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Med Surg II > Exam 2: Breast Cancer > Flashcards

Exam 2: Breast Cancer Flashcards

1
Q

Risk factors of breast cancer

A
  • personal history of breast cancer
  • family history
  • certain breast changes
  • gene changes
  • reproductive & menstrual history
  • radiation therapy to the chest
  • DES (diethylstillbestrol)
  • exposure to estrogen like chemicals
  • being obese/overweight after menopause
  • breast density
  • alcohol
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2
Q

name two types of breast cancer

A

Non-invasive

  1. lobular carcinoma in situ (LCIS)
  2. Ductal carcinoma in situ (DCIS)

Invasive

  1. ductal
  2. Lobular

Inflammatory breast cancer

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3
Q

what is ductal carcinoma in situ

A

proliferation of malignant cells inside the milk ducts without invasion into the surrounding tissue

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4
Q

what is invasive breast cancer

A

tumors arise from duct or lobular system and invade surrounding tissues

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5
Q

what is the most common breast cancer type

A

ductal carcinoma

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6
Q

which genes are associated with increased risk

A

BRCA1 and BRCA2

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7
Q

signs and symptoms

A
  1. nontender, palpable, irregularly shaped, fixed mass
  2. dimpling, peau d’orange, incr vasculature
  3. nipple discharge and retraction
  4. Asymmetry of breast
  5. enlarge axillary lymph nodes
  6. tenderness or soreness around the mass
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8
Q

early signs and symptoms and late signs and symptoms

A

early signs and symptoms:
none
late signs and symptoms:
skin dimpling, nipple retraction, or skin ulceration

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9
Q

diagnosis

A
  1. BSE (breast self exam(
  2. CBE (clinical breast exam)
  3. Mammography
  4. CT scan, MRI
  5. Biopsy
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10
Q

What is the BRCA1 and BRCA2 gene?

A

genes that normally suppress tumors. however, when gene mutate they can cause cancer

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11
Q

2 chemo meds used from prevention?

A

tamoxifen and raloxifene

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12
Q

protective factors

A
  1. 30-60 mins of exercise
  2. breastfeeding decr. return of period –> decr. estrogen
  3. decr. stress
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13
Q

when should women start breast exams?

A

BSE: early 20s told about benefits and limitations, report new symptoms
CBE: early 20s and 30s every 3 yrs and asymptomatic women periodically over 40
Mammography: begin annually after 40

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14
Q

what is the proper timing of a BSE

A

premenopausal: 5 to 7 days after period
postmenopausal: once a month

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15
Q

steps of BSE

A
  1. in front of mirror, check breasts discharge, puckering, dimpling, or scaling
  2. check contour: clasp hands behind head and press forward
  3. check contour: press hands on hips and bow slightly. pull elbow and shoulders forward
  4. raise left arm, w/ 3 or 4 fingers feel around breasts w/ circular motion working towards nipple
  5. repeat step 4 but lying down
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16
Q

2 types of surgery

A
  1. breast conserving

2. non-breast conserving

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17
Q

types of breast-conserving surgery

A
  1. lumpectomy

2. partial mastectomy

18
Q

types of non-breast conserving surgery

A

simple, radical and modified radical mastectomy

19
Q

what does breast conservation Tx involve

A

excise tumor in breast completely and obtain clear margins while achieving acceptable cosmetic result

20
Q

what is a modified radical mastectomy?

A

treats invasive cancer

breast tissue and nipple complex is removed. some of axillary lymph nodes too

21
Q

what is a total mastectomy?

A

same as modified but no removal of axillary lymph nodes

22
Q

what is a sentinel lymph node

A

1st node that recieves drainage from primary tumor of the breast

23
Q

how is a sentinel node identified

A

sentinel node biopsy
injecting blue dye/radioisotope into breast. travels to node via lymphatic pathways. surgeon uses handheld probe to locate node and excise it and sends it for analysis

24
Q

changes in bowel and urine post SLNB

A

blue-green discoloration for 1st 24 hrs

25
Q

name 3 potential complications

A

lymphedema
hematoma/seroma formation
infection

26
Q

what is lymphedema?

A

chronic swelling of an extremity due to interrupted lymphatic circulation due to the accumulation of protein rich fluid in the interstitial space

27
Q

comment post op complication of which surgery

A

ALND

28
Q

signs and symptoms of lymphedema

A

painful swelling of the arm, weakness, shoulder pain, and tingling sensation in the arm and shoulder

29
Q

risk factors for lymphedema

A

radiation therapy, increased age, infection, pre-existing cardiovascular conditions and obesity

30
Q

steps for reducing chances of transient edema

A
  • performing prescribed exercises
  • elevating the arm above the heart several times a day
  • gentle muscle pumping (making of this every single)
31
Q

hand and arm care after axillary lymph node dissection

A
  1. Avoid BP, injections, and blood dreams in affected arm
  2. use sunscreen higher than SPF 15
  3. Wear insect repellent to avoid bug bites
  4. Wear gloves for gardening
  5. Use cooking mitts when taking things out of the oven
  6. Use electric razor and avoid cutting cuticles or pushing them back
  7. Avoid lifting objects heavier than 5 to 10 pounds
  8. if trauma or break in the skin wash area with soap and water apply OTC antibacterial (bacitracin or neosporin)
32
Q

what is hematoma or seroma formation

A

hematoma: collection of blood inside a cavity
seroma: collection of serous fluid may accumulate under the breast incision

33
Q

when might a hematoma occur and what are the signs and symptoms

A

12 hours after surgery

swelling, tightness, pain, and bruising of the skin

34
Q

when will you you notify Dr.

A

Gross swelling or increased bloody output from the drain

35
Q

2 ways hematoma is treated

A
  1. Compression wrap apply to the incision for approximately 12 hours
  2. Return to OR so incision can be reopened to identify the source of bleeding
36
Q

treatment for small hematomas

A

warm shower or apply warm compress to help increase absorption
heals in 4 to 5 weeks

37
Q

signs and symptoms of seroma

A

swelling, heaviness, discomfort, and sloshing of fluid

38
Q

when might seromas occur

A

after drain is removed or if drain is obstructed

39
Q

who is at a higher risk for infection

A

patients with diabetes, immune disorders, advanced age and those with poor hygiene

40
Q

signs and symptoms of infection

A

redness, warmth around incision, tenderness, foul-smelling drainage, temperature greater than 100.4°F, chills

Med Surg II (6 decks)

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