Breast Cancer Flashcards
Common issues presenting with breast ca?
Breast pain
Nipple changes/discharge
Lumps (majority benign cysts/ fibro-adenomas
Incidence of breast cancer? How common?
Most common cancer in women in UK
Strongly related to age - 80% over 50 yrs
Male breast ca = 1% of diagnosis
Assessment for breast cancer : GP & Surgeon
Presenting complaint Duration of complaint Previous breast history/medical history Any trauma On medication? Menopause status Smoking and drinking history Family history Number of children, breastfeeding? Previous mammograms Then a clinical examination - both breasts and axilla examined
Diagnostic Tests? Radiology and cytology.
Over 40 - mammogram arranged +/- ultrasound
Under 40 - ultrasound examination ( if cancer diagnosed, mammogram arranged)
MRI - if req for further assessment
FNA (fine needle aspirate) - rarely used for diagnostic purposes
Core biopsy - pts given local anaesthetic, majority taken under ultrasound guidance
Punch biopsy - used for lesions in skin, areola/nipple rash or along with core biopsy where inflammatory breast ca suspected
Breast cancer pathology.
- Invasive cancer: ductal, no special type (70%) and lobular - extend beyond basement membrane of ducts & lobules
- Non-invasive cancer: ductal carcinoma in situ (DCIS), lobular carcinoma in situ -remain within the ducts
First line management for early breast cancer?
Aim to achieved local control by eradication of the primary lesion.
Wide local excision: removal of tumour & about 1cm of normal tissue. Suitable for unifocal lesions <4cm
Mastectomy +/- immediate reconstruction (delayed reconstruction optional) :
Large /central or multifocal tumours
Patient preference
Surgical management of axilla?
All surgery for invasive cancer requires axillary assessment:
Axillary node clearance if node positive at diagnosis
Sentinel node biopsy if node negative at diagnosis
Risk factors for breast cancer
Increasing age (2-3 invasive found in women over 55) Family history (mum sister or daughter) Genetic: BRACA1 & BRACA2 mutations First child over 30 yrs Nulliparity (no pregnancies) Geographical (UK higher than Japan) Late menopause Socio-economic factors, deprivation Birth control, oral contraception HRT (oestrogen and progesterone) High alcohol intake Obesity (high fat diet) Lack of physical activity Smoking Working night shift (changes in melatonin
Signs and symptoms of breast cancer
Breast lump: hard and irregular Change in breast size and shape Pain(sometimes) Skin dimpling (Orange peel) Thickening and oedema of skin Nipple discharge -blood stained Nipple retraction Nipple crusting (pagers disease of nipple) Dilation of superficial veins -obstruction Palpable axillary node (advanced cancer) Ulceration of skin ( advanced cancer)
Post operative care of breast cancer
Routine observations: NEWS: pulse, blood pressure, temperature, o2 saturations, respirations etc.
Pain control
Wound care: pressure dressing 8hrs post op(depends on surgeon), observe for bleeding/ haemotoma formation, care of drain (removed 24-48hrs depending on seroma) (drains not used very often now), skin care
Psychological support/emotional support
Breast prosthesis (if applicable)
Arm exercises: to stop lymphoedema
Advice on wound care post discharge
Advice on reduction of risk for lymphoedema (keep arms elevated when possible, massages)
Who to contact for advice and support: eg clinical team support, concerns checklist, psychologist, Macmillan one to one, telephone( breast ca care), regular events.
Breast reconstruction types?
Implants( silcone)
Reconstruction using own skin flap from either back or abdomen
Combination of both ^
Breast cancer staging (tumours)
Stage I - tumour 2cm, not fixed, no axillary node involvement
Stage II - tumour 5cm, with or without axillary node involvement
Stage IIIa - tumour >5cm, or fixed axillary node involvement
Stage IIIb - any tumour, with supra vicular node involvement, fixation to chest wall, inflammation & ulceration
Stage IV - any size tumour & presence of distant metastatic disease
If breast cancer returns?
More aggressive than previous.
Sites for spread = brain, lungs, liver and bone
If metastatic spread, care is usually palliative
Lymphoedema priorities?
Skin care: avoid minor skin injuries, treat cuts immediately, finger nails short and clean
Bloods or IVs not taken from this limb
Exercise: active and passive
Massage - lymphatic drainage
Elastic - support hosiery
Breast cancer and culture and psychological impact
Multicultural society, be aware & respectful of cultural beliefs. Breasts seen as sexual in western society - surgery can affect relationships and the way women and partner feel about femininity
Psychological impact - coping with life threatening diagnosis. Fear of recurrence, fatigue, difficulty moving forward, sex life, relationships, body image
