deck_2932700 Flashcards

1
Q

Incidence breast cancer

A

• Incidence of 1 in 8 women in Australiadiagnosed before 85yo

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2
Q

In‐Situ breast cancer

A

• Pre‐invasive cancer that has not breachedthe epithelial basement membrane• Marker for the later development ofinvasive carcinoma• Usually asymptomatic• Common due to breast cancer screening• Mastectomy is recommended

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3
Q

Invasive Breast Cancer

A

Invasive Ductal (IDC most common) and LobularCancer cells have started to break throughducts/lobules and invade surrounding areaswith ability to travel through the blood streamand lymphatic system

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4
Q

Usual clinical presentation of breastcancer

A

• Most frequently in the upper, outer quadrantof the breast• May present as a hard lump ‐ may beassociated with indrawing of the nipple ordischarge. May feel nothing• May have skin involvement with puckeringskin appearance or frank ulceration andfixation to the chest wall as the diseaseadvances locally

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5
Q

Types of Surgery Breast Cancer

A

• Wide local excision (WLE)/lumpectomy• Axillary dissection or SNB• Simple Mastectomy• Modified Radical Mastectomy

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6
Q

Where breast drains

A

axillasupraclavicular, cervical chain

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7
Q

Wide Local Excision

A

• Removal of the breast lump whilst conservingthe remaining tissue.• May return for re‐excision 1 week later ifmargins not clear

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8
Q

Sentinel Node Biopsy

A

• The first node that the tumour drains to• Determined by injection of tumor with bluedye and trace which node turns blue first thenremove it• If + for tumour cells, further AD done

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9
Q

Simple Mastectomy

A

• Removal of breast but not the lymph nodes (for in situ carcinoma)

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10
Q

Modified Radical Mastectomy

A

• Removal of breast plus axillary lymph nodesIf it is large or multifocal

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11
Q

Radical Mastectomy

A

Removal of breast, axillary nodes and PectoralisMajor – rarely doneIf it has invaded through breastr and into the muscle

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12
Q

• Return to activity advice/posture aftter mastectomy

A

Go back to normal, light activites early - dressing, eating, picking up their phone with that hand

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13
Q

Exercises Mastectomy/WLE with AD

A

• Check op notes• Level 1 exercises for 1 week plus encouragelight use of arm for normal activity• Keep arm <90 degrees• Level 2 exercises commenced after this, solong as drain removed• Gradual progression as pain allows

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14
Q

Exercises WLE/SNB

A

• Level 1 exercises for few days plus encouragelight use of arm for normal activity• Level 2 exercises commenced after this, solong as drain removed• Gradual progression as pain allows

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15
Q

Posture and Activity Advice mastectomy

A

• Good posture in standing, sitting and walkingespecially mastectomy• Watch for protective postures – pillow support• No heavy lifting/repetitive use/sustainedposturesNeed yto keep circulation going - every 1/2 hour if doing something like computer or knitting, stop, stretch and move around

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16
Q

Why might women have poor posture after mawstectomy

A

painBody image

17
Q

When does lymphoedema occur after mastectomy

A

• Can develop at any time even years ahead

18
Q

Lymphoedema Prevention Mastectomy

A

• Avoidable risk factors – factors that challengeimmune system or impede flow of lymph• Instruct patient to be aware of signs andsymptoms to identify early• Avoid BP/cannulas/blood taken on the operatedside always (Armer 2013)

19
Q

Possible Post‐op Complications Mastectomy

A

• Pain• Seroma• GH ROM/movementdysfunction• Soft tissuecontracture/adhesions• Numbness/hypersensitivity in arm/breast• AWS/Cording• Neural tension• Lymphoedema

20
Q

What is Axillary Web Syndrome/Cording

A

A visible web of axillary skin overlyingpalpable cords of tissue that are made taughtand painful by shoulder abduction

21
Q

Aetiology Axillary Web Syndrome/Cording

A

• Lymphovenous injury, stasis andhypercoagulability(tissue injury releases tissuefactor that causes hypercoagulability) as aconsequence of superficial venous stasis,lymphatic disruption and tissue injury causedby axillary clearance

22
Q

Risk Factors / Onset axillary cording

A

• Slimmer women – BMI < 25• Younger women – Age < 50yo• Why?? Unknown• Onset from 2‐8 weeks post‐op

23
Q

Signs of AWS

A

• Shoulder abduction restricted• Hardened palpable cords which are painfulbut not erythematic• Cords may extend down medial upper arm,across cubital fossa into anterior forearm

24
Q

Treatment axillary webbing

A

• Massage• Stretches (need to push into some pain)• LLLT trial – no research but good early results

25
Q

What is neoadjuvant chemo and why is it used

A

Chemo before the surgery. Used to try and shrink large tumors before surgery

26
Q

What is adjuvant chemo and why is it used

A

• Adjuvant – can begin quite quickly post‐ope.g. 2 weeks post‐op. Commonly 6 cycles ‐ 3weekly

27
Q

Radiotherapy for breast cancer

A

• All WLE’s, reduces local recurrence• Mastectomy• Axilla/SCF if extensive nodal disease• 50Gy/25f• Increases risk of lymphoedema

28
Q

Physio role in post operative period mastectomy

A

• Education• Movement/strength recovery• Prevention of adhesions• Return to activity/exercise• Lymphoedema/Cording• Support and monitoring