cancer test 2 breast cancer Flashcards
risk factors for breast cancer
female
increased age
alcohol
personal history of breast cancer
hormonal factors
nulliparity or late age of 1st pregnancy
not breastfeeding for up to a year
hormonal replacement therapy
dense breast tissue
late menopause
family history of breast cancer
BRCA 1 and BRCA 2 mutations
modifiable risk factors for breast cancer
-obesity and weight gain after menopause
-high-fat diet
-sedentary lifestyle
-alcohol
-smoking
-night shift
malignant signs for breast cancer
nontender, poorly defined hard lesions
advanced signs of malignant breast cancer
skin dimpling, nipple retraction, skin ulceration
to detect any malignancies that r in the ducts if they have abnormal discharge from the nipple
galactography
gold standard for women with average risk of breast cancer. usually done every year
mammography
gold standard surgical biopsy for palpable breast tumors. aka lumpectomy
excisional biopsy
what agents should be discontinued for someone getting a surgical biopsy
anything that can increase risk of bleeding like ASA, NSAIDS, vitamin E, ginkgo, garlic, coumadin
some benign conditions of the breast
mastalgia
cysts (fibrocystic breast disease)
fibroadenomas
atypical hyperplasia
lobular carcinoma in situ
two non cancerous breast diseases that can increase risk for cancer
-atypical hyperplasia
-lobular carcinoma in situ (LCIS)
proliferation of malignant cells inside milk ducts without invasion
ducati carcinoma in situ (DCIS)
DCIS
-will turn invasive if not treated
-mammogram to show calcifications
-considered stage 0 breast cancer
-diagnosed with biopsy
- estrogen most common reason for this type of cancer
- breast conservation treatment (lumpectomy, wide excision, segmental mastectomy)
-caused by malignant cells that r blocking the lymph channels in the skin. sometimes mistaken as infection
-orange
-chemo, radiation, then surgery
peau d’orange (inflammatory)
malignancy of mammary ducts
paget’s disease
early sign of pagets
nipple and areola may have redness
late sign of pagets
scaling and thick, looks eroded
stage 0 breast cancer characterization
in situ, early type of breast cancer
stage 1 breast cancer characterized
localized tumor <1 inch in diameter
stage 2 breast cancer characterized
tumor 1-2 inches in diameter, spread to axillary lymph nodes
stage 3 breast cancer characterized
tumor 2 inches or larger, spread to other lymph nodes and tissues
stage 4 breast cancer characterized
cancer has metastasized to other body organs
prevention strategies in high risk patient for breast cancer
-combo of genetic, hormonal, environmental
-long term surveillance
-chemo prevention (tamoxifen and raloxifene)
-prophylactic mastectomy
clinical manifestations of breast cancer
-upper outer quadrant
-nontender, fixed and hard with irregular borders
-no s and s other than a mammographic abnormality
determines staging and prognosis for breast cancer
biopsy
goal of surgery for breast cancer
to regain control of the disease
lumpectomy, wide excision, partial or segmental mastectomy
breast conservation treatment
indications for mastectomy
-history of radiation to breast or chest wall
-inflammatory breast cancer
-diffuses suspicious or malignant appearing calcifications
-widespread disease
-positive margins after repeat re-excision
-tumors greater than 5cm in diameter
-focally positive margins
-<35 yr olds, BRCA1 or 2 mutations
treats invasive breast cancer
-removal of breast, nipple, areola, and a portion of axillary lymph node
modified radical mastectomy
removes breast, nipple, and areola but not the axillary lymph nodes
-usually for non invasive breast cancers like DCIS
total/ simple mastectomy
most important prognostic factor in breast cancer
status of lymph nodes
shorter operating room time
SLNB
longer operating room time
ALND
no surgical drain
SLNB
has surgical drain
ALND
lymphedema risk minimal
SLNB
lymphedema risk higher
ALND
presence of neuropathic sensations postoperatively
ALND
decreased rom post op
ALND
seroma may occur post op
ALND
who’s not a good candidate for tissue expander
woman who’s had radiation or connective tissue disease
what can’t someone get done with a tissue expander in
MRI
who’s not a good candidate for TRAM flap
diabetes or other comorbidities
complications of TRAM flap
-breathing because they don’t take deep breaths due to abdomen surgery
at risk for DVTs and atelectasis
post op education for breast surgery
-tenderness, soreness, tingling will go away
-can have neuropathic pain after chronically
doxorubicin, cyclophosphamide, paclitaxel (chemo) can cause what SE
cardiac toxicity and bone marrow suppression, n/v, alopecia, mucositis, anaphylactic, weight gain, taste changes, skin changes, fatigue, neuropathy, amenorrhea
management of bone marrow suppression
neupogen, neulasta
erythropoietin
premenopausal tend to be
estrogen receptors negative
post menopausal women tend to be
estrogen receptors positive
treats hormone receptor plus breast cancer
tamoxifen
treats osteoporosis in post menopausal women
raloxifene
anastrozole
exemestane
aromatose inhibitors (lower estrogen levels)
SE of hormonal therapy for breast cancer
hot flashes, night sweats, vaginal dryness, discharge, bleeding, mood disturbances, DVTs or PEs, bone thinning, osteoporosis
