CANCER AND BREAST CA Flashcards
what is a WELL-DIFFERENTIATED CANCER?
benign cancer cells similar to the characteristics of a normal cell
Tends to grow and spread more slowly
what is POORLY-DIFFERENTIATED CANCER?
Malignant cells that look very different from normal cells
How does metastasis occur?
Direct spread of tumor cells by diffusion to other body cavities
Circulation by way of blood and lymphatic channels
Transplantation or direct transport of tumor cells from one site to another.
STAGING IN CANCER
STAGE I: in Breast and Lung cancer
Tumor is only seen in that organ
It is localized
Tumor is less than 2cm
No nodes involved
STAGE II:
Tumor increased in size between 2-5 cm
May or may not involve the lymph nodes in the axilla
STAGE III:
Tumor is larger about more than 5 cm
Has metastasized
Already involved the lymph nodes
Probably has invaded surrounding tissues or both
STAGE IV:
Involved other organs such as the brain or bones.
Cancer has invaded or metastasized to other parts of the body.
Reasons for staging:
A way in which characteristics of cancer can be described
The size of the tumor is less than 2 cm: Stage 1 cancer
Size of tumor is between 2-5 cm: Stage 2 cancer
To help the physicians know the treatment for the cancer
If it’s in the early stages (stage 1&2) → SURGERY
If cancer metastasized → no operation needed, only anti-cancer drugs/radiation.
To classify the extent and spread of the cancer
Localized → stage 1
Lymph nodes involved → stage 2
Goes to other structures → stage 3
Involved many organs → stage 4
To estimate the prognosis of cancer
Stage 1 & 2: good prognosis
Stage 3 & 4: bad prognosis
difference between Carcinoma, Sarcoma, and lymphoma
Epithelial cells are the ones affected
Seen in the skin, stomach, liver
Connective tissue is affected
See in the bones and kidneys
It is in the blood
why aging is the number 1 risk factor for CA?
Immune system is reduced since you have used it for so many years
Older adults may not be able to repair these mutations as they once did.
what is the difference between SITU and INFILTRATING?
In SITU
The cancer cell is inside the lobule or inside the duct.
It is not going out.
Infiltrating
The cancer cell was able to move out of the duct or the lobule.
It is something invasive.
what part of the pectoralis is removed during modified radical mastectomy and total radical mastectomy
Modified: minor or major pectoral removed
Total: minor and major pectoral
removed
what are the 2 main kinds of breast CA?
DUCTAL, meaning it starts in the tubes, or milk ducts
LOBULAR, meaning it starts in the milk-producing glands.
DUCTAL CARCINOMA IN SITU (INSIDE)
Most common non-invasive cancer (localized)
LOBULAR CARCINOMA IN SITU
Collection of abnormal cells is present, but doesn’t extend beyond the affected lobule.
INFILTRATING DUCTAL CARCINOMA (Going Out)
Cancerous cells break through the duct wall and invade the breast tissue
Most common sites for metastasis are the bones, lungs, liver, and brain.
INFLAMMATORY BREAST CANCER
An aggressive cancer in which the affected breast looks inflamed, red, and feels warm
Death occurs within 18 to 24 months of diagnosis
The skin has the appearance of an orange peel, with an engorged look.
“Peau d’ Orange”
late manifestation of inflammatory breast CA
PAGET’S DISEASE
It is the nipples that are affected.
Eczema
Itching
Thickening of the areola
Can be invasive or non-invasive
More common in men than in women.
Symptoms include: scaly, erythematous, pruritic lesion of the nipple.
what is the main food of the cancers?
Estrogen for female causes breast CA
testosterone for male causes prostrate CA
Effect of alcohol in CA
Drinking a lot of liquor → suppresses the ability of WBC to multiply and inhibit the action of killer WBC on cancer cells
can also lead to cancer of the liver
Will lessen the ability of macrophages to produce TUMOR NECROSIS FACTORS (TNF)
TNF is a protein that contributes to inflammation
Inflammation is an essential part of the immune system.
Once TNF is sufficient in amount, it will attack not only the bacteria and viruses but also cancer cells.
The BEST IMAGING TOOL for detecting breast CA
MAMMOGRAM
BEST TIME TO SCREEN YOURSELF ?
1 week after menstrual period or 1-2 weeks after the onset of menses.
Before menstruation, breast is dense and hard because of the presence of progesterone
How often should you subject yourself to mammography?
Women 55 and older may continue yearly screening or transition to every 2 years
Healthy women: have mammography every year beginning at age 45
Aged 40 -44: option to begin yearly screening
How will you prepare a patient who will undergo mammography?
(NURSING INTERVENTION)
Do not apply talcum powder or body lotion because this can give impression of calcification within the breast
No fasting required
Explain that no jewelry should be worn around the neck. This can preclude total visualization of the breast
Patient had Breast augmentation implants (silicone) was used, if they have cancer mammography will hinder the machine to see tumor.
How to know if there is breast implants?
True: if you place patient in supine postion → adipose tissue in breast goes to side → flatten breast
Silicon: if placed flat in bed → breast still standing with no decrease in size
Mammography cannot be done→ INSTEAD = ULTRASONOGRAPHY
Inform the patient that some discomfort may be experienced during breast compression.
Machine is going to press on the breast
DIGITAL MAMMOGRAPHY IS INDICATED FOR?
Small chest or those who have big chest but does not like mammography due to discomfort
HEALTH TEACHINGS or PREPARATION FOR DIGITAL MAMMOGRAPHY:
On the day of your mammogram, please DO NOT USE deodorant, powder, perfume or lotion under your arms or near or your breast area. These products may show up on your mammogram images.
Caffeine should be eliminated one week prior to your exam. This is for your comfort, as caffeine can sometimes cause breast tenderness
Wear a two-piece outfit so you only need to remove your top.
BREAST ULTRASONOGRAPHY IS INDICATED FOR?
Indicated for patients: with firm rigid breasts; breast implants
Take about 10 - 15 minutes to finish
HEALTH TEACHINGS or PREPARATION FOR BREAST ULTRASONOGRAPHY
No fasting or sedation is required
Instruct the patient not to apply any lotions or powders to the breast.
Supine position, a conductive paste (cold) is applied.
Duration: 15 minutes
CLINICAL BREAST EXAM
Done by a physician not nurse that will palpate breast
YEARLY : 40 years or older
EVERY 3 YEARS : 20 - 39 years or older
BREAST SELF- EXAMINATION When is the best time to perform BSE?
Premenopausal (beginning at age 20)→ After menses (MONTHLY): DAY 5 to 7; counting the first day of menses as day 1
Post menopausal or not menstruating : once monthly
The latter half of the mestrual cycle is influenced by the secretion of progesterone, which causes breast
vasculature and ductal structures to dilate with resultant tissue engorment
This will make breast very nodular and tender
How will you position the patient?
What part of hands used when palpating breast?
(FOR EXAMINATION)
Supine position
Shoulder is first elevated with a small pillow
to help balance the breast on the chest wall.
Failure to do this allows the breast tissue to slip laterally and a breast mass may be missed.
Systematically palpated using the flat part (pads) of the second,third, and fourth fingertips, held together, making dime-size circles.
Clockwise direction
Sitting position
Palpation of the axillary and clavicular areas is easily performed
Axillary lymph nodes
the examiner gently abducts the patient’s arm from the thorax.
With the left hand, the patient’s right forearm is grasped and supported.
The right hand is then free to palpate the axilla.
WHAT GENE ARE BEING TESTED IN BRCA TESTING
Usually the chromosome 13 (BRCA-2) and 17 (BRCA-1) are involved
What are these genes for? (BRCA GENES)
Function: Normally present in body and protect the body from getting certain cancer ex. Breast cancer
Tumor suppressor genes that normaly function to identify damaged DNA and therefore restrain abnormal cell growth
WHAT HAPPENED IF THERE ARE MUTATION IN THIS GENES?
prevent genes from suppressing tumors or identify damaged DNA → possible we inherit these mutations → more likely to get breast, ovaria, colon cancer
WHAT IS PHROPHYLACTIC MASTECTOMY?
primary prevention modality that can reduce the risk of breast cancer by 90% to 95%
“risk-reducing” mastectomy.
PREOPERATIVE INTERVENTIONS :
Shower with an antibacterial soap
Teaching topics include:
Expected length of stay
Routine postoperative monitoring
Caring for a drainage tube
ROM
Pain management
Consent should be obtained
Demonstration of deep breathing, coughing, incentive spirometry exercises, splinting wound
Talk to patient for anticipated contraptions. After modified radical mastectomy, possible to have: Jackson pratt or hemovac, 2 iv fluids, oral airway, oxygen, foley catheter
Pain but not worry → opioids will be given such as demerol or tramadol
MODIFIED RADICAL MASTECTOMY
Treats invasive breast cancer.
Procedure: Removal of breast tissue, including the nipple–areola comple
TOTAL MASTECTOMY
Like modified radical mastectomy, it also removes the breast and nipple–areola complex but does not include axillary lymph node dissection (ALND).
Could be for patients with noninvasive breast cancer
BREAST CONSERVATION TREATMENT
GOAL: excise the tumor in the breast completely and obtain clear margins while achieving an acceptable cosmetic result.
Lumpectomy or tylectomy
Only remove the tumor plus 2-3 inches of the surrounding tissue.
SENTINEL LYMPH NODE BIOPSY
It is going to map the lymph nodes that contain the cancer cells → a dye will be injected, blue in color and can make bedsheet black in color. Once injected it will go to the lymph node carrying the cancer cells.
(+) lymph node result = continue modified radical mastectomy
(-) lymph node result = no operation will be performed
If results are NEGATIVE, the rest of the axillary lymph contents can be assumed to be free of tumor and are not removed.
Jackson-pratt or hemovac drains
Usually in place or 2-4 days
Drainage should not exceed 200 mL in 8 hours
up to 4th postoperative day
The normal drainage should not exceed 200 ml in 8 hours
DRAIN
Excessive BRIGHT RED DRAINAGE may indicate HEMORRHAGE.
It should not exceed 200 ml in 8 hours.
If less, it is good, BUT if it is less on the 1st day or no return then that is abnormal.
Drains are generally removed when drainage is about 30 mL/ 24 hours.
WHY DO WE NEED TO ELEVATE PT ARMS AFTER SURGERY?
you need to elevate it up to 4 weeks
Elevate it because surgery was done → INFLAMMATION → chemical mediator will be released → plasma which is rich in protein → will go in the interstitial compartment and → LYMPHEDEMA
Forearm resting on a pillow to facilitate drainage and adequate circulation
Continue to elevate her affected arm at home for 4-6 weeks after surgery to help reduce initial swelling and discomfort.
Give the patient a small foam ball and tell her to squeeze it with the hand on her surgical site to help circulate lymph fluid.
With the affected arm, they should press and release the ball 20 to 25 times every hour → to help circulate the lymph fluid.
So the arm should be elevated even if the patient goes home
WHY DOES THE AFFECTED ARM KEEP IMMOBILE FOR 24 HRS
That affected arm is kept relatively immobile for 24 hours to decrease any strain on the incision site
If the patient had removed the left breast then you can place, left arm precaution meaning to say no iv fluid, extraction of blood, taking of blood pressure or venipuncture.
When can you perform hand exercises?
Hand exercises to facilitate lymphatic flow may be started (24 hours after the surgery) → to prevent contractures
NURSING INTERVENTION FOR PT UNDERGONE MASTECTOMY
Mastectomy patients should not wear anything that might irritate the incision until after the wound has healed, generally in 6-10 weeks.
Do not wear bra after operation as it can cause inflammation of the incision site
A patient who has undergone axillary node dissection should not shave the affected under arm or apply depilatory creams or strong deodorants for at least two weeks post op.
Patient-controlled analgesia → can be tramadol, fentanyl or demerol.
Medicating the patient before activities such as:
Turning
Getting out of bed for the first time is advisable
Demerol or other pain medications is given when patient is awake, every four hours, up to three days post-op
Before any activity give pain medication first
Sleep on her back or nonsurgical side
The nurse should position the patient on her back or the nonsurgical side. The nurse should not position the patient on the surgical side because it will cause pressure on the affected arm.
Carry luggage or her handbag on her nonsurgical side.
PREVENTING/MINIMIZING LYMPHEDEMA
Wear no constricting clothing or jewelry including wristwatch on affected arm
Place the arm in a SLING when the client ambulates INITIALLY
Eventually the arm can be positioned at the client’s SIDE.
Use protective hand and finger covering when washing dishes, cooking, sewing.
Avoid lifting or moving heavy objects (6-8 weeks) because it can lead to more edema.
Avoid using bags with shoulder straps on the affected side.
Teach them to use the affected limb for normal everyday activities such as hair brushing, bathing.
So it must not be completely immobilized
Avoid prolonged exposure to heat such as hot tubs and saunas.
There could be vasodilation that could worsen the lymphedema of the affected side.
Let the patient sleep on her back or nonsurgical side.
AFTER 6 WEEKS OR WHEN ARM FUNCTION IS RESTORED post-operative arm and shoulder exercise are institute gradually
Head wall climbing
Rope turning
Broomstick lifting
Towel stretch
Radiotherapy and lumpectomy
Lumpectomy or modified radical mastectomy will be followed by radiation.
It usually started 2-3 weeks after surgery, when the wound is completely healed and the patient can comfortably raise her arm over her head.
Radiation can burn the skin
The treatments are usually done 5 days a week for a total of 5-6 weeks
What are the anti hormonal that will be given to the patient after surgery?:
TAMOXIFEN (Nolvadex, Fenahex, Gyraxen)
20 mg PO DAILY FOR 5 YEARS
Tamoxifen will not allow the estrogen to enter the cancer cell. The cell will feel hungry and die.
ANASTROZOLE (ARIMIDEX)
First line oral therapy of post-menopausal women with either early or advanced breast cancer.
This is good for post-menopausal women.
ALENDRONATE (Fosamax) is given with anastrozole to prevent osteoporosis.
what foods is best for PT with breast CA
ISOFLAVONES
An ANTIESTROGEN ACTIVITY which may decrease risk of estrogen-dependent cancers.
FOODS
Tofu
You can have tofu soup, tofu steak, garbanzos (Chickpeas)
LYCOPENE
Potent antioxidant that may reduce the risk of cancer
FOODS
Watermelon
Tomatoes
Papaya
Apples
