Breast Cancer Flashcards
Breast cancer is the ___ leading cause of death.
What cells are affected?
What is key for increased survival?
4th leading cause of death
Epi cells surrounding mammary ducts or lobules
EARLY DETECTION
- increases survival when it’s localized.
Which population tends to have worse outcomes?
African American AFABs
- Diagnosed later
- Worse outcomes
Multifactorial; health disparities
3 Categories of Breast Cancer:
technically only 2…
- Noninvasive (20%): w/in duct
- Invasive (80%): duct + tissue
- Metastasized: bone, liver, lung, brain
5 Types of Breast Cancer:
Which type is non-invasive?
Which isn’t a “true” cancer?
- Ductal Carcinoma in Situ → non-invasive
- Lobular Carcinoma in Situ → not “true” CA
- Infiltrating Ductal Carcinoma
- Inflammatory Breast cancer
- Triple-negative breast cancer
Types of Breast Cancer:
Ductal Carcinoma in Situ
Early, non-invasive breast cancer
About 14-50% of these cases will become invasive if left untreated
Lack Biologic capacity to metastasize
Types of Breast Cancer:
Lobular Carcinoma in Situ
Typical age of diagnosis?
Rare cancer that begins in the lobules
- Not a “true” cancer → CAN’T spread
Increases the chance that breast cancer will develop later
Typically diagnosed at 40-50
Observation?? (don’t know what she meant..)
Types of Breast Cancer:
Infiltrating Ductal Carcinoma
Presentation?
What defining characteristics occur late in disease?
Starts in mammary ducts and epithelial cells lining the ducts then grow into tissue in an irregular pattern.
Presentation:
-Felt as a poorly defined, irregular lump
Late in Disease:
- Fibrosis will develop around lump (dimpling)
- Peau D’Orange due to edema can develop later in disease also
Types of Breast Cancer:
Inflammatory Breast cancer
Diagnosis?
Presentation?
Invasive; Highly aggressive
Typically diagnosed later in disease
May not show up on a mammogram
Presentation:
- No palpable lump
- Redness, Swelling, Pain
Types of Breast Cancer:
Triple-negative breast cancer
What risk factors are associated with this?
What population is at a higher risk of developing this?
Invasive; Highly Aggressive Lacks receptors typical to Breast Cancer - No estrogen receptor - No progesterone receptor - No human epidermal growth factor 21
Risk factors:
BRCA positive + Pre-menopausal
African American Women are at higher risk compared to other races
What % of breast cancer is associated with males?
Issues?
Presentation?
<1%
Diagnosis often delayed → worse outcomes
Presentation:
hard, painless lump; Sub-areolar
With or Without gynecomastia
Breast Cancer + Risk Factors
Non-environmental
- Gender
- 99% AFAB - Age
- 95% of cases >40 yrs - Genetics (BRCA-1 or BRCA-2)
- 1st Degree relative (sister, mom, daughter) - Bone density
- Increased bone density increases risk - Early menstruation or Late menopause
- Atypical hyperplasia
Breast Cancer + Risk Factors
Environmental
- Alcohol
- Obesity
- Hormone Replacement Therapy (HRT)
- Oral Contraceptics w/ Estrogen
- Null Parity
- Radiation exposure
Breast Cancer + Screening
What’s the test?
What age is recommended for screening with no risk factors?
Mammogram
AFAB >40 years for AVERAGE RISK
Breast Cancer + Screening
At what age should screening be done annually?
AFAB >50 years
Breast Cancer + Screening
At what age should screening be done for people with a 1st degree relative with breast cancer or gene mutation?
How often?
Does testing differ?
Screened 10 years before their 1st-degree relative developed breast cancerANNUALLY
Mammogram + MRI (& ultrasound?)
Breast Cancer + Screening
When should Self-Breast exams (SBEs) be done and what’s important to know?
Assess at the same time every month
KNOW YOUR NORMAL
- Some lumps are normal
- Report changes
→ schedule a Provider Breast Exam
Breast Cancer + Diagnosis
What tests are used for diagnosis?
What confirmation test is used if a mass is identified?
Diagnostic mammogram =
mammogram + ultrasound
Biopsy
Breast Cancer + Diagnosis
What other tests are used for Diagnosis?
- Liver enzymes (ALT, AST, AlkP)
- Calcium levels
- Breast tomosynthesis
- CXR
Breast Cancer + Prevention
What type of prevention do we implement for High-risk people? (4)
For pts w/ BRCA-1/BRCA-2 gene mutation
Secondary prevention:
- Annual mammograms & MRI
- Clinical breast exams
- Prophylactic mastectomy/oophorectomy
- Anti-Estrogen chemotherapeutic agents
Breast Cancer + Assessment Patient History (3)
- Identify Risk factors
- Identify any Breast mass
- Health Maintenance
Breast Cancer + Physical Assessment
What technique is used for a Clinical Brest exam performed by an AP?
”face of the clock” method for lump location
Breast Cancer + Physical Assessment
What 3 broad things are we looking at?
- Lump characteristics:
- Skin changes
- Pain
Breast Cancer + Physical Assessment Lump characteristics (4)
- Shape
- Size
- Consistency
- fixed or mobile
Breast Cancer + Physical Assessment Skin Changes (3)
- Peau D’orange
- Nipple changes
- Ulceration
Breast Cancer + Interventions
What type of interventions are best?
CAM
80% of AFABs use some form of complementary alternative medicine.
Breast Cancer + CAM Interventions
What’s important to educate our patients about related to CAM?
Name some CAM therapies:
Tell the provider about any and all CAM!
- Vitamins
- Diet
- Herbal Therapy
- Massage
- Meditation
- Acupuncture
Breast Cancer + Tx Interventions
Plan is based on _____, _____, and _____.
Type, Extent, and Location of possible Mets
Breast Cancer + Tx Interventions
4 Types of Treatments:
- Surgery
- Radiation
- Chemotherapy
- Hormonal therapy
Breast Cancer + Tx Interventions
6 Types of Surgery:
- Lumpectomy
- Partial Mastectomy
- Total Mastectomy
- Radical Mastectomy
- all breast tissue removed + lymph nodes - Neoadjuvant
- Reconstruction
Breast Cancer + Surgery
Differentiate b/t Total Mastectomy, Radical Mastectomy, & Neoadjuvant
Total → removal of all breast tissue
Radical → removal of all breast tissue + Lymph nodes
Neoadjuvant → removal of all breast tissue & Lymph nodes + Chemo/Radiation
Breast Cancer + Post-surgical Interventions:
What should we NOT do r/t the side that had a mastectomy? (2)
What if the patient had a double mastectomy?
What could this put the patient at risk for?
- No BP readings on affected side
- NO venipuncture on affected side
Take BP readings on the LEG
RISK FOR LYMPHEDEMA
(if BP done on the affected side)
Breast Cancer + Tx Interventions
What Precautions should we employ r/t mastectomy? (1)
BEST PRACTICE?
- ADD a SIGN OVER the BED!
BEST PRACTICE:
ASK THE PATIENT!!
AND
EDUCATE them to advocate for themselves
Breast Cancer + Post-surgical Interventions
How often do we take VS? (review)
What are we monitoring for?
Drains?
Positioning?
Pain?
- Vital Signs
- q15 min for 1st hr →
- q30 min for next hr →
- q1 hr for next 12 hrs - Bleeding assessments
- Drain care
- Type of drains that’ll be used
- Want serosanguinous
- Monitor for sanguineous - Position
- Semi-fowlers - Pain Management
- Multimodal (opioids 1st → then switch)
Breast Cancer + Post-surgical Interventions
What type of exercises do we employ?
When do they start active ROM & what Key Teaching do we need to prove?
Arm exercises
→ Elbow extension & flexion
→ Squeezing a medicine ball
Active Rom → 1 week post-op
Key teaching:
Don’t perform active ROM to the point that it HURTS!!
Breast Cancer + Post-surgical Interventions
Home care Patient Teaching
- Activity restrictions
- NO lotion or deodorant (sorry, you gotta stank for awhile)
- NO elevating arm above the head!
- ENCORE referral (YMCA)
- Lymphedema teachings→
Breast Cancer + Post-surgical Interventions
Activity nursing considerations (3)
- Walking :)
- Incentive spirometer
- CONSULT W/ PT!!
Breast Cancer + Post-surgical Interventions
What increases the risk for Lymphedema? (4)
- Obesity
- Extensive Axillary disease
- Infection during recovery
- Radiation
Breast Cancer + Post-surgical Interventions
Lymphedema Education:
- Instruct pt that they’ll be aiming to prevent this for the rest of their life… :(
- Educate on S/S
- Feeling of heaviness
- Aching
- Numbness, paresthesia (Tingling of arm)
- Swelling in arm or upper chest - Contact Provider ASAP if S/S occur!!
Breast Cancer + Radiation
When would Radiation therapy be employed?
Name the 2 types:
5-6 weeks post-surgery
Types:
- Whole breast
- Partial breast
Breast Cancer + Chemotherapy
How and when is this given?
Duration?
Central IV Access
Combination Regimen
4-6 week cycles (for 2-3 weeks)
Total treatment time is 3-6 months
Breast Cancer + Chemotherapy
Nurse’s Role (3)
- Administer Chemotherapy
- Manage Central Line
- Manage symptoms
Breast Cancer + Hormonal Therapy
Why is this done?
When can we use this?
What can occur?
- Reduce Hormones (estrogen, progesterone) available to Cancer
- Only for cancers with hormone receptors
(doesn’t work for triple negative) - Menopausal Symptoms
