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Med surg > breast CA > Flashcards

breast CA Flashcards

1
Q

breast CA

A
  • 1:8 women; 50% are 65+
  • <10% in men
  • most common malignancy
  • arises from epithelial lining of the ducts or lobules
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2
Q

possible causes of breast CA

A
  • not understood
  • related to hereditary
  • genetics; gene mutation
  • hormone regulation
  • risk increases after 60yrs
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3
Q

uncontrollable risk factors of breast CA

A
  • age
  • gender
  • reproductive history
  • family hx
  • menstrual hx
  • race
  • radiation
  • genetics
  • tx with DES
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4
Q

controllable risk factors of breast CA

A
  • obesity
  • exercise
  • breastfeeding
  • alcohol
  • HRT
  • BC pills
  • not having children
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5
Q

BRCA-1

A

tumor suppressor gene on chromosome 17

-has 40-80% mutation causing BRCA

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6
Q

BRCA-2

A

tumor suppressor gene on chromosome 11

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7
Q

BRCA

A
  • high risk for developing ovarian CA

- prophylactic bilateral oophorectomy in women with mutations to decrease risk of BRCA & ovarian CA

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8
Q

BRCA pathophysiology

A
  • BRCA mostly arises from epithelial lining of the ducts (most invasive) or lobules epithelium
  • BRCA is invasive or in situ
  • the greater the size & axillary node involvement, the worse
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9
Q

tumor differentiation

A
  • human epidermal growth factor receptor 2 (HER-2)

- estrogen & progesterone receptor status

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10
Q

HER-2

A

transmembrane receptor that helps regulate cells growth but over expressed in the BRCA

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11
Q

breast self exam may show

A
  • painless lump or thickening
  • thickening or swelling that persists
  • nipple pain or retraction
  • breast skin irritation or dimpling
  • spontaneous discharge
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12
Q

s/s of breast CA in Paget’s disease

A
  • rare BRca
  • persistent lesion of nipple & areola
  • with or w/o palpable mass
  • dx of infection of dermatitis can delay tx
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13
Q

s/s inflammatory breast CA

A
  • rare but most aggressive form
  • Peau d’Orange: dimpling or orange peel-like
  • skin discoloration may indicate advanced BRCA
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14
Q

inflammatory breast CA

A
  • IBC
  • different from other breast CA because of its clinical presentation, aggresiveness, & poor prognosis
  • can closely resemble mastitis
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15
Q

pt who respond to IBC chemo

A

typically undergo mastectomy with complete axillary lymph node dissection

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16
Q

pt who don’t respond to IBC chemo

A

they are not good candidates for surgery. they may undergo additional chemo and/or radiation and later be evaluated for surgery

17
Q

IBC radiation tx

A

-targets the chest wall & lymph nodes in the axillary, infraclavicular, supraclavicular, & internal mammary regions with a combo of electron & photon tangent fields or matched electron fields to minimize the risk to nearby organs

18
Q

s/s of IBC

A
  • rapid onset
  • erythema
  • engorgement
  • induration
  • dimpling (resembling an orange peel)
19
Q

tx of breast CA

A
  • surgery
  • radiation
  • hormone tx
20
Q

surgery for breast CA

A
  • modified radical mastectomy: removes the entire breast, skin envelope, IMF, part of the pec minor
  • lymph nodes are tested for signs of CA with a sentinel node biopsy
  • if positive, an axillary node dissection is performed
  • lumpectomy
  • quadrantectomy
  • simple mastectomy
  • modified radical mastectomy
  • sentinel lymph node biopsy
  • breast implants
  • nipple areolar reconstruction
21
Q

radiation tx for breast CA

A

-usually used after chemo & surgery for CA cells that might remain locally around the breast & under the arm

22
Q

hormone tx for breast CA

A
  • may retard the IBC
  • series of meds that block hormones from attaching to CA cells
  • tamoxifen
  • aromatase inhibitors
23
Q

tamoxifen

A
  • SERM
  • block any estrogen present in the body from attaching to the receptor on the CA cells
  • slows the growth of tumors & killing tumor cells
24
Q

aromatase inhibitors

A
  • drugs that block the action of an enxyme that converts androgens in the body into estrogen
  • effective only in post menopausal woomen
25
Q

triple negative breast CA

A

-basal cells line the ducts and tubes of the breast AKA basal tumor

26
Q

diagnostics tests for breast CA

A
  • clinical breast exams
  • mammograms
  • US
  • fine needle aspiration biopsy
  • stereotactic mammography needle biopsy
  • lymphatic mapping & sentinal lymph node biopsy
  • staging (TNM)
  • BRCA 1-2
27
Q

simple mastectomy

A

BR tissues or lymph nodes

28
Q

modified radical mastectomy

A
  • BR tissue
  • axillary nodes
  • some chest muscle
29
Q

nursing interventions with breast CA surgery

A
  • clarify & explain tx
  • explore decisional planning
  • keep arm elevated on two pillow
  • encourage verbalization of feelings
30
Q

complications of breast CA

A
  • lymphedema
  • recurrence (local or regional)
  • metastasis
31
Q

screening recommendations

A
  • annual mammograms starting @ 40yrs
  • clinical breast exam: annual @ 40 yrs; q3yrs for women 20-39
  • self breast exams @ 20 yrs
32
Q

nutrition guidelines

A
  • eat a variety of healthy foods, emphasis on plant sources
  • eat 5+ servings of vegetables & fruits
  • choose whole grains vs processed grains
  • limit consumption of red meats
  • balance caloric intake with physical activity
  • lose weight if overweight or obese
  • adapt a physical active lifestyle
  • limit alcohol

Med surg (11 decks)

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