Brest Cancer + Pneumonia Flashcards
Provide a definition of breast Cancer
- A malignant tumor that has developed from cells in the breast (epithelial tumor involving ducts or lobules)
- Usually breast cancer either begins in the cells of the lobules or ducts
- Takes 3-4 years before cancerous lump develops to a palpable level
What is the Pathophysiology of breast cancer?
- arise from increase in number of breast cells resulting in atypical breast cells being created => carcinoma => invasive cancer
- occurs due to interaction with environment + defective gene
- when cells become cancerous they lose the ability to stop dividing, to attach to other cells and stay where they belong and cannot commit suicide
- can be inherited or acquired after birth e.g. BRCA1 & BRACA2
What are the clinical signs and symptoms of breast cancer?
- new lump or area of thickened tissue in either breast
- a change in size of shape of one of both breasts
- bloodstained discharge from either nipple
- a lump/swelling in either armpit
- dimpling on the skin of your breasts
- a rash on/around the nipple + shape change/bleeding
- a change in appearance of your nipple (sunken)
- pain is not usually a symptom of breast cancer
What are the red flags for Breast Cancer?
- Paget’s disease (redness, itching, crusty skin)
- fixation of the mass to the chest wall or to overlying skin
- satellite nodules or ulcers in the skin
- matted or fixed Axillary lymph
- supraclavicular or infraclavicular lymphadenopathy
- severe back pain that is unrelieved by rest or change of position
- presents at night in a woman
- breast cancer has a predilection for axial skeletal bony metastases
- metastases can also occur hematogenously (carried by blood) to the lungs
- severe back pain unrelieved by rest or change of position
- back pain presents at night in women with past history of breast cancer
How do you to assess a breast cancer lump?
- position
- size
- consistency
- mobility
- fixity
- nipple discharge
- nipple inversion
- skin changes
What are the signs and symptoms of metastasised Breast Cancer?
- palpable mass in supraclavicular, chest or Axillary regions
- unilateral upper extremity numbness and tingling
- back, hip or shoulder pain
- pain on weight bearing
- leg weakness or paresis (movement has become weakened or impaired)
- bowel/bladder changes
- jaundice
What are the risk factors of breast cancer?
- older age (oestrogen exposure)
- previous history of breast cancer or other breast conditions
- family history of breast cancer or related cancers such as ovarian cancer
- hormonal factors e.g. taking HRT for 5 years or more, not having had children, bearing children earlier or not breast feeing children
- early menarche/late menopause
- lifestyle factors e.g. being over weight after menopause, smoking, alcohol
What are the secondary breast cancer symptoms?
- fatigued constantly
- constancy nausea
- unexplained weight loss
- loss of appetite
- 2-5 years post remission = danger zone
What treatments are available for breast cancer?
- always refer if suspicious
- surgery
- radiotherapy
- chemotherapy
- hormone therapy
- biological therapy (targeted therapy)
How would you manage breast cancer?
- maintain healthy weight
- exercise regularly
- have a low intake of saturated fat
- do not drink alcohol
Would Donna’s occupation make her more or less likely to develop pneumonia?
- more likely
- occupation results in high contact with people
- enclosed cabin for long durations resulting in a high risk of infection, however, studies have shown that as the air circulated is particularly sterile of microorganisms due to the altitude and that humidity is low, this does not increase risk of infection
Suggest some reasons why Donna may have been admitted to hospital for one bout of pneumonia but not for the subsequent one
- successful treatment previously with antibiotics
- risks higher in hospital due to pneumonia acquired in hospital + other diseases e.g. MRSA virus infection may be higher
- potentially aspirational pneumonia from self infection of previous incident so same strain
When conducting your physical examination how could you differentiate between COPD and pneumonia?
Pneumonia vs COPD:
- COPD - bronchitis more likely in bronchioles than alveoli (although Emphysema in alveoli)
- sounds - COPD = wheezing vs pneumonia = crackling
- percussion - COPD = hyperresonance vs pneumonia = stony dullness
When conducting your physical examination how could you differentiate between asthma and pneumonia?
- sounds - asthma = wheezing/whistling vs pneumonia = crackling/bubbling/rumbling
- percussion - asthma = hyperresonance vs pneumonia = stony dullness
- asthmas reduced PEAK flow
A patient, that you have previously treated successfully for back pain, calls you in practice and says ‘the doctor says I have pneumonia, can you help me get rid of it?’
How would you manage this?
- ask them about what their doctor had told them about pneumonia
- if their doctor prescribed them drugs then encourage them to complete the course of treatment
- suggest they reduce their alcohol consumption and reduce saturated fat
- long term to exercise regularly and maintain a healthy weight
