Breast Cancer

Question 1

Breast Cancer Etiology

Answer 1

environmental, hormonal, reproductive, and hereditary factors

BRCA-1 and BRCA-2

Question 2

What is the most common breast cancer?

Answer 2

infiltrating ductal carcinoma

2 types: inflammatory carcinoma and pagets disease

Question 3

What is most malignant form of breast cancer?

Answer 3

Inflammatory carcinoma

Question 4

Inflammatory Carcinoma of the breast

Answer 4

edema with dimpling, with appearance of an orange peal

Question 5

Pagets Disease of breast cancer

Answer 5

rare type

infiltration of nipple epithelium

Question 6

Common sites of breast cancer metastasis

Answer 6

bone,brain, lung, liver, skin, lymph

Question 7

Ectoderm:
Mesoderm:
Endoderm:

Answer 7

Ectoderm: exposed layer to outside environment, such as skin, epithelium
Mesoderm: “filler in the middle”, connective tissue, such as bone, muscle, fat
Endoderm: “innards”, glands, organs

Question 8

Fibrocystic Changes

Answer 8

no increase in cancer
hyperplasia of epithelial lining of milk ducts
common between 35-50 years
accompanied by cyclic pain and tenderness, and subsides with menopause
discrete mass not usually felt
ultrasound if mammography cannot differentiate

Question 9

Fibroadenoma

Answer 9

benign breast lump
common
small painless, round mobile mass
most common in 15-25 yrs
rarely associated with cancer

Question 10

Breast Cancer Risk Factors

Answer 10

• age ( increase age, increase risk)
• first degree relative
• +5 years of hormone use
• physical activity
• obesity, (fat cells store estrogen)
• Alcohol intake
• Length of menstruation(menses before age 12?)
• Menstruation plays huge risk due to hormonal changes and cell proliferation
• more pregnancies, lower risk due to decrease in menstruation (same with breast feeding)

Question 11

Prophylactic Measures for Breast Cancer

Answer 11

• prophylactic mastectomy reduces breast cancer by 90%

- prophylactic oophorectomy reduced ovarian cancer by 90% and breast cancer by 50%

Question 12

What if axillary nodes are positive for malignant cells?

Answer 12

High recurrence rate (50-75%)

Question 13

Prognosis and treatment depends on:

Answer 13

• Staging such as TNM system
• lymphatic involvement
• -estrogen and progesterone receptor status (progesterone plays huge risk)
• BRCA1 & BRCA2
• Genetic marker HER-2/neu (poor prognosis, usually not diagnosed still stage 3-4)

Question 14

Carcinoma arises from ____ Cells

Sarcoma arises from ____ Cells

Answer 14

ectodermal and endodermal

mesodermal

Question 15

Where does cancer metastasize if estrogen receptor is positive?

Answer 15

Bone

Question 16

Where does cancer metastasize if estrogen receptor is negative?

Answer 16

soft tissue: brain, liver, lung

Question 17

TNM Staging for Breast Cancer

Answer 17

Stage 0: TIS, NO, MO

Stage 1: T1, NO, MO

Stage 2-A: TO-2, N0-1, MO
Stage 2-B: T2-3. N0-1, MO

Stage 3-A: T0-3, N0-2, M0
Stage 3-B: T-4, Any N, MO

Stage 4: Any T, N0-1, M1

Question 18

Manifestations of Breast Caner

Answer 18

• breast mass or thickening
• unusual lump
• rash near nipple
• flaking or eruption near nipple
• dimpling, pulling, or retraction
• nipple discharge
• change in nipple position
• burning, stinging, or prickling sensation

Question 19

How to: Breast Self Exam (BSE)

Answer 19

• monthly towards end of period
• in shower or bath
• Look in mirror with arms at side, overhead, hands on hip and tightening pectoral muscles
• examine when lying down with towel under shoulder
• squeeze nipple between thumb and index finger

Question 20

Breast Screening:
Self
Healthcare Practitioner
Mammography

Answer 20

self- monthly starting age 18
Clinical- every 3 years beginning age 20, annually after 40
Mammography- every 1-2 years after age 40, annually after 50, and whenever there are symptoms

Question 21

Radical Mastectomy

Answer 21

removal of entire breast, underlying chest muscles, and lymph nodes under arms

Question 22

Simple Mastectomy

Answer 22

removal of complete breast only

Question 23

segmental mastectomy

Answer 23

‘lumpectomy’

removal of tumor and surrounding tissues

Question 24

Modified Radical Mastectomy

Answer 24

removal of breast tissue and lymph nodes under arm while leaving chest wall muscles

Question 25

Apoptosis

Answer 25

• programmed cellular death that cancer cells bypass
• Celebrex and baby ASA ( COX-2 inhibitors) encourage breast and colon cancer cells to die
• “nibs” drugs inhibit enzyme required to cancer cell growth

Question 26

Tamoxifen Citrate (Nolvadex)

Answer 26

• Oral chemotherapy for breast cancer
• works by interfering with estrogen activity
• treats advance and early breast cancer, and prophylactic for high risk

Question 27

Trastuzumab (Herceptin)

Answer 27

• used to stop growth of breast tumors that have HER-2/neu receptor
• binds to receptor and inhibits tumor proliferation

Question 28

Chemotherapy side effects

Answer 28

-extravasation
-allergic reactions
-N/V , anorexia, change in taste (ondansetron before meals and easy digestible foods)
-myelosuppression
-drug toxicities (heart, liver, nerves)
-mucositis (gums)
-alopecia
fatigue
-infertility

Question 29

Myelosuppression side effects

Answer 29

• neutropenia (administer neupogen)
• anemia (administer epogen and transfusion)
• thrombocytopenia (transfusion)

Question 30

Nursing Diagnosis for Breast Cancer

Answer 30

• Anxiety
• Decisions Conflict
• Grief
• Risk for Infection
• Risk for Injury
• Disturbed bodily image over loss of breast