breast CA Flashcards
breast CA
- 1:8 women; 50% are 65+
- <10% in men
- most common malignancy
- arises from epithelial lining of the ducts or lobules
possible causes of breast CA
- not understood
- related to hereditary
- genetics; gene mutation
- hormone regulation
- risk increases after 60yrs
uncontrollable risk factors of breast CA
- age
- gender
- reproductive history
- family hx
- menstrual hx
- race
- radiation
- genetics
- tx with DES
controllable risk factors of breast CA
- obesity
- exercise
- breastfeeding
- alcohol
- HRT
- BC pills
- not having children
BRCA-1
tumor suppressor gene on chromosome 17
-has 40-80% mutation causing BRCA
BRCA-2
tumor suppressor gene on chromosome 11
BRCA
- high risk for developing ovarian CA
- prophylactic bilateral oophorectomy in women with mutations to decrease risk of BRCA & ovarian CA
BRCA pathophysiology
- 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
tumor differentiation
- human epidermal growth factor receptor 2 (HER-2)
- estrogen & progesterone receptor status
HER-2
transmembrane receptor that helps regulate cells growth but over expressed in the BRCA
breast self exam may show
- painless lump or thickening
- thickening or swelling that persists
- nipple pain or retraction
- breast skin irritation or dimpling
- spontaneous discharge
s/s of breast CA in Paget’s disease
- rare BRca
- persistent lesion of nipple & areola
- with or w/o palpable mass
- dx of infection of dermatitis can delay tx
s/s inflammatory breast CA
- rare but most aggressive form
- Peau d’Orange: dimpling or orange peel-like
- skin discoloration may indicate advanced BRCA
inflammatory breast CA
- IBC
- different from other breast CA because of its clinical presentation, aggresiveness, & poor prognosis
- can closely resemble mastitis
pt who respond to IBC chemo
typically undergo mastectomy with complete axillary lymph node dissection
pt who don’t respond to IBC chemo
they are not good candidates for surgery. they may undergo additional chemo and/or radiation and later be evaluated for surgery
IBC radiation tx
-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
s/s of IBC
- rapid onset
- erythema
- engorgement
- induration
- dimpling (resembling an orange peel)
tx of breast CA
- surgery
- radiation
- hormone tx
surgery for breast CA
- 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
radiation tx for breast CA
-usually used after chemo & surgery for CA cells that might remain locally around the breast & under the arm
hormone tx for breast CA
- may retard the IBC
- series of meds that block hormones from attaching to CA cells
- tamoxifen
- aromatase inhibitors
tamoxifen
- 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
aromatase inhibitors
- drugs that block the action of an enxyme that converts androgens in the body into estrogen
- effective only in post menopausal woomen
triple negative breast CA
-basal cells line the ducts and tubes of the breast AKA basal tumor
diagnostics tests for breast CA
- clinical breast exams
- mammograms
- US
- fine needle aspiration biopsy
- stereotactic mammography needle biopsy
- lymphatic mapping & sentinal lymph node biopsy
- staging (TNM)
- BRCA 1-2
simple mastectomy
BR tissues or lymph nodes
modified radical mastectomy
- BR tissue
- axillary nodes
- some chest muscle
nursing interventions with breast CA surgery
- clarify & explain tx
- explore decisional planning
- keep arm elevated on two pillow
- encourage verbalization of feelings
complications of breast CA
- lymphedema
- recurrence (local or regional)
- metastasis
screening recommendations
- annual mammograms starting @ 40yrs
- clinical breast exam: annual @ 40 yrs; q3yrs for women 20-39
- self breast exams @ 20 yrs
nutrition guidelines
- 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
