capillaries)
pre-collectors
Pre-collector channels contain ___.
smooth muscle
Perforating pre-collector connects superficial and deep lymphatics through the ____.
fascia
lymph collectors have (one/two)-way valves
one-way
What is the smallest functional unit of lymph collector?
lymphangion
lymphangions are innervated by the ____.
autonomic system
(true/false) lymph collectors absorb fluid.
FALSE (transports only)
definition: collects lymph fluid from organs, extremities, and trunk
lymph trunk
definition: transports lymph fluid into VENOUS circulation
lymph ducts
What duct in the lymphatic system empties 3/4 of all lymph fluid?
Thoracic duct
Where does lymph fluid enter the venous system?
Left subclavian vein
What duct empties the other 1/4 of lymph fluid that the thoracic duct is not responsible for?
right lymphatic duct
definition: Separate lymphatic regions associated with specific groups of lymph nodes
lymphatic watersheds
Lymph transport is regulated by what?
Intrinsic contractions of the Lymphangions
extrinsic contractions of:
- muscles
- arterial pulse
- breathing
- negative pressure in central veins
- external compression
What connects lymph collectors?
watersheds (anastomoses)
How can lymphatic load increase?
- active hyperemia (inflammation, heat, massage)
- passive hyperemia (CHF, DVT, CVI)
- hypoproteinemia (renal/liver disease)
definition: Damage to actual lymphatic system
mechanical insufficiency
What is the difference between edema and lymphedema?
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
What is considered as the gold standard of care for lymphedema?
Complete decongestive therapy (CDT)
What does the active phase (phase I) of complete decongestive theory involve?
- skin care
- bandaging
- exercise
- manual lymph drainage
What does the maintenance phase (phase II) of complete decongestive theory involve?
compression garments
self-care
HEP
definition: dried skin
skin plaques
definition: overhanging skin
skin lobules
definition: have a wart like appearance
papillomas
definition: dimpling of the skin
peau d-orange
When should strengthening exercises be initiated after surgery for lymphedema?
4-6 weeks post op
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
manual lymph drainage
definition: accumulation of interstitial fluid caused by tumor infiltration or compression of lymphatic vessels
malignant lymphedema
Manual lymph drainage is (contraindicated/indicated) for those with malignant lymphedema
CONTRAINDICATED
What are contraindications for manual lymph drainage?
- malignant lymphedema
- recent irradiated skin
- low cardiac function
- acute, untreated DVT
Short stretch compression bandages stretch ___% of their original length.
60%
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
lymphedema treatment act
What kind of device mimics manual lymph drainage that can be used independently when at home?
pneumatic compression pump
What is a good option of treatment for patients who refuse to wear compression garments every day to treat lymphedema?
pneumatic compression pump
definition: minimally invasive surgery for lymphedema that directly connects lymphatic vessels to veins to re-route lymph fluid directly into circulatory system
Lymphaticovenous Anastomosis (LVA)
definition: surgery that involves a vascularized lymph node transfer of functional lymph nodes with micro-anastomsis to area of removed or damaged node beds
lymph node transplant
defintion: surgery that removes excess solids from areas of lymphedema
suction-assisted protein lipectomy (SAPL)
What procedure is used for debulking lymphedema in the event of an extreme case?
Charles procedure
