Breast Cancer Flashcards
Statistics of breast cancer and prevalence?
- More than 200,000 diagnosed with breast cancer every year
- Prevalent among white women
- Primarily among older women
- 2nd most common occurring cancer in women
How is breast cancer classified?
Noninvasive (in situ)
Invasive (invades surrounding tissue)
What is breast cancer?
Unregulated growth of abnormal cells in the breast tissue
How does breast cancer begin?
Begins as a single transformed cell and is often hormone dependent
What are the different categorization of breast cancer?
- Carcinoma of the mammary ducts
- Carcinoma of the mammary lobules
- Sarcoma of the breast
What is the most common type of carcinoma of the mammary ducts?
Infiltrating ductal carcinoma
What are the three receptors known to fuel most breast cancers?
- Estrogen
- Progesterone
- Human Epidermal Growth Factor Receptor 2 (HER2)
What is triple negative breast cancer?
A type of breast cancer that is negative to all three receptors that are usually the fuel to most breast cancers
What type of treatment is triple negative breast cancer most responsive to ?
Chemotherapy
What are the Atypical types of breast cancer?
Paget’s disease
Inflammatory carcinoma
What is Paget’s disease?
Rare breast malignancy found in the areola
Most commonly in women
Tumors within the same breast are often found
What are symptoms of pagets disease?
Itching, tingling, or redness of areola
Discharge of yellowish/bloody
Flaking, crusty, or thickened of skin around nipple
Flattened of nipple
What is inflammatory carcinoma?
Most malignant form of breast cancer
Aggressive and fast growing
High risk for metastasis
Peau d’orange (plugging of the dermal lymphatics)
Cancer growth can be from what?
Slow to rapid
What are some of the factors that can affect prognosis?
Tumor size Axillary node involvement Tumor differentiation Estrogen and progesterone receptor status HER2 status
Which receptor helps regulate cell growth?
HER-2
What are some possible causes of breast cancer?
Environmental
Hormonal
Reproductive
Hereditary
What are the breast cancer susceptibility genes?
BRCA1
BRCA2
Which gene is responsible for 10% of women with hereditary breast cancer with genetic mutations causing up to 80% in women
BRCA2
What are some risk factors of breast cancer?
Gender- women Age Family history (breast cancer- 1 degree) Personal history (breast cancer) Previous chest irradiation Menstrual history (early menarche, late menpause) Life style
What is included in lifestyle risk factors?
Oral contraceptives Not having children Having children after age of 30 Hormone replacement therapy (for more than 5 years) Alcohol Not breastfeeding Obesity High-fat diets Physical inactivity
What are predisposing risks in men?
States of hyperestrogenism
Family Hx of breast cancer
Radiation exposure
What should be enforced as to prevention of breast cancer?
Monthly self breast exams
Routine screenings for genetic abnormalities
Early detection helps with what?
Reduce mortality
Promote positive outcomes
What does a “lump” feel like?
Hard Irregularly shaped Poorly delineated Non mobile Non tender
Where does breast cancer often occur within the breast?
Upper outer quadrant (location of most glandular tissue)
What can women with BRCA1 or BRCA2 mutations do as part of prevention?
Prophylactic bilateral oophorectomy (decrease breast and ovarian cancer)
Prophylactic bilateral mastectomy (reduce risk of breast cancer by 90%)
What are some of the diagnostic tests performed for breast cancer?
Mammography
Aspiration biopsy
Excisional biopsy
When does ACS recommend getting mammograms?
Annually at age 40
Every 3yrs for women in 20s and 30s
When should an aspiration biopsy be done?
And what sample is taken?
With a cystic mass or fibrocystic changes
Fluid or tissue
When should an excisional biopsy be done?
And what sample is taken?
Suspicious lump is identified
Tissue
What are tumor markers?
Protein molecules detected in serum or other body fluids
What are some types of tumor markers?
CEA HER1 HER2 EGFR CA-15-3 CA-27-29
What are some types of treatment for breast cancer?
Surgery Radiation Chemotherapy Targeted therapy Hormone therapy
What types of surgery are available for breast cancer?
Segmental
Simple
Modified radical
Radical
What is a segmental mastectomy?
Lumpectomy
‘Breast-sparing’
Removal of breast cancer and normal, healthy tissue surrounding it
What is a simple mastectomy?
Removal of breast tissue, nipple, areola, and skin but not all lymph nodes
What is a modified radical mastectomy?
Removal of all entire breast
Tissue, nipple, areola, and most of axillary lymph nodes
What is a radical mastectomy?
Removal of breast tissue, along with chest muscle and axilla lymph nodes
What is part of breast conservation therapy?
Lumpectomy
Radiation therapy
When is a segmental mastectomy an option?
For tumors for 4-5 cm
What is an advantage of breast-conservation therapy?
Maximize benefits of both cancer treatments and cosmetic outcome while minimizing risks
What is a disadvantage of breast-conservation therapy?
Increased cost of surgery and radiation possible side effects of radiation
What are some types of breast reconstruction?
Breast implants and tissue expansion
Musculocutaneous flap procedure
Nipple-areolar reconstruction
What are the indications of breast reconstructions?
Improve self image
Regain a sense of normalcy
Assist in coping with the loss of a breast
What remains a powerful prognostic factor of breast cancer?
The presence or absence of malignant cells in lymph nodes
What is the advantage of immediate reconstruction?
One surgery
One anesthesia
One recovery period
Before the development of scar tissue or adhesions
What is the standard of care for the majority of breast cancer cases with axillary lymph node involvement?
Chemotherapy
What are the benefits of chemotherapy and other pharmacologic agents?
Reduces the rate of reoccurrence and the death rate
What is letrazole?
Aromatase inhibitor
Reduces risk of recurrence after surgery
What is bevacizumab?
Combined with chemotherapy has extended cancer free survival for meta cancer patients
What is radiation therapy used for?
Examples
Usually follows surgery to kill any cells that could cause recurrence or metastasis
- Shrink the tumor before surgery
- Palliative radiation
External beam
High dose brachytherapy
What is intraoperative radiotherapy?
Probe inserted into the cavity created by a lumpectomy
Radiation equivalent to 6 weeks of doses is given in 25mins
What are some complications of breast cancer?
Local recurrence (skin and chest wall)
Regional recurrence (Lymph nodes)
Distant metastasis
- (Skeletal-bone, spinal cord, brain, pulmonary, liver, bone marrow)
An example of hormone therapy for breast cancer?
Tamoxifen Citrate
-Selective estrogen receptor modulator (SERM)
What is the purpose of Tamoxifen Citrate?
- Prevents estrogen from attaching to estrogen receptors on the cancer cells
- Inhibits tumor growth and ultimately kills tumor cells
When is Tamoxifen Citrate used ?
Treat advanced breast cancer
Adjuvant for early stage breast cancer
Preventative treatment in women at high risk for developing breast cancer
What is targeted therapy used for?
To counteract specific genetic mutations that promote cancer growth
What is Trastuzumab?
What is it used for?
Used to stop the growth of breast tumors that express the HER2/ neu receptor (which binds an epidermal growth factor that contributes to cancer cell growth) on their cell surface
- This drug is a recombinant DNA-derived monoclonal antibody that binds to the receptor, inhibiting tumor cell proliferation
What is lymphedema?
Accumulation of lymph in the soft tissues
S/S of lymphedema?
- Pain
- Heaviness and impaired motor function in the affected arm
- Numbness and paresthesia of the fingers
- Cellulitis
What are the intervention measures for lymphedema ?
- Administration of analgesics to minimize post-op pain and allow for exercise
- Teach measures to prevent lymphedema
- Procedures should not be done on affected side
- Protect from infection
- lymph drainage is altered
What should be part of the nurse planning ?
- Client will make informed treatment decisions
- Client will express feelings regarding diagnosis, treatment and prognosis
- Family and significant others will provide appropriate support for client
- Accurate and complete answers
- Open communication
