Breast Cancer Flashcards
Anatomy of the Breast/Breast Tissue
Lymph Nodes
Benign Breast Disorders
↠ Breast infections: mastitis/breast abscess
↠ Fibroadenoma
↠ Fibrocystic
↠ Ductal ectasia
↠ Intraductal papilloma
↠ Gynecomastia
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
?
- 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
fibroadenoma
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
- Treat = heat; dec caffeine; oral contraceptives may be helpful
?
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
Ductal ectasia
?
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
Ductus stasis
?
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 (↑)
Galactorrhea
Reglan (metoclopramide)
- Dopamine antagonist
- anti-emetic & gut motility stimulator
- Treat GERD
- Treat gastroparesis in DM pts
?
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
Intraductal papilloma
?
Occurs in perimenopausal women
Is just a mass in the duct; is benign but may need surgical intervention to remove if causing problems
Aductal papilloma
?
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
Gynecomastia
Fibrocystic Collaborative Management
↠ Hormonal management
↠ Vitamins C, E, & B-complex
↠ Diuretics (provide relief of breast swelling <menses)
↠ ? avoidance of caffeine/reduction of dietary fat
↠ Mild analgesics (e.g., NSAIDs, ibuprofen, naproxen)
↠ Limiting salt intake
↠ Well padded supportive bra
↠ Heat/ice
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
- 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
Health Promotion
- Decrease alcohol consumption
- Exercise
- Decrease fat intake
- Ideal weight
- Breast self-exam (BSE)
- Mammogram
- Clinical breast exam
BSE
- Provide teaching
- Best performed 5-7 days >1st day of menses or once monthly for postmenopausal women
- Review the feel of the normal breast tissue & identify changes
- Routine BSE helps pts become familiar with their own “normal”
Mammogram
- The ACS still recommends that women 40-44 should have the choice whether or not to have a mammogram
- All women should be familiar w/the known benefits, limitations, & potential harm linked to breast ca screening
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+
55
Women age __ to __ should get mammograms every yr
45-54
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
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
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)
- 1st category incl in situ lesions of ductal carcinoma in situ (DCIS) & lobular carcinoma in situ (LCIS)
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
↠ May be nipple changes like inversion, thickening of tissue, or drainage
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
Taking Actions
Treatment
> Surgery, chemotherapy, & radiation
Surgery alternatives
> Breast conservation therapy (lumpectomy), or total mastectomy
Treatment for in situ lesions
___ requires surgical treatment
Lesions thought to be large (>4 cm) require mastectomy
Ductal carcinoma in situ (DCIS)
___ 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
LCIS
- 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
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)
- Treatment for locally adv/inoperable cancers
> Neoadjuvant chemo & possible radical mastectomy
- Treatment for local recurrence & systemic metastases
> Tumor not initially operable, chemo considered
> 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
Breast Cancer in Men
> 1%
Hard, painless subareolar mass
Usually found @ a later stage than women (poorer prognosis)
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)
Relevant Cues: S/S
- Lump (single, firm, painless)
- Nipple d/c
- Dimpling
- Nipple retraction
- Induration
- Edema, erythema
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
Stage ___
ductal carcinoma in situ (DCIS), or the lobular carcinoma in situ (LCIS)
0
Stage __ and __
Is the extent of spread to lymph/axillary nodes
2, 3
Stage ___
2cm or less, no lymph involvement, no metastasis
1
Stage ____
Tumor of any size w/direct extension to chest wall or skin & w/distant metastasis
4
Surgical Therapy
- Breast conservation
- Mastectomy
↠ 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
Mastectomies can be radical, simple, or modified radical
Preoperative Nursing Diagnosis
- Deficient knowledge
- Anxiety/Fear
- Risk for ineffective coping
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
- Provide pt w/realistic expectations
- Support coping
- Involve or provide info for supportive services & resources
- Support pt decisions
Postoperative Nursing Diagnoses
- Disturbed body image
- Impaired skin integrity
- Pain
- Deficient knowledge
- Risk for injury
- Self-care deficit
- Breast prostheses
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
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
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
Evaluating Outcomes
↠ Survival
↠ Prolonging life
↠ Eliminating or limiting chemo & radiation s/e
↠ Wound healing
↠ Absence of infection
↠ Emotional stability
↠ Support systems
