Breast Cancer 2 Flashcards
Targeted Therapy
a medication treatment which targets the overexpressed protein
Herceptin
- 25% of breast cancers overexpress a protein called HER-2
- Tumors that overexpress HER-2 are more aggressive, associated with reduced survival rates, and are resistant to some forms of chemotherapy
Herceptin targeted therapy
- monoclonal antibody administered IV
- targets and blocks the HER-2 pathway
- inhibits tumor growth
- exerts synergistic effects with chemotherapy
Hormone Therapy
Breast cancer cells tested for presence/absence of estrogen and/or progesterone receptors. Hormone therapy removes or blocks source of estrogen to promote tumor regression.
- Estrogen receptor positive (ER+) tumors use estrogen to grow and so they may respond to hormonal treatment that blocks or decreases estrogen
- Progesterone Postive (PR+) cancers may also respond to hormonal treatment
Which type of tumors tend to grow more aggressively? hormone negative or hormone positive
hormone negative
Tamofixen (nolvadex)
Classification: Selective Estrogen Receptor Modulator (SERM)
Use: Hormone receptor positive breast cancer before or after menopause
Action: Competes with estrogen for binding sites in breast and other tissues. Reduces estrogen respose tereby suppressing tumor growth.
Side/Adverse Effects: nausea, hot flashes, weight gain, bone pain, endometrial cancer, thrombophlebitis
Nursing Implications:
- Teach that bone pain will subside and can be treated with non-narcotic analgesics
- Teach that medication will be given daily for three to five years
- Teach to obtain routine pap smears, report vaginal bleeding
- Administer with food or fluids
- May take an antiemetic 30-60 minutes prior to administration is needed
- Teach signs and symptoms of thrombophlebitis. No other interventions for thrombophlebitis prevention helpful.
Anastrozole (Arimidex)
Classification: Nonsterodial Aromatase Inhibitor
Use: Post-menopausal women with hormone receptor positive breast cancer
Action: Inhibits the enzyme aromatase (hormones in the body called androgens are changed into estrogen by the enzyme aromatase)
Side/Adverse Effects: nausea, hot flashes, weight gain, joint pain, pathologic fractures, vaginal dryness, peripheral edema
Nursing Implicaitons:
- Take with or without food, at approximately the same time of day
- Teach patient to elevate extremities when at rest, as needed, for peripheral edema
- Teach importance of bone density examinations, calcium, and vitamin D supplementation
- Teach that medication will be given daily for five years. Many patients are now switched to this medication after 2-3 years of tamoxifen therapy due to studies showing modest increase in survival
Breast Cancer Summary
Risk Factors:
- Female
- Over Age 50
- Family history (breast, colon, endometrial)
- menarche before age 12
- menopause after age 55
- full term pregnany after 30
- no kids (nulliparty)
- obesity and weight gain after menopause
- ionizing radiation exposure
- genetic mutations on brca1 and 2 genes
Screening methods:
- annual mammography for women beginning at age 40
- annual MRI for high-risk women
- clinical breast exam every 3 years for women 20-40, greater than 40 every year
- breast self-exam monthly women greater than 20
Clinical Manifestations:
- Single lump: unilateral, hard, non-mobile, non-tender
- Often found in upper outer quadrant
- dimpling of skin
- nipple discharge
- swelling of part of the breast
- scaliness of nipple or breast
Treatment:
Surgery:
MRM: Removal of entire breast and axillary lymph nodes and lining over pectorals major muscle. JP drain present
Lumpectomy: Tumor removed with margin of surrounding healthy tissue. Major portion of the breast is left. JP drain present
Adjuvant:
- Radiation
- Chemotherapy
- Targeted Therapy
- Hormonal Therapy
How is course of treatment determined?
- Stage and grade of tumor
- menopausal status
- lumph node status
- hormone receptor status
- HER-2/neu status
- Other various prognostic indicators
Sentinel lymph node biopsy
Minimally invasive method of identifying lympthatic metastasis from solid tumors.
Sentinel lymph node
the first lymph node along the route of lymphatic drainage from a primary tumor
Sentinel Lymph Node Biospy Procedure
- 30-a few hours before surgery, technetium-99 sulfer colloid (a radionuclide) is injected at the 3-, 6-, 9- and 12 o’clock positions into the breaste tissue surrounding the primary tumor or biopsy cavity
- Blue dye may also be used to increase the sensitivity of the test
- One or two sentinel nodes (indicated by the uptake of the agent/dye) removed
- Pathologic evaluation performed
- Further axillary lymph node dissection may be performed when a SLN contains malignant cells
Nursing Interventions for lymph node biospy
- Teach patient to expect blue/green urine and areas of chest wall blue in appearance
- Force fluids to enhance excretion of dye which is nephrotoxic
- No radioactive precautions
- Assess for risk for bleeding, infection, and pain
- Teach S/Sx to report
- Provide emotional support
Sentinel Lymph Node Biopsy information
- sentinel lymph node removed and examined to determine if more extensive lymph node dissection is necessary
- if negative for metastatic cells no further node removal is indiciated
- if positive for metastatic cells further lymph node dissection may be indicated
- advantage: reduces risk lymphedema
- contraindicated: tumors greater than 5 cm, palpable lymph nodes are present or multiple tumors exist
Post Masectomy Lymphedema
A chronic, non-curable condition in which buildup of lymphatic fluid occurs due to damage to lympatic system. This condition may occur soon after treatment or years after initial treatment. Estimated to occur in 15-28% of breast cancer survivors (less than 5% with sentinel lymph node biopsy)
Risk factors for post mastectomy lymphedema
- removal of some or all of the lymph nodes
- radiation to the underarm area
- injury or untreated infection of the arm or hand on the same side as the surgery
