Breast Cancer Flashcards
What are the highest risk factors of breast cancer for women?
- ≥60 years of age
- Family history
- Personal history of cancer (breast, colon, endometrial, ovarian)
- Early menarche or late menopause
- Full-term pregnancy >30 years of age
True or False
Having any first-degree relative with breast cancer increases a woman’s risk of breast cancer 1.5 to 3 times, depending on age.
• True
What are some other risk factors for breast cancer in women?
- Weight gain and obesity after menopause
- Exposure to ionizing radiation
- Combined hormone replacement therapy
Women who have BRCA-1 and BRCA-2 mutations have a __% to __% lifetime chance of developing breast cancer.
• 40% to 80%
A female patient presents with a persistent lesion of the nipple and areola w/ s/s of itching, burning and bloody nipple discharge. This is indicative of what condition?
• Paget’s Disease (of the breast)
What is the treatment for Paget’s Disease?
• Simple or modified radical mastectomy.
What indicates a good prognosis w/ Paget’s Disease?
• When it is confined to the nipple
What are some common s/s of breast cancer?
- Hard lump, Irregularly shaped, poorly delineated, non-mobile, non-tender
- Irritation or dimpling of breast skin (peau d’orange)
- Redness or flaky skin in the nipple area or the breast.
- Inverted nipple
- Nipple discharge other than breast milk, including blood.
- Any change in the size or the shape of the breast.
- Pain in any area of the breast.
On what location of the breast do most breast cancers occur?
• Upper lateral aspect of either breast
What are the clinical manifestations of a local breast cancer reoccurrence in the skin or chest wall?
• Firm discrete nodules, occasionally pruritic, usually painless, commonly in or near a scar
What are the clinical manifestations of a regional breast cancer reoccurrence?
• Enlarged nodes in axilla, supra clavicular area
Progressive back-pain, bowel and bladder function, and lower sensation loss can indicate distant metastasis in what location?
• Spinal cord
Headache described as different, unilateral sensory loss/weakness, ataxia, and N/V can indicate distant metastasis in what location?
• Brain
Shortness of breath, tachypnea, and cough can indicate distant metastasis in what location?
• Pulmonary
Abdominal distention/ascites Rt lower quadrant pain , nausea/vomiting, weight loss ,jaundice, peripheral edema can indicate distant metastasis in what location?
• Liver
Anemia, infection, weakness, increased bleeding and infection risk, petechiae, mild confusion, and dyspnea can indicate distant metastasis in what location?
• Bone marrow
Besides physical examination, what are diagnostic studies done for breast cancer?
- Mammography
- Ultrasound
- Biopsy
- MRI, if indicated
Why is lymphatic mapping performed w/ breast cancer?
• To see if there is any lymphatic involvement and if so, the extent
Why is a lymph node dissection performed?
• To remove any lymph nodes that may contain cancer cells and prevent metastasis
Is a well differentiated breast tumor more or less aggressive?
• Less
Breast cancer is rated from stage I to Stage IV. Describe stage 1 and stage 4.
- I: Small (<2cm) tumor w/ no lymph node involvement
* IV: Any size tumor w/ nodal involvement and distant metastasis
Lymphedema is a result what procedure associated w/ mastectomy?
• Axillary node dissection
What is lymphedema and what causes it?
- Accumulation of lymph in the soft tissues
- Cause: When axillary nodes cannot return lymph fluid to central circulation, fluid accumulates in arm, causing obstructive pressure on veins and venous return.
Lymphedema causes what other clinical manifestations?
- Pain
- Impaired motor function in arm
- Numbness
- Paresthesia of the fingers
What is the treatment for acute lymphedema?
- Complete decongestive therapy
- Elevation of arm (level with heart)
- Diuretics
- Isometric exercises
- Wearing a fitted elastic pressure gradient sleeve during waking hours
True or False
Blood pressure readings, venipunctures, and injections should not be done on an arm with Lymphedema.
• True
What is the patient education provided re: lymphedema post mastectomy?
- Instruct patient to protect arm from even minor trauma (e.g., sunburn, pinprick).
- Advise surgeon of all traumas, and observe site for inflammation.
- Make sure patient understands that there will always be a risk for lymphedema.
Breast cancer is treated w/ Chemo/radiation therapy and surgery. What would warrant chemotherapy before radiation?
• Evidence of systemic disease
What are the goals of combined surgery and radiation for breast cancer?
- Maximize benefits of cancer tx and cosmetic outcome
* Minimize risks
A modified radical mastectomy is the removal of breast and axillary lymph nodes but preserves…
• The pectoralis major muscle
What is Postmastectomy Pain Syndrome?
• Unusual pain associated symptoms that last beyond the 3 month mastectomy healing time.
What are the s/s of Postmastectomy Pain Syndrome?
- Chest and upper arm pain, tingling down arm
- Numbness, shooting or prickling pain
- Unbearable itching
Treatment for Postmastectomy Pain Syndrome includes the use of what types of drugs?
- NSAIDS
- Antidepressants
- Antiseizure drugs
- Topical lidocaine patches
Restoring arm function on affected side after mastectomy and axillary lymph node dissection is one of the most important goals. What are the associated interventions?
- Place in a semi-Fowler’s position with arm on affected side elevated on a pillow.
- Flexing and extending fingers should begin in recovery room
- Postoperative arm and shoulder exercises are instituted gradually at surgeon’s direction
Postmastectomy exercises are designed to:
- Prevent contractures and muscle shortening
* Maintain muscle tone, and improve lymph and blood circulation.
The goal of all exercise is a gradual return to full range of motion in what time frame
• Within 4 to 6 weeks post-mastectomy
What is the follow up schedule for a patient that has had breast cancer and mastectomy?
• Every 6mos for 2yrs, then annually
True or False
Breast cancer is one of the solid tumors that is least responsive to chemotherapy.
• False, it is one of the MOST responsive
Estrogen can increase growth of breast cancer cells if cells are estrogen receptor positive. How is this addressed with drugs?
• Hormonal therapy: removes or blocks source of estrogen, promoting tumor regression
Tamoxifen (Nolvadex) is what type of drug and how does it treat breast cancer?
- It is an anti-estrogen
* By blocking estrogen, it starves the tumor of it and the tumor shrinks
Fever, inflammation, and erythema at the surgical site. Why should these symptoms be reported?
• Possible infection
Any unusual swelling. Why should this be reported?
• Indicates possible lymphedema, possible metastasis
Unusual, persistent back pain. Why should these symptoms be reported?
• Possible spinal/bone metastasis
Persistent weakness. Why should this be reported?
• Could be indicative of anemia through bone metastasis
Persistent shortness of breath. Why should this be reported?
• Possible metastasis to lungs
Episodes of confusion. Why should this be reported?
• Possible metastasis to brain.
True or False
Major risk for breast cancer is increased age.
• True
True or False
Less than half of all breast cancers are diagnosed in women age 65 or older.
• False, MORE than half are
Tolerance to treatment and long-term prognosis are influenced more by patient’s _____ than by age.
• Health status
