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MS1 Exam Two > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

How many women diagnosed every year with breast cancer?

A

200,000

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2
Q

How many die yearly?

A

39,000

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3
Q

Breast cancer is most prevalent among…?

A

white women

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4
Q

Breast cancer is primarily a disease of…

A

older women

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5
Q

_____ most commonly occurring cancer in women

A

2nd most common

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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

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7
Q

Breast cancer is classified as…

A

NON-INVASIVE (in situ) or INVASIVE (invades surrounding tissue)

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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
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9
Q

Most breast cancers are…

A

Adenocarcinomas

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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
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11
Q

Atypical Types of BC

A
  • Paget’s disease

- Inflammatory carcinoma

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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)
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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
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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

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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)
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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
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17
Q

BC Susceptibility Genes

A
  1. BRCA1 gene (chromosome 17)
  2. 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
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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
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19
Q

Risk Factors for BC

A
  • Gender
  • Age
  • Family hx
  • personal hx
  • previous chest irradiation
  • menstrual history (early menarche or late menopause)
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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
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21
Q

Breast Cancer in Men Symptoms

A
  • lump
  • nipple discharge
  • reddening
  • inversion of nipple
  • skin dimpling
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22
Q

Pre-disposing risks in men

A
  • states of hyperestrogenism
  • family hx of BC
  • radiation exposure
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23
Q

Prevention of BC

A
  • Monthly self breast exams
  • early detection (reduces mortality and promotes positive outcomes)
  • routine screening for genetic abnormalities
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24
Q

Lumps

A
  • hard
  • irregularly shaped
  • poorly delineated
  • non-mobile
  • non tender
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25
Q

BSE

A

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
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26
Q

Women with BRCA1 or BRCA2 mutations can prophylactically…

A
  • Prophylactic bilateral oophorectomy: can decrease the risk of breast and ovarian cancer
  • Prophylactic bilateral mastectomy: may reduce risk of BC by 90%
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27
Q

Where does BC occur most often in breast?

A
  • Upper, Outer Quadrant (50%)

- Nipple (18%)

28
Q

Mammographic abnormality

A
  • 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
Q

Mammogram

A

-each breast is compressed horizontally and then obliquely and an x-ray is taken of each position

30
Q

Diagnostic Tests for BC

A
  • Mammogram
  • Aspiration biopsy
  • Excisional biopsy
31
Q

Aspiration biopsy

A
  • percutaneous needle biopsy
  • cystic mass or fibrocystic changes
  • fluid or tissue
32
Q

Excisional biopsy

A
  • suspicious lump is identified

- tissue

33
Q

Tumor Markers

A

Protein molecules detected in serum or other body fluids:

  • CEA
  • HER1
  • HER2
  • EGFR
  • CA-15-3
  • CA-27-29
34
Q

Treatment of BC

A

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
Q

Staging

A

0-4

TNM= tumor size, nodal involvement, presence of metastasis

36
Q

Surgery Treatment

A
  • segmental mastectomy
  • simple mastectomy
  • modified radical mastectomy
  • radical mastectomy
37
Q

Lumpectomy

A

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
Q

Advantages to lumpectomy

A

-goal of the combined treatment: maximize benefits of both cancer treatment and cosmetic outcome while minimizing risks

39
Q

Disadvantages of lumpectomy

A

increased cost of surgery and radiation possible side effects of radiation

40
Q

Mastectomy

A
  • simple mastectomy: complete breast
  • modified radical mastectomy: breast and lymph nodes
  • complete mastectomy: breast, lymph nodes, chest wall
41
Q

Lymph nodes

A

the presence or absence of malignant cells in lymph nodes remains a powerful prognostic factors

42
Q

Diagnostic Lymph Nodes

A

examination of lymph nodes provide prognostic information to determine further treatment

-chemo, hormone therapy, or both

ALND status

43
Q

ALND Status

A

Axillary Lymph Node Dissection status

-4+ greatest risk of recurrence

44
Q

sentinel lymph node

A

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
Q

Axillary lymph node dissection

A

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
Q

Lymph mapping

A

first step in a sentinel node biopsy.

It’s done to find the sentinel node.

47
Q

Breast Reconstruction Types

A
  1. Breast implants and tissue expansion
  2. Musculocutaneous Flap Procedure
  3. Nipple-Areolar reconstruction
48
Q

Indications for Breast REconstruction

A
  • improve self image
  • regain a sense of normalcy
  • assist in coping with the loss of a breast
49
Q

Mammoplasty

A

-cosmetic and reconstruct

50
Q

Advantage of immediate reconstruction

A
  • one surgery
  • one anesthesia
  • one recovery period
  • before the development of scar tissue or adhesions
51
Q

Chemotherapy

A

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
Q

Other Pharmacological agents for BC

A
  • Letrazole (aromatase inhibitor): reduced risk of recurrence after surgery
  • Bevacizumab: combined with chemo has extended cancer-free survival for meta ca patients
53
Q

Radiation Therapy

A
  • 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
Q

intraoperative radiotherapy

A
  • probe inserted into the cavity created by the lumpectomy

- radiation equivalent to six weeks of doses is given for approx. 25 minutes

55
Q

Hormone Therapy

A

-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
Q

Targeted Therapy

A
  • 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
Q

Complications of BC

A
  • Local recurrence (skin and chest wall)
  • Regional recurrence (lymph nodes)
  • Distant metastasis (skeletal-bone, spinal cord, brain, pulmonary, liver, bone marrow)
58
Q

Lymphedema

A
  • 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
Q

Intervention for Lymphedema

A
  • 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
Q

Clients diagnosed with BC require….

A

-holistic care that addresses physical, psychological, social and spiritual needs

61
Q

Nursing Process: Assessment

A
  • 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
Q

Nursing Process: Diagnosis

A
  • acute pain
  • anxiety
  • disturbed body image
  • decisional conflict
  • risk for infection
  • risk for injury
63
Q

Nursing Process: Planning

A
  • 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
Q

Nursing Process: Implementation

A
  • 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
Q

Nursing Process: Evaluation

A
  • 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
Q

Culturally competent care

A

cultural values strongly influenced how women respond to and cope with BC and treatment

MS1 Exam Two (6 decks)

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