breast cancer

Question 1

age

Answer 1

1. Increased number of mutagenic changes over a long lifespan
2. Increased number of older women

Question 2

familial history

Answer 2

Accounts for 5-10% of cases (BRCA I & BRCA II genes)

Earlier onset than non-inherited breast cancer

Question 3

Gender

Answer 3

1. 99% of cases are women

2. 1% of cases are men

Question 4

Menstrual history

Answer 4

1. Early menarche, late menopause
2. Nulliparous or 1st child after age 30
   (Earlier breast development with pregnancy protects from cancer)

Question 5

hormone therapy

Answer 5

Menopausal Hormone Therapy (MHT) following menopause shows slight increases risk for reproductive cancers (breast cancer) and CAD

Question 6

obesity

Answer 6

1. Especially after menopause

2. Can cause stimulating effect on breast cancer growth (estrogen stored in adipose tissue)

Question 7

radiation exposure

Answer 7

Survivors of Hiroshima show increased cancers, including breast

Question 8

previous risk of breast cancer

Answer 8

Increased risk of cancers in the opposite breast

Question 9

Benign breast disease

Answer 9

Fibrocystic disease NOT associated with breast cancer

Question 10

epidemiology

Answer 10

Most Common Cancer in Women: Accounts for about 1/3 of all cancers in women; Approx. 1 in 8 chance of developing
Worldwide problem: Highest in US, Western Europe
Incidence rates have increased since 1980s, while deaths have decreased
Breast Cancer in Blacks: Often diagnosed later, poorer survival rates

Question 11

prognostic indicators

Answer 11

Staging: according to TNM
Tumor size: 2 cm or less without nodes has best prognosis
Increased axillary node involvement increases risk of distant metastases
Cell Activity:
Fraction of tumor cells in synthesis phase: fast growing with poorer prognosis
Improved prognosis if 10 or more receptors on cell for estrogen (ER+) or progesterone (PR+)
These tumors respond to hormonal manipulation

Question 12

breast comprised of

Answer 12

Ducts (milk producing glands)
Lobules (milk passageways)
Stroma: Fatty tissues and ligaments

Question 13

carcinomas

Answer 13

Tumors arise in ductal or lobular tissue

Question 14

carcinoma in situ

Answer 14

When confined to lobule or duct

Question 15

DCIS Ductal carcinoma in situ

Answer 15

most common
Pre-cancerous
Found on mammogram
Non invasive

Question 16

breast cancer can be divided into 4 quadrants

Answer 16

Upper outer quadrant most common site for cancer

Question 17

clinical manifestations

malignant

Answer 17

1. Shape more difficult to define
2. Less mobile (becomes fixed to chest wall)
3. Can cause retraction and dimpling

Question 18

clinical manifestations

benign

Answer 18

1. Well defined edges
2. Encapsulated
3. Freely moveable

Question 19

characteristics of nipples

Answer 19

pain, scaly-ness ulceration, retraction/deviation at odd angle, or spontaneous discharge

Question 20

dimpling of skin

Answer 20

Peau d’orange appearance

Question 21

lump

Answer 21

irregular, star shaped

often not tender

Question 22

mammography

Answer 22

1. Can detect breast cancers before they are palpable
2. Cannot always differentiate malignant from benign
3. Not 100% guarantee

Question 23

clinical breast exam

Answer 23

ACS (American Cancer Society) recommends annual mammogram and clinical breast exam for women past age 40yrs.

Question 24

breast ultrasound

Answer 24

Can determine size, differentiate fluid filled cyst from solid lesion

Question 25

breast biopsies

Answer 25

Fine needle aspiration: cysts vs. solid tumors
Core biopsy: takes tissue sample
Incisional removes some of tumor
Excisional removes all of tumor

Question 26

diagnostics to determine metastasis

Answer 26

1. Bone Scan
2. Bone Marrow Biopsy
3. Liver Scan
4. CXR- chest x-ray
5. Other

Question 27

surgical removal is the mainstay

Answer 27

Localized disease: lumpectomy with removal of tumor and margin of tissue; separate incision to determine nodal involvement

Question 28

sentinel node biopsy

Answer 28

inject radioactive dye or blue dye near tumor; identify first node or “sentinel” node to contain dye
- Fewer nodes removed for pathology

Question 29

mastectomy

Answer 29

Simple: removal of breast
Modified radical: removal of breast and lymph nodes
Radical: removal of breast, nodes, and muscle

Question 30

postoperative care

Answer 30

1. Arm on affected side: movement limited for 24 hours; Hand exercises may be started
2. Elevate arm on affected side- to promote venous return
3. Jackson Pratt drain may be placed if lymph nodes or tissue removed
4. TEACH: no BPs, injections, watches, lifting on affected side
5. Avoid burns, injuries to affected side- trauma wont drain well
   RATIONALE: avoid trauma that may lead to infection when lymph removed

Question 31

lymphedema

Answer 31

1. Lymph system is a one way vascular system to drain interstitial tissue fluid back to venous system
2. Occurs with increased removal of nodes/tissues

Question 32

radiation

Answer 32

1. Standard use following lumpectomy (5-6 weeks) to irradiate any remaining cells
2. May be used pre-op for large tumors
3. Requires close follow-up
4. SE: redness, dryness, itching, edema, tenderness, and fatigue (bone marrow suppression)

Question 33

hormonal therapy

Answer 33

1. Competes for estradiol binding sites on ER+ cells
2. Greatest benefit in women past age 50
3. Decreases recurrence rate

Question 34

hormonal therapy side effects

Answer 34

1. Hot flashes
2. Nausea
3. Fluid Retention
4. Vaginal Discharge
5. Increased risk of endometrial cancer
6. Amenorrhea

Question 35

area of metastases

Answer 35

1. Bone
2. Lung
3. Liver
4. Brain

Question 36

treatment for advanced disease

Answer 36

Palliative Radiation for areas of metastases

Question 37

Recurrence of breast cancer

Answer 37

1. Usually within 2-8 years

2. The earlier the recurrence, the graver the prognosis