Breast Cancer Flashcards
What is fibrocystic breast cancer?
Characteristics: generalized breast lumpiness/nodularity with tenderness, Pain, swelling, symptoms may decrease after period
- Lumps/cysts are soft or firm, single or multiple, smooth, round and movable.
- May enlarge and become tender
- Nipple discharge may be present- milky, yellow or greenish discharge
What is the pathophysiology of breast cancer?
- Size
- Axillary node involvement
- Tumour differentiation
- Estrogen and progesterone receptor status
- Human epidermal growth factor receptor 2 (HER-2) status
What are the three types of breast cancer?
- invasive/infiltrating lobular carcinoma
- noninvasive
- invasive/infiltrating ductal carcinoma
What is an invasive/infiltrating lobular carcinoma?
Tumors occur as an area of ill defined thickening in breast (1 or both breasts).
What is a noninvasive breast cancer?
cancer confined on ducts
What is the two types of noninvasive breast cancer?
- ductal carcinoma in situ(DCIS)
2.lobular carcinoma in situ(LCIS)
What is ductal carcinoma in situ(DCIS)?
proliferation of malignant cells within the ducts without invasion. Stage 0 breast cancer, simple/total mastectomy 98-99% cure rate.
- unilateral, progresses to invasive if untreated
What is lobular carcinoma in situ(LCIS)?
- premalignant cancer
- Those with LCIS have a higher risk of developing invasive breast cancer in same or opposite breast
- Treatment may not be necessary, tamoxifen may be used.
What is invasive (infiltrating) ductal carcinoma?
- Most common type of breast cancer, forms in ducts
–> Colloid, Inflammatory, Paget’s disease, Medullary, Tubular
what are the complications of breast cancer?
Local: skin
Regional: lymph nodes
Distant: skeletal, spinal cord, brain, pulmonary, liver, bone marrow
How often are you suppose to do self exams for breast cancer? Most common site?
after each period, upper outer quadrant
What is the diagnostic studies for breast cancer?
- History, including risk factors
- Physical examination, including breast and lymphatics
- Mammography, ultrasound, biopsy
- MRI, if indicated
- alnd, slnd
What is an axillary lymph node dissection (ALND)?
often performed to determine if cancer has spread to the axilla on the side of the breast cancer. The more nodes involved, the greater the risk of recurrence.
What is an sentinel lymph node dissection (SLND)?
remove only one node that is most likely to be cancerous
What is a mastectomy?
Removal of breast, pectoral muscles, axillary lymph nodes, all fat and adjacent tissue
What is the TNM system?
Tumour size (T)
Nodal involvement (N)
Presence of metastasis (M)
What are the four stage ranges for tumour size?
stage 1: <2 cm
stage 2: <5cm
stage 3: 5-10 axillary nodes
stage 4: any size tumour, any type of nodal involvement, distant metastasis
What is surgical therapy for breast cancer?
- Most common options for resectable BC
–> Breast conservation surgery with radiation therapy
–> Modified radical mastectomy with or without reconstruction
–> lumpectomy, axillary node dissection, modified radial mastectomy
What is breast conserving procedures(lumpectomy)?
removal of entire tumor with a margin of normal surrounding tissue.
What is axillary node dissection?
removal of 12 – 20 nodes. Was standard of care until early 2000s.
What is modified radical mastectomy?
removal of breast tissue and an axillary node dissection. Preferred if tumour too large to excise to excise adequate margins. Patients have the option of breast reconstructive surgery.
What is lymphedema?
Accumulation of lymph in soft tissues
- When axillary nodes cannot return lymph fluid to central circulation, fluid accumulates in arm, causing obstructive pressure on veins and venous return.
- Make sure client understands that there will always be a risk for lymphedema after surgery
What is the prevention for lymphedema?
- Frequent and sustained elevation of arms
- Performing arm exercises daily
- Avoidance of constrictive clothing
- NO BP’s or IM’s IN AFFECTED ARM
What is post-mastectomy pain syndrome?
Can occur following a mastectomy or an axillary node dissection
What is the S&S of post-mastectomy pain syndrome?
- Chest and upper arm pain, tingling down arm
- Numbness, shooting or prickling pain
- Unbearable itching persisting beyond 3-month healing time
What is the treatment of post-mastectomy pain syndrome?
- Nonsteroidal anti-inflammatory drugs
- Antidepressants
- Topical lidocaine patches or EMLA
- Antiseizure drugs
What is adjuvant therapy?
Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back.
What is an mammoplasty?
- Surgical change in size or shape of breast
- Cosmetic or reconstructive
- Possible complications of hematoma, hemorrhage, and infection
What is the S&S of breast cancer?
hard, irregularly shaped, poorly delineated, non-mobile, and non-tender to palpation
What is the late S&S of breast cancer?
pain, ulceration, edema, “orange peel skin” due to plugging of dermal lymphatics
What are the types of mammoplasty?
- Breast implants and tissue expansion
-Musculocutaneous Flap Procedure: Client’s own tissue may be used to repair soft tissue defects if there is insufficient muscle after mastectomy (from back or abdomen) - Nipple-Areolar Reconstruction
How do you restore arm function on? the affected side after a mastectomy
Exercising: are designed to prevent contracture and muscle shortening, maintain muscle tone, and improve lymph and blood circulation
What drug is used as a hormonal agent of choice in estrogen receptor-positive with breast cancer cells?
Tamoxifen (nolvadex)
During surgical therapy of axillary node dissection, how do you prevent lymphedema?
NO BP, IM, or OV in affected arm
What is Pagets disease?
AKA nipple cancer, scaly lesion, burning, itching around nipple/areola. bloody nipple discharge
