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N4- Test 3 > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Breast Cancer is influenced by multiple factors,

Name 4

A
  • Heredity
  • Smoking
  • chemical/radiation exposure
  • ESTROGEN - know!!
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2
Q

Q: What are non-modifiable risk factors for breast cancer?

A
  • Age: >50 (POST-MENOPAUSE
  • >60 years
  • Personal/family ovarian/colon cancer history
  • female sex
  • race (white women at higher risk)
  • breast density
  • radiation exposure
  • early menarche (<12)
  • late menopause (55 or >) (accumulation of estrogen)
  • genetics (tumor markers: BRCA1/BRCA2 mutations).
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3
Q

What are modifiable risk factors for breast cancer?

A
  • Obesity, Sedentary lifestyle
  • High-fat diet: produces more estrogen
  • Alcohol
  • Weight gain after menopause.
  • Radiation exposure.
  • Nulliparity (no childbirth).
  • Hormonal Factors:
    -Hormone replacement therapy.
    -Combined oral contraceptives (risk higher <35 years old).
  • Most significant modifiable risk: Weight.
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4
Q

Q: What are protective factors against breast cancer?

A
  • Breastfeeding for at least 1 year.
  • Moderate physical activity.
  • Maintaining a healthy body weight.
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5
Q

List 3 Main Breast Cancer Types

A
  1. Invasive Ductal Carcinoma
  2. Paget’s Disease
  3. Inflammatory Breast Cancer
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6
Q

Most Common Type of Breast Cancer

A

Invasive ductal carcinoma
* Starts in MILK DUCTS
* then breaks through wall of duct
* Metastasizes to other areas such as bone, lung, and liver.

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7
Q

Type of Breast Cancer:
* Rare
* Involves nipple/areola
* Causes: itching, burning, discharge.

A
  • Paget’s Disease
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8
Q

Type of Breast Cancer:

  • VERY Aggressive
  • Breast resembles an orange peel.
A
  • Inflammatory Breast Cancer
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9
Q

Q: What are signs of breast cancer?

A
  • Lump or thickening.
  • Nipple changes or pain.
  • Change in breast size or shape.
  • Skin changes (dimpling, redness).
  • Persistent pain/tenderness.
  • Swelling in the armpit.
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10
Q

Q: When is the best time to perform a Clinical Breast Exam (CBE)?

A
  • 3-7 days AFTER menses starts (hormones are less likely to cause breast tenderness or swelling)
  • perform the exam at the same time in the menstrual cycle for consistency.
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11
Q

What is a MAMOGRAPHY?

A

technique using X-rays to diagnose and locate tumors of the breasts.

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12
Q

Mammogram guidelines:

Women over ages 40-44 should get __ screening.

A

Optional ANUAL mammogram

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13
Q

Mammogram guidelines:

Women over the age 45

A

YEARLY mamograms

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14
Q

Mammogram guidelines:

Women over age 55

A

Every 1 or 2 years.

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15
Q

Q: What are the types of mammography?

A
  • Traditional Mammogram: Low-dose X-ray.
  • Digital Mammogram: Images on a computer for better contrast adjustments.
  • 3D Mammogram: More precise; reduces false positives.
  • Breast MRI: Adjunct, evaluates contralateral disease, invasive lobular carcinoma.
  • Ultrasound: Follows up on abnormal MRI findings.
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16
Q

3 Types of Needle Biopsies

A
  1. Fine needle aspiration
  2. Core needle biopsy
  3. Stereostatic core biopsy
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17
Q

Needle Biopsy LEAST invasive but also LEAST accurate

A

Fine Needle Aspiration

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18
Q

Surgical biopsies

List 2

A
  • Excisional Biopsy (Lumpectomy): Removes lump.
  • Incisional Biopsy: Sample taken.
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19
Q

Lumpectomy

A
  • surgical procedure to remove a lump or abnormal tissue from the breast
  • preserves most of the breast tissue
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20
Q

Lymph Node Biopsies

2 types

A
  • Sentinel Lymph Node Dissection (SLND):
  • Axillary Lymph Node Dissection (ALND):
    -Important prognostic factor for recurrence
    -checks the extent of the spread
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21
Q

What do Sentinel Lymph nodes main job?

A
  • They are like the “watchtower” or “guards” of the lymphatic system in a particular area, checking for cancer cells that may spread from the tumor.
  • Other nodes receive lymph after the sentinel nodes
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22
Q

Sentinel Lymph Node Biopsy Overview

A
  • less invasice
  • minimal risk of lymphedema (edema in lymph nodes)
  • nor surgical drain
  • post-op neuropathic sensations (unusual, nerve-related feelings)
  • Decreased ROM in affected arm unlikely but possible.
  • Better for patients WITH NO comorbidites
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23
Q

Axillary Lymph node Dissection Overview

A
  • More invasive
  • Higher risk of lymphedem
  • surgical drain present
  • post-op neuropathic sensations (unusual, nerve-related feelings)
  • Decreased ROM in affected arm MORE LIKELY postoperatively
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24
Q

Nursing Interventions:

Most important PRE- procedure

A

Confirm patient discontinued ANTICOAGULANTS.

(avoid hematoma)

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25
Q

Nursing intervention POST-procedure

A
  1. Teach aftercare- incision, restriction on activities
  2. Concerning symptoms: infection s/s education, drain infx s/s
  3. Follow ups
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26
Q

What post-op education should a nurse provide to a patient after a lymph node dissection?

List 6

A
  • Avoid BP, injections, or blood draws on the affected side.
  • Use sunscreen and insect repellant to prevent skin irritation and infection.
  • Wear gloves when gardening and oven mitts when handling hot objects.
  • Avoid cutting cuticles to prevent infection.
  • Use an electric razor for shaving armpits to reduce the risk of cuts.
  • Avoid lifting objects heavier than 10 lbs to reduce strain on the affected arm.
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27
Q

Teach patient, if trauma or skin break occurs to:

A
  • Wash the area with soap and water.
  • Apply OTC antibacterial ointment.
  • Observe closely for signs of infection (redness, swelling, warmth, fever, chills).
  • Call the MD if signs of infection develop.
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28
Q

What does TNM staging stand for?

A

T: Tumor size.
N: Nodal involvement (lymph node status)
M: Metastasis.

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29
Q

How many stages of Breast cancer are there?

A

Stages I- IV

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30
Q

Breast Cancer Stage I characterisitics

A

Very small tumor
No lymph node involvement

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31
Q

Breast Cancer Stage II characteristics

A
  • Tumor has not spread to distant organs
  • In nearby lymph nodes
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32
Q

Breast Cancer Stage III characteristics

A
  • Tumor has invaded muscles and lymph nodes
  • No organ spread
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33
Q

Breast Cancer Stage IV characteristics

A
  • Metastatic cancer (spread to distant organs)
  • Regardless of lymph node involvement
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34
Q

2 Tx options for Breast Cancer

A
  1. Lumpectomy
  2. Mastectomy
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35
Q

What is Lumpectomy

LUMP= lump ; ECTOMY= removal/cut out

A
  • Breast-conserving surgery
    -tumor and a small margin of surrounding tissue are removed, leaving most of the breast intact.
  • Adjuvant therapy required: additional treatment after surgery
  • Day surgery: outpatient procedure
  • 2 week activity restrictions
  • LOWEST RISK of post-op complications
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36
Q

What is Mastectomy

A
  • Removal of entire breast
  • Universal option: regardless of tumor size
  • Breast reconstruction may be performed
  • Requires hospital stay
  • Drain tubes placed and managed
  • HIGHER RISK OF POST-OP COMPLICATIONS

MAST= breast ; ECTOMY= cut out/remove

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37
Q

3 Types of Mastectomy

A
  1. Simple Mastectomy
  2. Modified Radical Mastectomy
  3. Radical Mastectomy
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38
Q

Type of Mastectomy:

  • Breast tissue, nipple, and lymph nodes are removed.
  • ONLY Muscles are left intact
A

Modified Radical Mastectomy

39
Q

Type of Mastectomy:

Same as Modified Radical but chest muscles (Pectoralis major and minor are removed)

A

Radical Mastectomy

40
Q

Breast Cancer:

Post-Op Nursing intervention

A

o Pain control.
o Lymphedema prevention (No BP/injections on that arm).
o Drain/wound care.
o Educate on possible nerve pain and sensations

41
Q

What cells does Chemotherapy target?

A
  • Fast-growing cells
    -which include both cancer cells and healthy cells (e.g., GI tract, bone marrow, hair follicles).
42
Q

Q: How does chemotherapy affect bone marrow?

A
  • Thrombocytopenia (low platelets).
  • Neutropenia (low white blood cells).

-penia = low

43
Q

Alopecia

44
Q

Q: What LABS should be monitored during chemotherapy?

A
  • CBC (complete blood count)
  • WBC count
  • platelet count
  • electrolytes
45
Q

Chemotherapy drug used to treat various cancers

A

Doxorubicin (Adriamycin)

“red devil”

46
Q

Q: What is a key side effect of Doxorubicin (Adriamycin)?

A
  • Cardiotoxicity (heart damage)
  • Risk of heart failure

so monitor patients for these!!!

47
Q

What precautions should be taken with immunizations while on Doxorubicin?

A
  • Limit immunizations (pts are immunocompromised)
  • avoid contact with individuals who recently received a live virus vaccine.
48
Q

List the 8 Live Vaccines

A
  • Measles, Mumps, and Rubella (MMR)
  • Varicella (Chickenpox)
  • Rotavirus
  • Yellow Fever
  • Intranasal Influenza
  • Bacille Calmette-Guerin (BCG)
  • Smallpox
  • Shingles (Zostavax)
50
Q

Radiation side effects

A
  • Skin changes (sunburn, dermatitis)
  • Fatigue
  • Long-term consequences (may develop over time)
51
Q

Radiation- Patient teaching

A
  • Use mild, unscented soap or nondrying antipruritic soap if skin dryness or itchiness persists.
  • Pat the area dry (avoid rubbing).
  • Avoid deodorant on affected area.
  • Wear loose clothing; avoid tight tops or underwire bras.
  • Avoid extremes in temperature (hot or cold).
  • Protect skin from ultraviolet light for at least 1 year post-therapy.
52
Q

Type of radiation therapy where radioactive material is placed directly inside or very close to the tumor, allowing for localized treatment

A

Brachytherapy

53
Q

2 types of Brachytherpy (internal radiation)

A
  1. High Dose Rate Brachytherapy
  2. Low-Dose Radiation or Permanent Implants
54
Q

Nursing Precautions for High-Dose-Emit Radiation Brachytherapy

A
  • Kept in hospital/radiation proof room
  • No children or pregnant visitors
  • Maintain 6-foot distance
  • Limit exposure to 30 min daily
  • Staff wear dosimeter
55
Q

What is the risk for Low-Dose Radiation Brachytherapy

A

Risk is minimal

56
Q

What are Adjuvant therapies?

A

Therapies that do not include chemo nor radiation

57
Q

Adjuvant Therapies for Breast Cancer:

Hormonal Therapy (medication) that blocks the action of estrogen, preventing estrogen from stimulating the growth of certain types of breast cancer.

A

Tamoxifen
(given oral)

Selective Estrogen Receptor Modulators

58
Q

Adjuvant Therapies for Breast Cancer:

Who can take Tamoxifen

A

BOTH pre-menopausal and post-menopausal women

59
Q

Side Effects of Tamoxifen

A
  • thrombocytopenia
  • leukopenia
  • Hot flashes
  • Joint pain
  • High cholesterol
60
Q

Tamoxifen:

Pts are at increased risk for

61
Q

Pts on Tamoxifen should report what symptom

62
Q

Tamoxifen:

Teach patients to avoid

A

grapefruit

63
Q

What labs should be monitored for pts on Tamoxifen?

A
  • Liver funciton tests (AST/ALT, albumin)
  • Renal function
  • CBC
  • Pregnancy test: Rule out pregnancy before therapy
64
Q

Adjuvant Therapies for Breast Cancer:

  • Hormonal Therapy (medication) that lowers estrogen levels by inhibiting the enzyme aromatase, which is responsible for producing estrogen.
  • Lower estrogen levels can help slow or stop the growth of certain breast cancers.
A

Anastrozole (Aromatase Inhibitor)

-given oral

65
Q

Adjuvant Therapies for Breast Cancer:

Who can take Anastrozole?

A

Post-menopausal only

66
Q

Side effects of Anastrozole

A
  • Mood swings/hot flashes
  • dizziness
  • Joint pain
  • High cholesterol
  • MI risk/cardiac ischema
67
Q

What should patients Report when taking Anastrozole?

A
  • Chest Pain
  • SOB
68
Q

Adjuvant Therapies for Breast Cancer:

  • Immunotherapy drugs that work by stimulating the body’s immune system to recognize and attack cancer cells.
  • Prevents T-cells from attacking cancer.
A
  • Pembrolizumab (Keytruda)
  • Nivolumab (Opdivo)
69
Q

How often is Immunotherapy given?

A

Infusions administered once every 3-6 weeks.

70
Q

Side Effects of Immunotheraphy Infusion

A
  • Autoimmune reactions
  • Infusion reactions
  • jaundice
  • tachycardia (increased HR)
  • diarrhea
  • cough
71
Q

S/S of Infection at Surgica Sites

A
  • Redness and warmth at incision site/port site
  • Excessive tenderness
  • Foul-smelling drainage
  • Temperature > 38 C
  • chills
72
Q

A collection of blood inside a cavity

73
Q

Hematoma:

Symptoms to look for:

A
  • Swelling, tightness, and pain
  • Notify Surgeon if drain output changes (amount, character, or becomes sanguineous instead of serosanguineous)
77
Q

Anticipated Care for Hematoma

A
  • Compression wrap for 12 hours
  • Monitor H&H
  • Frequent reporting of drain output
  • Possible return to OR if complications arise- NPO may be needed
79
Q

A collection of serous fluid under the incision site or in the axilla (armpit).

80
Q

What are the symptoms of a seroma?

A

Swelling
heaviness
discomfort at the site.

81
Q

What can cause a seroma?

A

Drain obstruction can lead to fluid buildup.

82
Q

How is a seroma managed?

A
  • Close monitoring of the size.
  • Assess drain lines for kinks or blockages externally.
  • If large, the surgeon may aspirate the fluid.
83
Q

Q: Do seromas typically require intervention?

A

Not typically.

84
Q

What am I?

Persistent pain following a mastectomy or breast surgery, caused by nerve damage during the procedure.

A

Mastectomy Pain Syndrome (MPS)

85
Q

What are the symptoms of Mastectomy Pain Syndrome (MPS)

A
  • Chest & upper arm pain
  • Itching, numbness, tingling in: chest, underarm, shoulder, upper arm
86
Q

How is Mastectomy Pain Syndrome (MPS) treated?

A
  • NSAIDs
  • Antidepressants
  • Topical lidocaine patches
  • EMLA cream (lidocaine + prilocaine)
  • Anti-seizure meds (e.g., gabapentin)
87
Q

What am I:

Swelling in the arm/hand caused by lymph fluid buildup when lymph nodes are removed or damaged or POST-mastectomy (e.g., surgery or radiation).

A

lymphedema

88
Q

What are the symptoms for Lymphedema?

A
  • Edema (swelling)
  • Heaviness, pain
  • Impaired motor function
  • Paresthesia (numbness/tingling) in fingers
89
Q

Q: When can lymphedema occur?

A
  • Immediately post-op OR
  • Months to years later
90
Q

Q: What should nurses teach Patient regarding Lymphedema?

A

Protect the affected arm/hand for life:
* No BP cuffs, blood draws, injections
* Avoid injury, cuts, burns on affected arm/hand
* use electric razor
* Careful manicures
* Use gloves when gardening
* Avoid heavy lifting but perform exercises daily
* Moisturize skin, avoid tight clothing
* Can use ELASTIC sleve or SCDs

91
Q

Immunotherapy-Monoclonal Antibodies

2 drugs

A

Bevacizumab (Avastin) & Durvalumab (Imfinzi)
* Cervical and Ovarian cancer used with chemotherapy
* IV only-cycles vary from 14 days -28 days
* Stimulates immune system to fight cancer by blocking proteins and other factors needed for replication
* Teach to report chills as possible sign of infection-fever may not develop in imuunosuppression.
* Teach to report diarrhea; may be sign of serious colitis

92
Q

Antineoplastic drugs
(stop growth and spread of cancerous cells)

2 main drugs

A

Cisplatin & Carboplatin

  • Ovarian cancer
  • IV only Given in cycles of 1 every 3-4 weeks
  • Causes thrombocytopenia & neutropenia-must check both prior to admin
  • Less GI upset than cisplatin
  • Watch for anaphylaxis
  • Cytotoxic Agent requires specialized training and certification to administer
93
Q

Doxorubicin
Antineoplastic med

A
  • IV Only
  • First-Line Breast Cancer Treatment w/combination therapy
  • Contraindicated in patient with recent myocardial infarction, severe hepatic impairment, drug induced myelosuppresion
  • Drug interactions: Decreases phenytoin & digoxin levels
  • Do not take live vaccines
  • S/E: pancytopenia, cardiac toxicity, mucositis, parasthesias, renal issues
  • Report: new/worsening SOB, orthopnea to provider

N4- Test 3 (7 decks)

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