Exam 2: Breast Cancer

Question 1

Risk factors of breast cancer

Answer 1

• 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

Question 2

name two types of breast cancer

Answer 2

Non-invasive

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

Invasive

1. ductal
2. Lobular

Inflammatory breast cancer

Question 3

what is ductal carcinoma in situ

Answer 3

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

Question 4

what is invasive breast cancer

Answer 4

tumors arise from duct or lobular system and invade surrounding tissues

Question 5

what is the most common breast cancer type

Answer 5

ductal carcinoma

Question 6

which genes are associated with increased risk

Answer 6

BRCA1 and BRCA2

Question 7

signs and symptoms

Answer 7

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

Question 8

early signs and symptoms and late signs and symptoms

Answer 8

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

Question 9

diagnosis

Answer 9

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

Question 10

What is the BRCA1 and BRCA2 gene?

Answer 10

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

Question 11

2 chemo meds used from prevention?

Answer 11

tamoxifen and raloxifene

Question 12

protective factors

Answer 12

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

Question 13

when should women start breast exams?

Answer 13

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

Question 14

what is the proper timing of a BSE

Answer 14

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

Question 15

steps of BSE

Answer 15

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

Question 16

2 types of surgery

Answer 16

1. breast conserving

2. non-breast conserving

Question 17

types of breast-conserving surgery

Answer 17

1. lumpectomy

2. partial mastectomy

Question 18

types of non-breast conserving surgery

Answer 18

simple, radical and modified radical mastectomy

Question 19

what does breast conservation Tx involve

Answer 19

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

Question 20

what is a modified radical mastectomy?

Answer 20

treats invasive cancer

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

Question 21

what is a total mastectomy?

Answer 21

same as modified but no removal of axillary lymph nodes

Question 22

what is a sentinel lymph node

Answer 22

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

Question 23

how is a sentinel node identified

Answer 23

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

Question 24

changes in bowel and urine post SLNB

Answer 24

blue-green discoloration for 1st 24 hrs

Question 25

name 3 potential complications

Answer 25

lymphedema hematoma/seroma formation infection

Question 26

what is lymphedema?

Answer 26

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

Question 27

comment post op complication of which surgery

Answer 27

ALND

Question 28

signs and symptoms of lymphedema

Answer 28

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

Question 29

risk factors for lymphedema

Answer 29

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

Question 30

steps for reducing chances of transient edema

Answer 30

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

Question 31

hand and arm care after axillary lymph node dissection

Answer 31

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)

Question 32

what is hematoma or seroma formation

Answer 32

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

Question 33

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

Answer 33

12 hours after surgery swelling, tightness, pain, and bruising of the skin

Question 34

when will you you notify Dr.

Answer 34

Gross swelling or increased bloody output from the drain

Question 35

2 ways hematoma is treated

Answer 35

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

Question 36

treatment for small hematomas

Answer 36

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

Question 37

signs and symptoms of seroma

Answer 37

swelling, heaviness, discomfort, and sloshing of fluid

Question 38

when might seromas occur

Answer 38

after drain is removed or if drain is obstructed

Question 39

who is at a higher risk for infection

Answer 39

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

Question 40

signs and symptoms of infection

Answer 40

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