Breast Cancer Flashcards
What is key to breast cancer prevention?
early detection
PATHO of breast cancer
Begins as a single transformed cell Grows and multiplies in the epithelial cells that line the mammary ducts or lobules Many forms • May be a palpable lump • May only be evident on a mammogram
Invasive vs noninvasivee BC (+percents)
• Noninvasive
20% –>Cancer remains within the duct
• Invasive
80% –> Cancer spreads into the tissue surrounding the duct
What is a metastasis in relation to BC- most common places?
Cancer cells leave the breast
Most common places for Mets: Blood, Lymph, Bone, liver, lung, and brain
Ductal Carcinoma In Situ (DCIS)
what is it? early or late?
=Early, noninvasive breast cancer
• About 14-50% of these cases will become invasive if left untreated
• Lack biologic capacity to metastasize
Lobular Carcinoma In Situ
what is it? when diagnosed? management?
=Rare cancer that begins in the lobules
–>Not a true cancer – cannot spread/become invasive
• Increases the chance that the breast cancer will develop later
• Typically diagnosed at 40-50 yo
• Management: Observation
Infiltrating/Invasive Ductal Carcinoma (IDC)
what is it? what does it feel like?
= Invasive cancer that starts in mammary ducts and epithelial cells lining the ducts
• Grows into a tissue in an irregular pattern
• May be felt as a poorly defined, irregular lump
• Fibrosis will develop around the lump (dimpling= later in disease)
◦ Peau D’orange
Inflammatory Breast Cancer-
what does it look like/feel like, when do we diagnose it in disease process?
= Highly aggressive, Invasive ◦ Swelling ◦ Pain • Typically diagnosed later in disease, dimpling, peau d'orange • May not show up on mammo • No palpable lump
Triple Negative Breast Cancer
what is it? common in what population?
= Highly aggressive
• Lacks receptors typical to breast cancer
◦ No estrogen receptor
◦ No progesterone receptor
◦ No human epidermal growth factor 21
• Common in females who are BRCA + and pre-menopausal
• AA women are at higher risk compared to other races
Male breast cancer presentation/ considerations
= Less than 1% of breast cancer cases • Typically presents ◦ as hard, painless lump ◦ Sub-areolar ◦ With or without gynecomastia • Diagnosis often delayed
BC risk factors
• Gender- females more likely • Genetics ◦ BRCA 1 ◦ BRCA 2 ◦ 1st degree relative: sister, brother, daughter • ^ Age • Bone density • Early menstruation or late menopause • Atypical hyperplasia • Alcohol consumption • Obesity • Hormone replacement therapy • Oral contraceptives • Null parity • Radiation exposure
When to get screening- high risk vs not
• High risk screening = conversation early- before age of 40, get mammo 10 years younger than when 1st degree relative developed cancer
+MRI/ Ultrasound
- Not high risk= age 40-50, annual mammo
when can you stop getting mammos?
75
whats up with breast exams?
• Self-exams ◦ People should be familiar with their breasts ◦ Report changes • Some lumps are normal Also have provider do it
Females at high risk for breast cancer interventions
- Secondary prevention
- Annual mammos
- Clinical breast exams
- Annual MRI screening
- Prophylactic mastectomy/oopherectomy
- Anti-estrogen chemotherapeutic agents
BC assessment
• History ◦ Risk factors ◦ Breast mass ◦ Health maintenance • “Face of the clock” method for lump location • Shape, size, consistency, fixed, or mobile • Skin changes ◦ Peau d’orange ◦ Nipple changes ◦ Ulceration • Pain
Diagnostics for BC
- Pathology of tissue/biopsy
- Liver enzymes
- Calcium
- Alkaline phosphatase
- Mammo
- Breast tomosynthesis
- Ultrasonography
- MRI
- Chest x-ray
Mammography/ Ultrasound = diagnostic
High risk: Annual Mammo + MRI
Interventions for BC (medical)
how do they determine what type of intervention?
• Surgery • Radiation • Chemotherapy • Hormonal therapy -->Plan is based on type of cancer and extent and location of mets
About 80% of women with BC utilize some form of complementary alternative medicine
Vitamins Diet Herbal therapy Massage Meditation Acupuncture
Breast conserving vs breast removal surgeries
• Breast Conserving Surgery = save as much of breast tissue as possible
◦ Lumpectomy
◦ Partial mastectomy
• Breast Removal Surgery= remove as much of breast tissue as possible
◦ Total mastectomy
◦ Radical mastectomy
• Neoadjuvant =
radiation then surgery
2 biggest post op mastectomy considerations
- No BP readings on affected side
* No venipuncture on affected side
other post op mastectomy considerations/interventions
-Vital signs
-Bleeding
-Drain care: should reduce over time, if becoming more sanguineous= report
-Positioning
-Pain management: multimodal, opioids post op probably
-Arm exercises: do not move past point of pain
-Squeeze ball
-Elbow extension/flexion
-Activity restrictions
-Home care
◦ No lotion, deodorant
◦ Elevation of arm
◦ Encore: support at YMCA
◦ Lymphedema
What is lymphedema and when gonna call the provider?
- Education: no BP in that arm ever
- Feeling of heaviness, aching, numbness, swelling, tingling of arm
- Swelling in upper chest
- Contact Provider if these sxs develop!
increased risk of lymphedema with
- Obesity
- Extensive axillary disease
- Infection
- Radiation
3 things about radiation and BC (when, how long, where)
- Post surgery
- 5-6 week period
- Whole breast vs partial breast
Chemotherapy things - cycles, total time, regimen types?
- Central IV access
- Combination regimen
- 4-6 week cycles (for 2-3 weeks)
- Total treatment time is 3-6 months
nurse role in chemo (3)
- Administer chemo
- Manage central line
- Manage symptoms
when we use hormone therapy with BC? what kind of sxs?
=Reduce hormones (ER, PR) available to cancer
- Only for cancers with hormone receptors
- > Menopausal symptoms
