Breast Cancer Flashcards
1
Q
How many women diagnosed every year with breast cancer?
A
200,000
2
Q
How many die yearly?
A
39,000
3
Q
Breast cancer is most prevalent among…?
A
white women
4
Q
Breast cancer is primarily a disease of…
A
older women
5
Q
_____ most commonly occurring cancer in women
A
2nd most common
6
Q
What is Breast cancer?
A
- unregulated growth of abnormal cells in breast tissue
- begins as a single transformed cell and is often hormone dependent
7
Q
Breast cancer is classified as…
A
NON-INVASIVE (in situ) or INVASIVE (invades surrounding tissue)
8
Q
Categorization of Breast Cancer
A
- Carcinoma of the mammary ducts (most common type is infiltrating ductal carcinoma)
- Carcinoma of the mammary lobules
- Sarcoma of the breast
9
Q
Most breast cancers are…
A
Adenocarcinomas
10
Q
Triple Negative Breast Cancer
A
-Breast cancers are generally diagnosed and treated based on the presence, or lack of 3 receptors known to fuel most breast cancers:
- estrogen receptors
- progesterone receptors
- and HER2
**Most successful treatments for breast cancer target these receptors
- Triple Negative BC none of these receptors are found, but is responsive to chemo typically.
- Triple Negative BC tumors do not respond to receptor targeted treatments
- particularly aggressive and more than likely to recur than other subtypes
11
Q
Atypical Types of BC
A
- Paget’s disease
- Inflammatory carcinoma
12
Q
Paget’s Disease
A
- rare breast malignancy
- can be confused with infection or dermatitis
- involving skin of the nipple and areola
- usually have one or more tumors inside the same breast (ductal carcinoma in situ or invasive BC)
13
Q
Inflammatory Carcinoma
A
- aggressive and fast growing breast cancer in which cancer cells infiltrate the skin and lymph vessels of the breast
- often produces no distinct tumor or lump that can be felt and isolated within the breast
- symptoms appear when lymph vessels become blocked by the breast cancer cells
- breast red, swollen, and warm, itching, pitted and nipple changes such as inversion, flattening or dimpling
14
Q
Pathophysiology
A
Various types:
-epithelial lining of ducts
- epithelial of the lobules
- in situ (within the duct)
- invasive (arising from the duct and invading through the wall of the duct)
Cancer growth: slow to rapid
15
Q
Factors that affect prognosis
A
- tumor size
- axillary node involvement
- tumor differentiation
- estrogen and progesterone receptor status
- HER-2 status (receptor that helps regulate cell growth)
16
Q
Possible causes of BC
A
- environmental
- hormonal (hormonal regulation of breast related to the development of BC)
- reproductive (estrogen and progesterone may act as tumor promotors)
- hereditary (BC susceptibility genes), HER2 gene
17
Q
BC Susceptibility Genes
A
- BRCA1 gene (chromosome 17)
- BRCA2 (chromosome 11)
- tumor suppressor genes: inhibits tumor development when functioning normally
- responsible for 10% of women with hereditary breast cancer with genetic mutations causing up to 80% in women
18
Q
Women who have BRCA mutations
A
- 40-80% lifetime chance of developing breast cancer
- As many as 1 in 200 to 1 in 400 women in the US may be carriers for these genetic abnormalities
- Associated with early onset breast cancer
- 5-10% of breast cancers are related to BRCA1 and BRCA2 mutations
- Also has increased risk for ovarian cancer
19
Q
Risk Factors for BC
A
- Gender
- Age
- Family hx
- personal hx
- previous chest irradiation
- menstrual history (early menarche or late menopause)
20
Q
Life style factors for BC
A
- oral contraceptives
- not having children
- having children after 30
- hormone replacement therapy for more than 5 years
- alcohol
- not breastfeeding
- obesity
- high-fat diets
- physical inactivity
- environmental pollution
21
Q
Breast Cancer in Men Symptoms
A
- lump
- nipple discharge
- reddening
- inversion of nipple
- skin dimpling
22
Q
Pre-disposing risks in men
A
- states of hyperestrogenism
- family hx of BC
- radiation exposure
23
Q
Prevention of BC
A
- Monthly self breast exams
- early detection (reduces mortality and promotes positive outcomes)
- routine screening for genetic abnormalities
24
Q
Lumps
A
- hard
- irregularly shaped
- poorly delineated
- non-mobile
- non tender
25
BSE
Breast Self Exam
- standing
- with fingertips close together gently probe each breast in one of 3 patterns
- several days after period ends, less likely to be swollen and tender
1. vertically from L to R
2. Star towards nipple
3. circular around nipple and out
26
Women with BRCA1 or BRCA2 mutations can prophylactically...
- Prophylactic bilateral oophorectomy: can decrease the risk of breast and ovarian cancer
- Prophylactic bilateral mastectomy: may reduce risk of BC by 90%
27
Where does BC occur most often in breast?
- Upper, Outer Quadrant (50%)
| - Nipple (18%)
28
Mammographic abnormality
- most often in the upper outer quadrant
| - ACS recommends annual mammograms at age 40 an clinical breast exams every 3 years for women in their 20s and 30s
29
Mammogram
-each breast is compressed horizontally and then obliquely and an x-ray is taken of each position
30
Diagnostic Tests for BC
- Mammogram
- Aspiration biopsy
- Excisional biopsy
31
Aspiration biopsy
- percutaneous needle biopsy
- cystic mass or fibrocystic changes
- fluid or tissue
32
Excisional biopsy
- suspicious lump is identified
| - tissue
33
Tumor Markers
Protein molecules detected in serum or other body fluids:
- CEA
- HER1
- HER2
- EGFR
- CA-15-3
- CA-27-29
34
Treatment of BC
Historically, mastectomy was the standard of care
- currently wide range of treatment options
- prognostic factors are considered when making treatment decisions about a specific breast cancer
- Surgery
- Radiation therapy
- chemo
- targeted therapy
- hormone therapy
35
Staging
0-4
TNM= tumor size, nodal involvement, presence of metastasis
36
Surgery Treatment
- segmental mastectomy
- simple mastectomy
- modified radical mastectomy
- radical mastectomy
37
Lumpectomy
aka segmental mastectomy
* option for tumors smaller than 4-5 cm
- removal of entire tumor with a margin of normal surrounding tissue
- radiation therapy
38
Advantages to lumpectomy
-goal of the combined treatment: maximize benefits of both cancer treatment and cosmetic outcome while minimizing risks
39
Disadvantages of lumpectomy
increased cost of surgery and radiation possible side effects of radiation
40
Mastectomy
- simple mastectomy: complete breast
- modified radical mastectomy: breast and lymph nodes
- complete mastectomy: breast, lymph nodes, chest wall
41
Lymph nodes
the presence or absence of malignant cells in lymph nodes remains a powerful prognostic factors
42
Diagnostic Lymph Nodes
examination of lymph nodes provide prognostic information to determine further treatment
-chemo, hormone therapy, or both
ALND status
43
ALND Status
Axillary Lymph Node Dissection status
-4+ greatest risk of recurrence
44
sentinel lymph node
A sentinel lymph node is defined as the first lymph node to which cancer cells are most likely to spread from a primary tumor. Sometimes, there can be more than one sentinel lymph node.
1-4 nodes removed
45
Axillary lymph node dissection
ALND
- used to be standard of care until recently
- 12-20 nodes same side
- done for two reasons:
1. help stage breast cancer
2. help prevent a regional recurrence of the disease
46
Lymph mapping
first step in a sentinel node biopsy.
It’s done to find the sentinel node.
47
Breast Reconstruction Types
1. Breast implants and tissue expansion
2. Musculocutaneous Flap Procedure
3. Nipple-Areolar reconstruction
48
Indications for Breast REconstruction
- improve self image
- regain a sense of normalcy
- assist in coping with the loss of a breast
49
Mammoplasty
-cosmetic and reconstruct
50
Advantage of immediate reconstruction
- one surgery
- one anesthesia
- one recovery period
- before the development of scar tissue or adhesions
51
Chemotherapy
standard of care for the majority of breast cancer cases with axillary lymph node involvement
-reduces the rate of reoccurence and the death rate
52
Other Pharmacological agents for BC
- Letrazole (aromatase inhibitor): reduced risk of recurrence after surgery
- Bevacizumab: combined with chemo has extended cancer-free survival for meta ca patients
53
Radiation Therapy
- usually follows surgery to kill any cells that could cause recurrence or metastasis
- shrink tumor before surgery
- palliative radiation
- external beam
- High-dose brachytherapy
- intraoperative radiotherapy
54
intraoperative radiotherapy
- probe inserted into the cavity created by the lumpectomy
| - radiation equivalent to six weeks of doses is given for approx. 25 minutes
55
Hormone Therapy
-Tamoxifen Citrate (Nolvadex)
Selective estrogen receptor modulator (SERM)
- Action: prevents estrogen from attaching to estrogen receptors on the cancer cells
- inhibits tumor growth and ultimately kills tumor cells
- treats advanced breast cancer
- adjuvant for early stage breast cancer
- preventative treatment in women at high risk for developing breast cancer
56
Targeted Therapy
- used to counteract specific genetic mutations that promote cancer growth
- Trastuzumab (Herceptin)
- 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
- recombinant DNA-derived monoclonal antibody that binds to the receptor, inhibiting tumor cell proliferation
57
Complications of BC
- Local recurrence (skin and chest wall)
- Regional recurrence (lymph nodes)
- Distant metastasis (skeletal-bone, spinal cord, brain, pulmonary, liver, bone marrow)
58
Lymphedema
- accumulation of lymph in the soft tissues
- pain
- heaviness and impaired motor function in the affected arm
- numbness and paresthesia of the fingers
- cellulitis
59
Intervention for Lymphedema
- 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)
60
Clients diagnosed with BC require....
-holistic care that addresses physical, psychological, social and spiritual needs
61
Nursing Process: Assessment
- family/personal hx
- benign breast dz, menstrual hx, preg hx, cancers
- BSE
- use of hormones
- exposure to radiation
- alcohol use
- obesity, diet
- physical activity
62
Nursing Process: Diagnosis
- acute pain
- anxiety
- disturbed body image
- decisional conflict
- risk for infection
- risk for injury
63
Nursing Process: 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
**promote open communication of thoughts and feelings between patient and family
**provide accurate and complete answers to treatment and disease related questions
**offer information on community resources and support groups
64
Nursing Process: Implementation
- Selection and implementation of nursing interventions must be individualized to meet the individual clients needs
* teaching (pre and post op)
* physiological needs
* pain
* prevent infection
* promote optimal circulation
* promote psychosocial well-being
* promote a health body image
* manage side effects of adjuvant therapy
65
Nursing Process: Evaluation
- clients are evaluated for expected outcomes based on specific client needs and care planning
* no complications from adjunct treatments
* medication side effects are minimized
* pain is managed to allow the client to rest and perform essential ADL's
* assist in developing positive but realistic attitude
* help identify sources of support
* encourage verbalization of anger and fears
* monthly BSE on both breast and surgical site
* breast imaging done at regular intervals (6m to 1yr)
66
Culturally competent care
cultural values strongly influenced how women respond to and cope with BC and treatment
