Cancer lecture 2, Breast and prostate Flashcards
Who is affected by breast cancer
Both men and women, however it is much more common in women
* 1/8 women develop it
* Second leading cause of cancer death in women (Lung is number one)
Where does breast cancer commonly metastasize
- Bone
- Lung
- Brain
- Liver
Screening recommendations: Breast cancer
- Self breast exam monthly, yearly screening by doctor
- Mammogram, low dose 2d x ray
- Tomosynthesis mammograms: 3d mammogram
- Shows calcifications or masses
- Detects changes in breast
- MRI or ultrasound are used to better assess possible changes in high risk pts
How often should women with average risk be screen for breast cancer
- Ages 40-44: Optional should be screened yearly with mammogram
- Ages 45-54: Should be screened with mammograms every year
- Ages 55+: Every 1-2 years based on choice
How often should women with high risk be screened for breast cancer
- Mammogram+MRI yearly starting at age 30
Women that are at high risk of breast cancer
- BRCA1/2 gene
- 1st degree relative with BRCA 1/2
- Radiation to the chest prior to age 30
Risks to breast cancer
- High genetic risk (BRCA1/2)
- History of prior breast cancer or benign breast disease
- Dense breast
- 65+
- African american or puerto rican descent
- 1st degree relative with breast cancer
- Prior radiation to breast or chest
- Early menarche
- Late menopause
- Nulliparity or 1st child after 30
- Hormone therapy after menopause
- Testicular disorders
- Excessive alc consumption
- Smoking
- Diabetes
- Use of oral contraceptives (Not proven)
Protective factors for breast cancer
- Having children before 30, breastfeeding
- Risk reducing or prophylactic mastectomy (BRCA 1/2)
- Risk reducing ovarian ablation (BRCA 1/2)
S+S breast cancer
- Lumpy or thicking of breast, and axilla
- Change in size or shape of breast
- Dimpling or puckering in the skin of the breast
- Nipple is turned inwards into the breast
- Fluid besides milk from nipple (Especially if its bloody)
- Scaly red or swollen skin on the breast, nippple or areola
- Dimpling in the breast looking like the skin of an orange (Peau d’orange )
Breast Biopsy: Fine needle aspirate (FNA)
Only cells are retrieved
Breast Biopsy: Core needle biopsy
Larger needle, more tissue taken
Breast Biopsy: Image guided biopsy
CT/Ultrasound or MRI to see exact area of abnormality
Breast Biopsy: Sentinel lymph node biopsy (SLNB(
- Assess degree of lymph involvement
- Aids in staging the disease and treatment planning
- The sentinel lymph node is the first lymph node that is close to the primary tumor, where the tumor would drain to
- If the node test positive that could mean the cancer has spread to the lymph and possible other organs
- Radioactive dye is injected near the tumor and is followed externally to see where it drains to
- The lymph node is then excised through a small incision for pathology
What is tested for in a breast biopsy
- Estrogen receptor (ER)
- Progesterone receptor (PR)
- HER2 status
- Tumor type and grade
- Lymph nodes for cancer cells
Informative things such as margins, invasiveness and other features not known until the tumor is removed surgically
SLNB+ LN dissection: Benefits
If negative the surgeon will not have to do more extensive surgery which can lead to more complications
SLNB+LN dissection: Complications
- False negatives
- Infection
- Lymphedema: If like 20-40 are removed the lymph system is interrupted and body cant absorb interstitial fluid, leading to a buildup of fluids
Lymphedema
- Build up of fluid in the interstitial space
- Occurs when multiple lymph nodes are removed or impaired
- Skin becomes thickened, red and tender
- Increased risk of infection
- More lymph nodes removed the worse the lymphedema
- May need to see lymphedema specialist
Breast cancer types: Ductal carcinoma in SITU (DCIS)
- Abnormal cells in the milk duct and have not invaded any tissue
- Early stage, precancerous
When it infiltrates tissue it becomes invasive/infiltrating ductal carcinoma
70-80% of all breast cancers
Breast cancer types: Lobular carcinoma in situ (LCIS)
- Abnormal cells in the milk producing glands and have not invaded tissue
- Early stage, precancerous
When it infiltrates tissue it becomes Invasive lobular carcinoma
More likely to be in both breast
Breast cancer types: Adenocarcinoma
Starts in the breast tissue, not the milk glands or duct
Breast cancer types: Triple negative breast cancers
- ER negative
- PR negative
- and HER2 negative
- Hella aggressive
Breast cancer types:Inflammatory breast cancer
- Aggressive breast appears inflamed, tender, swollen
- May not be evident on mammogram, not presenting as a lump
- Only accounts for 1-5%
Breast cancer surgery: Lumpectomy
- Only removes the lump
- Only removes the tumor and tissue around it +lymph somtimes
- After breast looks normal
- May require post op radiation+chemo, hormonal therapy or targeted drug
- Goal is breast preservation and cure
Breast cancer surgery: Total mastectomy
- Entire breast and SLNB with removal of one or more axillary lymph nodes
- May need chem, radiation and other therapies
Breast cancer surgery: Modified radical mastectomy
- All axillary lymph nodes and breast removed
- May need radiation, chemo and other therapies after
Breast cancer surgery: Reconstructive
- Uses implant or tissue from abdomen
- Can do nipple reconstruction with tattooing
Breast cancer surgery: Nursing interventions
- Elevating HOB 30 degrees post op
- Lie on unaffected side, support surgical side with pillows
- Surgical arm to be placed in sling when ambulating
- Do not give injections, take BP or obtain blood from affected arm/side
- Offer emotional support
- Monitor document surgical drainage, sites
- Educate on prothesis/ bras
Breast cancer surgery: Education
- Elevate extremity on pillow
- Never have affected arm in dependent position (Use sling)
- Perform arm exercises
- Wear non restrictive clothing
- Wear compression if you have lymphedema
- Provide info about support groups
Adjuvant and neoadjuvant chemo drugs
Dont memorize
- Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence)
- Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)
- 5-fluorouracil (5-FU) or capecitabine (Xeloda)
- Cyclophosphamide (Cytoxan)
- Carboplatin (Paraplatin)
Chemo drugs for breast cancer that has spread, metastatic breast cancer
Dont memorize
- Taxanes: Paclitaxel (Taxol),docetaxel (Taxotere),and albumin-bound paclitaxel (Abraxane)
- Ixabepilone (Ixempra)
- Eribulin (Halaven)
- Anthracyclines: Doxorubicin (Adriamycin), liposomal doxorubicin (Doxil), and epirubicin (Ellence)
- Platinum agents (Cisplatin, carboplatin)
- Vinorelbine (Navelbine)
- Capecitabine (Xeloda)
- Gemcitabine (Gemzar)
- Antibody drug conjugates (Ado-trastuzumab emtansine [Kadcyla], Fam-trastuzumab deruxtecan [Enhertu], Sacituzumab govitecan[Trodelvy])
HER2 Regimens (Chemo+ trastuzumab)
Dont memorize
AC-TH (doxorubicin, cyclophosphamide, paclitaxel or docetaxel, trastuzumab)
AC-THP (doxorubicin, cyclophosphamide, paclitaxel or docetaxel, trastuzumab, pertuzumab)
TCH (paclitaxel or docetaxel, carboplatin, trastuzumab)
TCHP (paclitaxel or docetaxel, carboplatin, trastuzumab, pertuzumab)
TH (paclitaxel, trastuzumab)
Used for breast cancer
Triple negative disease (Chemo+immunotherapy)
Dont memorize
TC/pembro-AC/pembro (paclitaxel and carboplatin plus pembrolizumab followed by doxorubicin and cyclophosphamide plus pembrolizumab)
TC/pembro-EC/pembro (paclitaxel and carboplatin plus pembrolizumab followed by epirubicin and cyclophosphamide plus pembrolizumab)
Hormone therapy, breast cancer: Tamoxifen
- Given post op surgery to reduce risk of recurrence in both breast or future
- Taken daily for 5-10 years
- Can increase risk for pt developing endometrial cancer
- May be given for high risk pt, that does not
Hormone therapy: Breast cancer: Aromatase inhibitors
- Decrease the amount of estrogen made in tissues other than the ovaries in postmenopausal people
- anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara)
- All are pills taken daily by mouth x 5-10 years
Nursing mgmt, breast cancer chemo
- Monitor for adverse effects of radiation therapy such as fatigue, sore throat, pain with swallowing/mucositis, dry cough, shortness of breath, nausea, anorexia
- Monitor for adverse effects of chemotherapy, bone marrow suppression/infection/bleeding/anemia, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression
- Realize that a diagnosis of breast cancer can impact women in different ways. Assess and provide support throughout diagnosis, treatment, and survivorship process
- Involve the patient in planning and treatment
- Educate patient regarding treatment, signs and symptoms, symptom management, and plan of care
Breast cancer prevention
- Healthy diet: fruits and veggies
- Timely mammogram
- Healthy weight
- Exercise
- Limit alc
- Avoid hormone replacement therapy
- Breast feed for a year
Prostate cancer
- 2nd leading cause of death in med (Cancer wise)
- Slow growing
- Manifestations are similar to benign prostate hyperplasia
- Black men in US and caribbean have the highest rate around the world
Prostate Cancer: Risk factors
- 65+
- Family history, BRAC1/2 can increase risk of aggressive prostate cancer
- History of vasectomy (Not definite)
- Environmental exposure to agent orange
- Unhealthy diet
- Obesity
- Rapid growth of the prostate
Prostate Cancer: Early S+S
- None usually
- Most prostate cancers are found early through screening
- DRE and PSA
Prostate Cancer: Later S+S
- Problems urinating
- Blood in urine or semen
- ED
- Pain in hips, back, spine, chest and other areas where the cancer could have spread to bones
- Weakness in legs or feet, loss of control of bladder or bowel from compression of spinal cord
- Swelling in legs or feet
- Unexplained weight loss
- Fatigue
Prostate specific antigen (PSA)
- Protein produced by cells in prostate gland and released into the bloodstream, measured by blood
- Normals levels are 1-1.5 ng/ml
- PSA rises in men with prostate cancer, but in some it can still be normal
- Above 3 is a flag
Other non-cancerous prostate conditions that can raise PSA
- DRE
- BPH
- Prostatitis: treated with antibiotics, and a couple weeks later level should be normal again
- Sexual activity with ejacualtion can temp raise PSA levels (Dont ejaculate before a PSA test as it can elevate levels)
- PSA is used to monitor response to prostate cancer treatment
Digital rectal exam (DRE)
Finger into anus and feeling of the prostate
Transrectal ultrasound
- Use the ultrasound for guidance and a biopsy tool to take very small slivers of prostate tissue. Biopsy specimens are taken from several areas of the prostate. Most people will have 12 to 14 pieces of tissue removed, and the procedure can take 20 to 30 minutes to complete.
- This procedure is usually done at the hospital or doctor’s office
- Local anesthesia given
Test for prostate cancer
- PSA: Used for diagnosis and treatment response
- DRE
- Transrectal ultrasound: Biopsy
- Transrectal MRI
- Bone scan (Assess for bone metastases)
- ST scan
- MRI
- PET/CT
Stage IV Prostate cancer:
Cancer has spread beyond the prostate
Stage IVA prostate cancer
Cancer has spread to regional lymph nodes
Stage IVB
Cancer has spread to distant lymph nodes, other areas of the body/ bones
Treatment options: Prostate cancer
- Eight types of standard treatment are used:
- Watchful waiting or active surveillance
- Surgery
- Radiation therapy and radiopharmaceutical therapy
- Hormone therapy—Androgen Deprivation Therapy (ADT)-intermittent or continuous
- Chemotherapy
- Targeted therapy
- Immunotherapy
- Bisphosphonate therapy—bone metastases
- There are treatments for bone pain caused by bone metastases or hormone therapy.
- New types of treatment are being tested in clinical trials.
- Cryosurgery
- High-intensity–focused ultrasound therapy
- Proton beam radiation therapy
- Photodynamic therapy
- Treatment for prostate cancer may cause side effects.
- Patients may want to think about taking part in a clinical trial.
- Patients can enter clinical trials before, during, or after starting their cancer treatment.
- Follow-up tests may be needed.
Prostate cancer surgery
- Radical prostatectomy: Removes prostate, surrounding tissue and seminal vesicles
- Radical laparoscopic prostatectomy: Same as other one but done through a smaller incision
- Pelvic lymphadenectomy: Removes lymph nodes in pelvis
Best chance at a cure
Prostate cancer therapy: Brachytherapy
Radioactive seeds are placed directly into prostate
Radiation therapy side effects
- Increased urge or frequency of urination
- loss of sexual function
- Bowel function issues (diarrhea)
- Fatigue
- Bladder or GI cancer
- Impotence or incontinence
- Hormone therapy
- Hot flashes, loss of sex drive, weak bones, diarrhea N, itching
Hormone therapy: Prostate cancer
Essentially chemical castration
* Abiraterone acetate can prevent prostate cancer cells from making androgens. It is used in men with advanced prostate cancer that has not gotten better with other hormone therapy. It is also used in men with high-risk prostate cancer that has improved with treatments that lower hormone levels.
* Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, such as testosterone, to decrease the amount of hormone being made.
* Luteinizing hormone-releasing hormone agonists can stop the testicles from making testosterone. Examples are leuprolide, goserelin, and buserelin.
* Antiandrogens can block the action of androgens (hormones that promote male sex characteristics), such as testosterone. Examples are flutamide, bicalutamide, enzalutamide, apalutamide, nilutamide, and darolutamide.
* Drugs that can prevent the adrenal glands from making androgens include ketoconazole, aminoglutethimide, hydrocortisone, and progesterone.
Surgery side effects: prostate cancer
- Impotence
- Leakage or urine from bladder or stool from rectum
- Shortening of penis 1-2 cm
- Inguinal hernia
Nursing mgmt prostate cancer
- Loss of urinary control may occur for short time following radiation therapy.
- Long-term side effects of radiation therapy (incontinence, scarring, bowel necrosis).
- For those impotent after surgery:
- Prosthesis .
- Prostaglandin E.
- Injections into base of penis.
- Urinary incontinence can be present for several months after the surgery.
- Teach family members about need for annual prostate exam for men over 40 years of age.
- Instruct about importance of fluid intake.
- Indwelling catheter.
- The patient has a large indwelling catheter with a 30-ml balloon.
- Some patients may have continuous bladder irrigation in the immediate postoperative period.
- Often patient will be discharged with an indwelling catheter.
- Teaching should be done before discharge concerning care of catheter, emptying of urinary bag, and monitoring for side effects and complications.
- Kegel exercises can strengthen the urinary sphincter and may help to improve incontinence.
Average, risk age 50 with prostate cancer, how long to live
10+
Prevention of prostate cancer
- Healthy diet to include omega 3 a fruits and veg
- Reduce animal fat consumption
When should a pt with a extremely high risk be assessed (prostate)
- Age 40, those with more than one first degree relative who had prostate cancer at an early age
Screening test for early detection of cancer
Mammogram
Colonoscopy: Colorectal
Pap smear: Cervical cancer
Factors leading to better survival rates
- Early detection, through test and screens
- Better treatments
- Improved mgmt of side effects
- New treatments such as targeted therapy and immuno therapy
Side effects of cancer surviviorship
·Appearance-related Side Effects
·Anxiety
·Balance Problems and Falling
·Blood Clots
·Bowel and Bladder Problems
·Chemo brain
·Cognitive Problems or Changes in Thinking
·Confusion and Delirium
·Constipation
·Dehydration and Lack of Fluids
·Depression
·Diarrhea
·Distress
·Drinking and Eating Changes
·Emotional, Mental Health, and Mood Changes
·Fatigue and Weakness
·Fertility and Sexual Concerns
·Fever
·Hair Loss
·Hiccups and Heartburn
·Hot Flashes and Sweating
·Hypothyroidism
·Incontinence
·Infections
·Infusion and Immune Reactions
·Leg Cramps
·Loss of Appetite
·Low Blood Counts
·Lymphedema
·Mouth Sores, Pain, and Dryness
·Nail Changes
·Nausea and Vomiting
·Peripheral Neuropathy
·Pain
·Prostheses
·Seizures
·Shortness of Breath
·Skin Problems
·Sleep Problems
·Swallowing Problems
·Swelling, Ascites, and Edema
·Taste and Smell Changes
·Urine Retention
·Weight Changes
Survivorship care
- Watching for recurrence
- Mgmt of long term side effects
- Treatment summary
- Healthy living
- Second cancer
- Infertility/ impotence
- History of cancer treatments
- Persistent effects
- Possible late effects
- Signs and symptoms to report
- Wellness plan
- Future cancer screening
Potential long term effects of treatment:
- Cardiovascular risk
- effect of anti estrogen therapies
- Radiation sequelae
- Surgery sequelae
- chemo sequelae
How are hospice and palliative similar
- The goal of both palliative care and hospice care is to provide better quality of life and relief from symptoms and side effects for people with a serious illness.
- Both have special care teams for a person’s physical, emotional, mental, social, and spiritual needs.
- Hospice care often includes palliative care.
How are hospice and palliative different: What care is given
- Palliative care can be offered and provided at any stage of a serious illness.
- Hospice care is offered and provided for patients during their last phase of an incurable illness or near the end of life, such as for some people with advanced or metastatic cancer.
How are hospice and pallative different: What other care can be given
- Palliative care can be provided while the patient is getting active treatment. In other words, it can be given at the same time as chemo, radiation, or immunotherapy for cancer.
- Hospice care is provided when there is no active or curative treatment being given for the serious illness. “Treatment” during hospice care means only managing symptoms and side effects.
How are hospice and palliative different: What the care team does
- A palliative care team is separate from the medical care team that’s giving and managing treatment for the illness, but communicates with the medical care team.
- A hospice care team coordinates the majority of care for a patient, and communicates with the patient’s medical care team.
Supportive care: Oncology
- Ethical care. Patients and families have the right to honesty regarding their health, care, treatments, and outcomes. Knowing the facts allows them to be involved in their care and make informed decisions. This promotes autonomy - a person’s right to self-determination.
- Advocating for the patient’s personal wishes becomes priority in palliative nursing.
- Most hospitals have ethics review boards that provide support dealing with ethical issues and clinical practice.
Supportive care: Psychosocial needs
- Psychosocial needs can include cultural, spiritual, religious, financial, social, coping, altered body image, and sexuality, for example.
- Palliative nurses must assess their patients’ need for information and their need for decision making control. These factors vary from patient to patient and are very important in coping and dealing with their disease.
- It is crucial for the palliative care nurse to differentiate between normal grief and depression.
Supportive care: Caregiver support
- Communication between the family, patient, and care providers is prioritized in hospice care.
- Suggestions on ways caregivers can offer support may include: keeping the person company, allowing the person to openly express concerns, talking about good times shared with person, honoring advanced directives, and/or respecting the person’s need for privacy.
- Providing caregivers with teaching like “when to call the doctor or hospice nurse,” “discussing your end-of-life plans in advance,” and “when to know you are overwhelmed” are very helpful
