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CANCER > CANCER AND BREAST CA > Flashcards

CANCER AND BREAST CA Flashcards

1
Q

what is a WELL-DIFFERENTIATED CANCER?

A

benign cancer cells similar to the characteristics of a normal cell
Tends to grow and spread more slowly

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2
Q

what is POORLY-DIFFERENTIATED CANCER?

A

Malignant cells that look very different from normal cells

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3
Q

How does metastasis occur?

A

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.

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4
Q

STAGING IN CANCER

A

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.

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5
Q

Reasons for staging:

A

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

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6
Q

difference between Carcinoma, Sarcoma, and lymphoma

A

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

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7
Q

why aging is the number 1 risk factor for CA?

A

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.

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8
Q

what is the difference between SITU and INFILTRATING?

A

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.

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9
Q

what part of the pectoralis is removed during modified radical mastectomy and total radical mastectomy

A

Modified: minor or major pectoral removed

Total: minor and major pectoral
removed

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10
Q

what are the 2 main kinds of breast CA?

A

DUCTAL, meaning it starts in the tubes, or milk ducts

LOBULAR, meaning it starts in the milk-producing glands.

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11
Q

DUCTAL CARCINOMA IN SITU (INSIDE)

A

Most common non-invasive cancer (localized)

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12
Q

LOBULAR CARCINOMA IN SITU

A

Collection of abnormal cells is present, but doesn’t extend beyond the affected lobule.

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13
Q

INFILTRATING DUCTAL CARCINOMA (Going Out)

A

Cancerous cells break through the duct wall and invade the breast tissue

Most common sites for metastasis are the bones, lungs, liver, and brain.

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14
Q

INFLAMMATORY BREAST CANCER

A

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.

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15
Q

“Peau d’ Orange”

A

late manifestation of inflammatory breast CA

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16
Q

PAGET’S DISEASE

A

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.

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17
Q

what is the main food of the cancers?

A

Estrogen for female causes breast CA
testosterone for male causes prostrate CA

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18
Q

Effect of alcohol in CA

A

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.

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19
Q

The BEST IMAGING TOOL for detecting breast CA

A

MAMMOGRAM

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20
Q

BEST TIME TO SCREEN YOURSELF ?

A

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

21
Q

How often should you subject yourself to mammography?

A

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

22
Q

How will you prepare a patient who will undergo mammography?
(NURSING INTERVENTION)

A

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

23
Q

DIGITAL MAMMOGRAPHY IS INDICATED FOR?

A

Small chest or those who have big chest but does not like mammography due to discomfort

24
Q

HEALTH TEACHINGS or PREPARATION FOR DIGITAL MAMMOGRAPHY:

A

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.

25
Q

BREAST ULTRASONOGRAPHY IS INDICATED FOR?

A

Indicated for patients: with firm rigid breasts; breast implants
Take about 10 - 15 minutes to finish

26
Q

HEALTH TEACHINGS or PREPARATION FOR BREAST ULTRASONOGRAPHY

A

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

27
Q

CLINICAL BREAST EXAM

A

Done by a physician not nurse that will palpate breast
YEARLY : 40 years or older
EVERY 3 YEARS : 20 - 39 years or older

28
Q

BREAST SELF- EXAMINATION When is the best time to perform BSE?

A

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

29
Q

How will you position the patient?
What part of hands used when palpating breast?
(FOR EXAMINATION)

A

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.

30
Q

WHAT GENE ARE BEING TESTED IN BRCA TESTING

A

Usually the chromosome 13 (BRCA-2) and 17 (BRCA-1) are involved

31
Q

What are these genes for? (BRCA GENES)

A

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

32
Q

WHAT HAPPENED IF THERE ARE MUTATION IN THIS GENES?

A

prevent genes from suppressing tumors or identify damaged DNA → possible we inherit these mutations → more likely to get breast, ovaria, colon cancer

33
Q

WHAT IS PHROPHYLACTIC MASTECTOMY?

A

primary prevention modality that can reduce the risk of breast cancer by 90% to 95%
“risk-reducing” mastectomy.

34
Q

PREOPERATIVE INTERVENTIONS :

A

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

35
Q

MODIFIED RADICAL MASTECTOMY

A

Treats invasive breast cancer.
Procedure: Removal of breast tissue, including the nipple–areola comple

36
Q

TOTAL MASTECTOMY

A

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

37
Q

BREAST CONSERVATION TREATMENT

A

GOAL: excise the tumor in the breast completely and obtain clear margins while achieving an acceptable cosmetic result.

38
Q

Lumpectomy or tylectomy

A

Only remove the tumor plus 2-3 inches of the surrounding tissue.

39
Q

SENTINEL LYMPH NODE BIOPSY

A

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.

40
Q

Jackson-pratt or hemovac drains

A

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

41
Q

DRAIN

A

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.

42
Q

WHY DO WE NEED TO ELEVATE PT ARMS AFTER SURGERY?

A

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

43
Q

WHY DOES THE AFFECTED ARM KEEP IMMOBILE FOR 24 HRS

A

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.

44
Q

When can you perform hand exercises?

A

Hand exercises to facilitate lymphatic flow may be started (24 hours after the surgery) → to prevent contractures

45
Q

NURSING INTERVENTION FOR PT UNDERGONE MASTECTOMY

A

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.

46
Q

PREVENTING/MINIMIZING LYMPHEDEMA

A

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

47
Q

Radiotherapy and lumpectomy

A

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

48
Q

What are the anti hormonal that will be given to the patient after surgery?:

A

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.

49
Q

what foods is best for PT with breast CA

A

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

CANCER (5 decks)

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