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UM - Integumentary > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What type of tumor accounts for 85% of all cancers

A

Carcinoma

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2
Q

What is the most common invasive breast cancer?

A

Invasive Ductal

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3
Q

What is the most aggressive type of breast cancer?

A

inflammatory

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4
Q

What are the primary ways cancer can spread?

A
  • blood
  • lymph
  • direct extension
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5
Q

Differentiate T1-T4 for the TNM Staging System

A

T1: <= 2 cm
T2: 2-5 cm
T3: > 5 cm
T4: Direct extension into the chest wall and/or skin

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6
Q

Differentiate N1-N3 for the TNM Staging System

A

N1: metastasis to ipsi, movable, axillary LN
N2: metastasis to ipsi fixed axillary or IM LNs
N3: Metastasis to infraclavicular/supraclavicular LN or to axillary and IM LNs

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7
Q

What is a PET Scan

A

a computerized radiographic technique that employs radioactive substances to examine the metabolic activity of body structures

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8
Q

List the types of biopsy

A
  • fine needle aspiration
  • incisional biopsy
  • excisional biopsy
  • stereotactic biopsy
  • sentinel lymph node biopsy
  • axillary dissection
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9
Q

What is a fine needle aspiration?

A

Dx procedure where a thin, hollow needle is inserted into a mass to extract cells - the most common initial dx for breast cancer

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10
Q

What is an incisional vs excisional biopsy

A

Incisional is just a section of tumor is removed (Not common breast cancer) vs excisional is the whole thing

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11
Q

What is a stereotactic biopsy?

A

Procedure that uses a computer and imaging performed in at least two planes to localize a tumor in 3-D space and guide the removal of tissue

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12
Q

what is a sentinel lymph node biopsy?

A

Finding the first node that drains the tumor bed via blue dye and completing a biopsy to see if it has spread to the lymph nodes or not

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13
Q

What is an axillary dissection

A

Removal of level I and II LN - typically 10-20 nodes

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14
Q

What is a lumpectomy?

A

Removal of a tumor and clean margin to conserve some breast tissue

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15
Q

What is a mastectomy?

A
  • removal of all breast tissue and possibly the fascia over the chest muscle
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16
Q

What are the two types of muscle-flap reconstruction surgeries?

A
  • Latissimus + Implant (not done often)
  • Transverse Rectus Abdominus Myocutaneous
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17
Q

What are the post-sx precautions/contraindications

A
  • Surgical drains: no flexion/abd over 90 degrees
  • open incisions
  • seroma: a pocket of clear serous fluid that occurs 30-90% of the time post breast cancer sx
  • undiagnosed swelling
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18
Q

What are dysfunctions commonly seen post breast cancer sx

A
  • postural changes (scap retraction & elevation, winging, & fwd head posture)
  • pain
  • postoperative vascular and pulmonary complications
  • swelling
  • ST restrictions
  • dec ROM and strength
  • loss of function
  • increased risk for infections and lymphedema
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19
Q

When is radiation done for breast cancer?

A
  • almost all lumpectomies & some mastectomies
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20
Q

T or F: Only the tumor site is radiated w/breast cancer

A

FALSE - the entire chest wall is radiated, just at an angle to try and be direct

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21
Q

Side effects of radiation?

A
  • fatigue
  • dec RBC, WBC, and Platelets
  • N/V
  • Skin changes (burns, cording)
  • fibrosis (6-36 mo post)
  • increased risk for lymphedema
22
Q

When is it appropriate to do manual therapy to the incisional site if pt has had radiation?

A

first 2-3 weeks before skin changes occur and then following radiation when skin returns to normal

23
Q

How do you manage fibrosis post radiation?

A
  • Deep tissue work/MFR in subacute state of healing
  • manual stretching
  • manual lymphatic drainage
  • maintenance of ROM
24
Q

Importance of scar tissue mgt post sx

A
  • improved lymph circulation
  • improved UE & trunk ROM
  • improved cosmesis
  • desensitization
  • prevent adhesion of tissue
25
Q

Side effects of chemo

A
  • fatigue
  • dec WBC
  • hair loss
  • N/V
  • neuropathies
  • pulm fibrosis
  • renal dysfunct
  • arrythmias or ataxia
26
Q

T or F: Hormonal therapy is a short term treatment

A

False - it is usually done for a long period of time (ex 5 years) to help prevent recurrence of cancer

27
Q

What is the goal of PT during chemo?

A
  • minimize fatigue
  • maintain weight & mm
  • independent strength & flexibility program
  • avg 20 mins aerobic exercise 3-5x a week
  • promote sense of active role in recovery
28
Q

Chemo exercise contra/precautions

A
  • first 24 hrs post chemo
  • fever
  • infection
  • severe fatigue
  • low blood counts
29
Q

List the 7 breast cancer shoulder impairment syndromes

A
  • neuromuscular coordination syndrome
  • pain syndrome
  • muscular force production syndrome
  • peripheral neuropathic syndrome
  • myofascial restriction syndrome
  • glenohumeral capsular restriction syndrome
  • lymphedema syndrome
30
Q

What is neuromuscular coordination syndrome

A
  • poor quality of movement in the absence of joint or peri-articular restrictions from disuse or nonuse
  • full PROM
31
Q

What is pain syndrome

A
  • primary limiting factor is the presence of pain upon movement
  • resting pain, empty end feel, pain t/o & @ end ROM, dec AROM and full PROM
  • perceived mm weakness
32
Q

What is muscular force production syndrome

A
  • presents w/AROM < PROM (normal + NORMAL EF) & no observable atrophy
  • diminished MMT strength but good contractility
33
Q

What is peripheral neuropathic syndrome

A
  • of one or several nn that innervate the mm of the shoulder joint complex
  • <2/5 strength w/poor contractility
  • mm atrophy and jt deformity
  • AROM < PROM
34
Q

What is myofascial restriction syndrome?

A
  • ST fibrosis, mm trigger points, or axillary web syndrome
  • AROM = PROM
  • palpable fibrosis
  • “cording”
35
Q

What is glenohumeral capsular restriction syndrome

A
  • limits in ROM w/ significant limits in accessory mvmts
  • Capsular end feel + capsular pattern
  • isolated GH limitations & poor SH rhythm
36
Q

What is lymphedema syndrome

A
  • pain upon movement or due to the appreciable increased weight of the limb
37
Q

What is axillary web syndrome?

A
  • Set of tense cords (nerves & LN) that are palpable/visible under the skin as a direct result of sx from breast cancer
  • limited shoulder abduction ROM
38
Q

Risk factors for developing axillary web syndrome?

A
  • age
  • extent of sx
  • lymph node involvement
  • complications during healing
  • lower BMI
39
Q

Impairments/Limitations w/AWS

A
  • pain
  • visible/palpable cords
  • loss of shldr and elbow ROM
  • dec arm strength & function
  • dec ADLs, vocational & social function
40
Q

Cording interventions

A
  • stretches
  • skin traction
  • STM
  • ROM
  • Strengthening
  • MFR
  • Cardiopulmonary
41
Q

What interventions are used for neuromuscular coordination syndrome?

A
  • neuro reed w/tactile and verbal cues, repetition & full & partial task practice
42
Q

What interventions are used for pain syndrome

A
  • modalities (NOT US)
  • meds
43
Q

What interventions are used for muscular force production syndrome

A
  • strengthening regimen
  • inc muscular force prod
  • restore length-tension rlns
44
Q

What interventions are used for peripheral neuropathic syndrome

A
  • monitor reinnervation
  • reduce postural effects
  • protect jts
  • bracing & splinting
45
Q

What interventions are used for myofascial restriction syndrome

A
  • myofascial stretching
  • home stretching
  • TPR
  • scar massage
46
Q

What interventions are used for glenohumeral capsular restriction syndrome

A

joint mobs

47
Q

What interventions are used for lymphedema syndrome

A
  • complete decongestive therapy
  • vasopneumatic pumping
48
Q

T or F: PT cannot help with the complications post breast cancer

A

False - PT can treat all complications (reduced function & ROM, pain, lymphedema, AWS) to improve function and QOL

49
Q

What is a significant difference for lymphedema measures?

A

> 10 % diff in volume, > 200 mL diff in volume, or > 2cm

50
Q

If PROM > AROM….
If PROM = AROM …

A

PROM > : Syndrome (neuromuscular coordination, pain, muscular force production, or peripheral neuropathic)

PROM = : Lymphedema, Myofascial restriction, or Glenohumeral capsular restriction

51
Q

Pt education to avoid blocking the flow of fluids through the body

A
  • don’t cross legs
  • change positions every 30 mins in sitting
  • don’t carry handbags or use a BP cuff on arm w/lymphedema
  • avoid extremes of heat
  • try and maintain a normal weight for your height

UM - Integumentary (6 decks)

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