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NUR 201 Week 13 > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Anatomy of the Breast/Breast Tissue

A

Lymph Nodes

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2
Q

Benign Breast Disorders

↠ Breast infections: mastitis/breast abscess

↠ Fibroadenoma

↠ Fibrocystic

A

↠ Ductal ectasia

↠ Intraductal papilloma

↠ Gynecomastia

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3
Q

Mastitis/abscess

  • Most lumps completely benign & caused by variety of conditions
  • Is an inflammatory condition of the breast that occurs most freq in lactating women
    > Breasts are not completely emptying during breastfeeding; milk becomes stagnant & infected
A
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4
Q

?

  • Most common in teens & through 30’s
  • Is a benign lump of connective tissue; lumpy breasts
  • Can occur anywhere on & vary in size
  • Solid, slowly enlarging, benign masses
  • Round, firm, easily movable, non-tender & clearly delineated from surrounding tissue
A

fibroadenoma

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5
Q

Fibrocystic breast disorders

  • Common; in women 20-50 y.o.
  • Usually pre-menopausal; thought to be an imbalance b/t norm estrogen/progesterone ratio
  • Breast pain; tender lumps; or areas of thickening; in UOQ
    > Menstrual cycle changes can inc sx’s; sx’s dec >menses & esp menopause
A
  • Treat = heat; dec caffeine; oral contraceptives may be helpful
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6
Q

?

Is usually seen in women approaching menopause

Duct in the breast becomes clogged, dilated, inflamed
May be some nipple d/c & usually warm compresses if needed & abx help

A

Ductal ectasia

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7
Q

?

Is a benign breast problem of women approaching menopause

Mass that’s hard w/irregular borders & tender to touch
May have some nipple d/c & some enlarged axillary nodes & edema
Usually just a duct that’s blocked
- Warm compresses & abx

A

Ductus stasis

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8
Q

?

Is inappropriate lactation from someone who’s not breastfeeding, not pregnant, not postpartum
- Can be clear or milky; may be bloody
- Usually by a hormonal disruption of some sort
* Reglan has a s/e of this (↑)

A

Galactorrhea

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9
Q

Reglan (metoclopramide)

  • Dopamine antagonist
  • anti-emetic & gut motility stimulator
A
  • Treat GERD
  • Treat gastroparesis in DM pts
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10
Q

?

Is a wort-like growth found in the mamillary ducts; is a benign tumor
- Women 40-55 y.o.
- May have bloody or serous d/c from nipple
- Usually can’t palpate any masses w/this

A

Intraductal papilloma

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11
Q

?

Occurs in perimenopausal women
Is just a mass in the duct; is benign but may need surgical intervention to remove if causing problems

A

Aductal papilloma

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12
Q

?

Is inappropriate breast development in males; a benign cond of breast enlargement
- Bilateral; in adolescent or elderly men d/t lack of muscle & inc fat
- d/t physiological, age-dependent, obesity, hepatic failure, hyperthyroidism, (testicular) tumors, cancer, rx’s (i.e., estrogen)
> Correct the underlying problem

A

Gynecomastia

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13
Q

Fibrocystic Collaborative Management

↠ Hormonal management
↠ Vitamins C, E, & B-complex
↠ Diuretics (provide relief of breast swelling <menses)
↠ ? avoidance of caffeine/reduction of dietary fat

A

↠ Mild analgesics (e.g., NSAIDs, ibuprofen, naproxen)
↠ Limiting salt intake
↠ Well padded supportive bra
↠ Heat/ice

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14
Q

Breast Cancer Risk Factors

  • Female
  • Increasing age
    > Beginning menopause @ an older age
  • Hormonal
    > Beginning your period @ a younger age (<12)
  • Late or no pregnancies
    > 1st child >30 y.o.
  • HRT
    > May affect the estrogen-progesterone balance
A
  • Personal & family hx
    > LCIS; atypical hyperplasia of the breast
    > A majority of ppl dx’d w/breast ca have no family hx
  • Genetic mutations (BRCA-1 & BRCA-2)
  • Exposure to ionizing radiation
  • Obesity/inactivity
  • Alcohol intake
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15
Q

Health Promotion

  • Decrease alcohol consumption
  • Exercise
  • Decrease fat intake
A
  • Ideal weight
  • Breast self-exam (BSE)
  • Mammogram
  • Clinical breast exam
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16
Q

BSE

  • Provide teaching
  • Best performed 5-7 days >1st day of menses or once monthly for postmenopausal women
A
  • Review the feel of the normal breast tissue & identify changes
  • Routine BSE helps pts become familiar with their own “normal”
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17
Q

Mammogram

  • The ACS still recommends that women 40-44 should have the choice whether or not to have a mammogram
A
  • All women should be familiar w/the known benefits, limitations, & potential harm linked to breast ca screening
18
Q

Women __ and older should switch to mammograms q2yr, or can continue yearly screening

Screening should continue as long as woman is in good health & is expected to live 10 yrs+

A

55

19
Q

Women age __ to __ should get mammograms every yr

A

45-54

20
Q

Breast Cancer

Relevant Cues
> Presence of a new mass or lump

Management/Take Action
> Diagnostic tests incl mammography, US, MRI, biopsy
> Lab data incl a CBC w/plt, LFTs, & cxr

A

Treatment
> Surgery, chemotherapy, & radiation

Surgery alternatives
> Breast conservation therapy (lumpectomy), or total mastectomy

Treatments for in situ lesions
> Lobular carcinoma in situ is not considered invasive but does inc chances of developing invasive breast ca; surgery may be an option
> Ductal carcinoma in situ (DCIS) has surgical treatment

21
Q

Pathophysiology

  • Cells can invade nearby tissues & spread to other areas through the bloodstream & lymphatic system
  • Breast ca can be divided into a series of categories r/t size, spread to lymph nodes, & distant spread of breast tumor to oth tissues (metastasis)
A
  • 1st category incl in situ lesions of ductal carcinoma in situ (DCIS) & lobular carcinoma in situ (LCIS)
22
Q

Clinical Manifestations/Relevant Cues

↠ Cancerous masses are typically hard, irregular, & painless but may be soft or rounded & tender

↠ Are sometimes changes in the breast shape or swelling

↠ Skin changes like peeling, flaking, pitting, dimpling, or redness

A

↠ May be nipple changes like inversion, thickening of tissue, or drainage

23
Q

Management/Take Action

☀ A baseline bone scan & liver scan may be obtained if pt is found to have skeletal sx’s or abn LFT’s

☀ CT of abdomen & bone scan also

A
24
Q

Taking Actions

Treatment
> Surgery, chemotherapy, & radiation

Surgery alternatives
> Breast conservation therapy (lumpectomy), or total mastectomy

A

Treatment for in situ lesions

25
Q

___ requires surgical treatment

Lesions thought to be large (>4 cm) require mastectomy

A

Ductal carcinoma in situ (DCIS)

26
Q

___ is another type of noninvasive dz

Cells look like ca cells & are contained within the lobules (milk-producing glands) of the breast

This is not considered ca but does inc the pt’s risk for developing invasive breast ca

Usually dx’d <menopause in women 40-50 y.o.

Traditionally treated w/close observation only but surgical excision is an option

A

LCIS

27
Q
  • Treatment for intermediate-stage & advanced-stage cancers (operable)
    > Preoperative neoadjuvant chemo
  • 1st line of treatment unless pt has underlying comorbids that preclude use of chemo
A

When treatment is given <surgery, it’s called neoadjuvant therapy or preoperative therapy

Neoadjuvant chemo & hormone therapy rx’s are the same as those used after surgery (adjuvant therapy)

28
Q
  • Treatment for locally adv/inoperable cancers
    > Neoadjuvant chemo & possible radical mastectomy
A
29
Q
  • Treatment for local recurrence & systemic metastases
    > Tumor not initially operable, chemo considered
A

> When work-up demonstrates that recurrence of tumor is confined to breast alone, a course of curative therapy is started

> For pts that’ve undergone initial breast conservation therapy, a complete mastectomy is next step. If tumor isn’t initially operable, chemo may be considered

30
Q

Breast Cancer in Men

> 1%
Hard, painless subareolar mass
Usually found @ a later stage than women (poorer prognosis)

A

Common Sites of Metastasis

  • Bone (spinal cord, skeleton, ribs)
  • Brain (HA, sensory loss, seizures, hemiparesis)
  • Lung (sob, tachycardia, non-productive cough)
  • Liver (jaundice, pain)
  • Bone marrow (anemia, infection, bleeding)
31
Q

Relevant Cues: S/S

  • Lump (single, firm, painless)
  • Nipple d/c
  • Dimpling
  • Nipple retraction
  • Induration
  • Edema, erythema
A

Staging

  • Tumor is staged according to extent of what’s happening; permits an accurate definition of dz extent; allows for more acc prognosis
    ? extends to chest wall or skin
    ? any axillary or lymph node involvements
    ? fixed or mobile
    ? has metastasized
32
Q

Stage ___

ductal carcinoma in situ (DCIS), or the lobular carcinoma in situ (LCIS)

A

0

33
Q

Stage __ and __

Is the extent of spread to lymph/axillary nodes

A

2, 3

34
Q

Stage ___

2cm or less, no lymph involvement, no metastasis

A

1

35
Q

Stage ____

Tumor of any size w/direct extension to chest wall or skin & w/distant metastasis

A

4

36
Q

Surgical Therapy

  • Breast conservation
  • Mastectomy
A

↠ Lumpectomy vs mastectomy will depend on not only tumor size & node involvement but MD & pt preference

↠ Breast conservation, preservation will make a wide excision of tumor & lymph node dissection; may be used w/radiation therapy
> For when you want to preserve as much breast tissue as possible (stages 1 & 2)
> Contraindicated in those w/an intolerance to radiation, pregnancy, or pre-existing rheumatic disorders like lupus or arthritis

S/e = breast pain, soreness, edema, skin reactions, arm swelling, sensory changes in breast & arm, fatigue, hematomas, infection, impaired mobility & prolonged treatment

37
Q

Mastectomies can be radical, simple, or modified radical

A
38
Q

Preoperative Nursing Diagnosis

  • Deficient knowledge
  • Anxiety/Fear
  • Risk for ineffective coping
A
39
Q

Preoperative Interventions

  • Review & reinforce info on treatment options
  • Prepare pt regarding what to expect before, during, & >surgery
  • Inform pt regarding surgical drains, arm/shoulder mobility, & ROM exercises
  • Maintain open communication
A
  • Provide pt w/realistic expectations
  • Support coping
  • Involve or provide info for supportive services & resources
  • Support pt decisions
40
Q

Postoperative Nursing Diagnoses

  • Disturbed body image
  • Impaired skin integrity
  • Pain
A
  • Deficient knowledge
  • Risk for injury
  • Self-care deficit
  • Breast prostheses
41
Q

Postoperative Interventions

  • Teaching is very important
  • Inform pt re: common postop sensations
  • Maintain privacy
  • Provide info
  • Support, coping & adjustment
  • Provide counseling & referral
  • Monitor for potential complications
A

Postoperative Care

  • Avoidance of using the affected arm for BP management, giving inj or drawing of blood
  • Careful monitoring of VS
  • Comfort measures
  • Mobility & diet
  • Breast reconstruction
  • Care of drainage tubes
42
Q

Nursing Diagnoses

↠ Acute pain r/t surgical procedure
↠ Anxiety r/t situational crisis & unpredictable outcome
↠ Disturbed body image r/t perceived effects of mastectomy
↠ Impaired physical mobility r/t weakness & muscle loss
↠ Ineffective therapeutic regimen management r/t lack of knowledge re: dz

A

Evaluating Outcomes

↠ Survival
↠ Prolonging life
↠ Eliminating or limiting chemo & radiation s/e
↠ Wound healing
↠ Absence of infection
↠ Emotional stability
↠ Support systems

NUR 201 Week 13 (4 decks)

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