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Nursing 271 > Med-Surg: Chapter 65: Breast Cancer > Flashcards

Med-Surg: Chapter 65: Breast Cancer Flashcards

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1
Q

Cancer if the breast

A
  • mostly occurs in women
  • second most common cause of caner-related deaths in women
  • single greatest risk factor: woman’s age
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2
Q

Risk Factors

A
  • age
  • higher number of ovulatory cycles in their lifetime
  • early menarche
  • late menopause
  • lack of pregnancy and live childbirth before the age of 30; only pregnancies resulting in a live birth lower the breast cancer risk
  • family hx of a first degree relative
  • benign, noncancerous breast disease that is proliferative; those with quickly growing cells such as hyperplasia, have an increased risk
  • excessive alcohol use, inactivity, obesity, and the use of hormones
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3
Q

Genetic Testing to Assess Breast Cancer Risk

A

-genetic testing provides an opportunity for women to learn whether they have a family hx of breast cancer caused by an inherited gene mutation
>two gene mutations: BReast CAncer gene (BRCA) 1 and BRCA 2
-can be done by a simple blood test
>indicated for patients who are at high-risk:

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4
Q

Cancer

A

condition in which the cells of the body grow and divide abnormally and uncontrollably
-cells can invade nearby tissues and spread to other areas through the bloodstream and lymphatic system

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5
Q

The First Stage: Stage 0

A
  • in-situ lesion of ductal carcinoma in situ (DCIS); ductal lesions occur in and are limited to the lining of the milk ducts
  • Lobular carcinoma in situ (LCIS); lobular lesions occurring in the lobules where milk is produced
  • DCIS and LCIS place the patient at higher risk for developing invasive breast cancer; invasive lesions are those that spread to other areas or organ systems
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6
Q

Stage I of breast cancer

A
  • tumor 2cm or less
  • no lymph node spread
  • no distant metastasis
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7
Q

Stage II of Breast Cancer

A
  • tumor may increase in size
  • possible spread to nearby lymph nodes
  • no distant metastasis
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8
Q

Stage III of Breast Cancer

A
  • tumor may increase in size
  • possible spread to lymph nodes, chest wall, or skin
  • no distant metastasis
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9
Q

Stage IV of breast cancer

A
  • tumor of any size with direct extension to chest wall or skin
  • with distant metastasis
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10
Q

Stages of Breast Cancer

A

> Stage 0:

  • in situ lesions (DCIS)
  • no lymph node
  • no metastasis

> Stage I:

  • tumor 2 cm or less
  • no lymph node
  • no metastasis

> Stage II:

  • tumor may increase in size
  • possible spread to nearby lymph nodes
  • no metastasis

> Stage III:

  • tumor may increase in size
  • tumor may spread to chest wall, lymph nodes, or skin
  • no metastasis

> Stage IV:

  • Tumor of any size
  • lymph node spread
  • metastasis
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11
Q

Clinical Manifestations

A
  • new mass or lump
  • cancerous masses: hard, irregular, and painless; may be soft, rounded, and tender
  • changes in shape of the breast or swelling
  • changes such as peeling, flaking, pitting, dimpling, or redness
  • changes in nipple such as inversion, thickening of the tissue, or drainage
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12
Q

Diagnostic Tests

A

-mammography
-ultrasonography
-magnetic resonance imaging (MRI)
-if necessary, biopsy
>patients may have breast cancer detected as part of routine screening mammography or mammography with MRI, or may present with a specific complaint that leads to the discovery of the tumor through diagnostic imaging
>once mammography detects a suspicious area, ultrasonography may be used to further define the area; the area will be recommended for biopsy if it is deemed suspicious on imaging
>Biopsy results will be definitive for diagnosis

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13
Q

Results from what will be definitive for diagnosis

A

biopsy

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14
Q

What may be indicated if the initial diagnostics indicate the tumor may be invasive?

A

a sentinel node biopsy

-this may help determine the extent or stage of breast cancer

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15
Q

Sentinel Node

A

the first lymph node to which cancer cells travel if they are to spread
-in breast cancer, generally found in the axilla but may be more center if the cancer is in the center of the chest
-injecting a radioactive substance or blue dye near the tumor and tracking it to the first node determines the sentinel node(s)
>if the sentinel lymph node is found to be free of cancer, it may not be necessary to proceed with removal of further lymph nodes
-if has cancer cells, more complete removal of the lymph nodes for evaluation, and axillary lymph node dissection may be completed

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16
Q

What happens after a diagnosis is made?

A

-laboratory data that may be obtained: a complete blood count (CBC) with platelets
-liver function tests
-chest x-ray
>CT of the abdomen and a bone scan if stage II or higher

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17
Q

Treatment

A

surgery, chemotherapy, and radiation

18
Q

Surgery Alternatives

A
  • breast conservation therapy (lumpectomy)

- total mastectomy

19
Q

Chemotherapy Options

A
  • Adjuvant chemotherapy, which is administered after surgery to destroy any remaining cancer cells
  • Neoadjuvant chemotherapy, administered before/prior to the surgical procedure in an attempt to shrink the tumor
20
Q

Treatment for In Situ Lesions

A
  • Lobular carcinoma in situ (LCIS) is not considered a precursor for invasive breast cancer and therefore has no directed treatment; directed at risk-reduction strategies b/c these women are at an increased risk of developing invasive breast cancer
  • Ductal Carcinoma in situ (DCIS) requires surgical treatment; lesions more than 4 cm require mastectomy
  • lesions of intermediate size that can be removed with clear margins can be considered for mastectomy or breast conservation therapy
  • small DCIS can be excised if the lesion without radiation therapy
  • Tamoxifen (Nolvadex), antiestrogen therapy, reduces risk of local recurrence in women undergoing breast conservation therapy
21
Q

Treatment for Early-stage Invasive Cancers

A
  • cancers smaller than 1 cm with clinically negative axilla treated with surgical excision
  • patients with large tumors that have comorbidities or no spread to axillary nodes may have surgical excision
  • mastectomy and breast conservation can be considered
  • radiation therapy recommended for patients undergoing breast conservation therapy
  • tumors at least 1 cm in size or with axillary node involvement are recommended to have cytotoxic adjuvant chemotherapy
  • if hormone receptor positive, endocrine therapy (aromatase inhibitor or tamoxifen) after completion of cytotoxic therapy
22
Q

Treatment for Immediate or Advanced Stage Cancers (operable)

A
  • preoperative neoadjuvant chemotherapy first line treatment unless has underlying comorbidities that preclude use of chemotherapy
  • after chemotherapy, tumor is reassessed to evaluate the potential of breast conservation therapy as a result of tumor response to chemotherapy
  • chemotherapy recommended after surgical treatment in all patients; followed by or done concurrently with radiation therapy
  • if tumor is hormone receptor-positive, endocrine therapy offered for 5 to 10 years
23
Q

Treatment for Locally advance and Inoperable Cancers

A
  • undergo neoadjuvant chemotherapy as initial treatment
  • if tumor responds to chemotherapy and becomes operable= undergo modified radical mastectomy
  • if responds dramatically = can be offered breast conservation therapy
  • if tumor does not respond to initial chemotherapy= switched to another chemotherapy regimen before surgery attempted
  • all patients should be offered postoperative chemotherapy and radiation to the breast or chest wall; in these cases immediate breast reconstruction is not encouraged
24
Q

Treatment for Local Recurrence and Systemic Metastases

A
  • if undergone initial breast conservation therapy; complete mastectomy is next step
  • if tumor not initially operable, chemotherapy may be considered
  • when not previously undergone radiation, surgical excision is done followed by chemotherapy and radiation
25
Q

Complications of Treatment

A
  • wound infection and dehiscence
  • immobility side effects of surgery such as pulmonary embolism and pneumonia
  • long-term complaints: shoulder immobility, pain, and lymphedema
26
Q

Lymphedema

A

occurs because of the removal of the axillary lymph nodes and subsequent scarring, resulting in disruption of lymph drainage in the arm
-result is swelling of the arm

27
Q

Once Chemotherapy has begun, the patient may experience a variety of side effects associated with the cytotoxic drugs

A
  • hair loss
  • nausea
  • vomiting
  • mouth pain
  • diarrhea or constipation
  • peripheral neuropathy
  • rash
  • nail changes
  • decreased WBC count with possible subsequent fever
  • may result in premature ovarian failure which may lead to bone loss and loss of fertility
  • possible long-term risk of myelodysplastic syndrome (dysfunctional blood cells)
28
Q

Radiation Side Effects

A
  • redness with patchy desquamation (shedding of the outer skin layers) of the treated skin
  • skin may also itch but does not have a “burning” sensation
  • breast swelling and discoloration may continue for 6 months after treatment but usually resolves in 12 to 18 months
  • pneumonitis, a nonproductive cough with a chest x-ray demonstrating an infiltrate in the radiated area may develop 6 weeks to 6 months after treatment completion
  • radiation to the myocardium may lead to latent (15-20 years) cardiac morbidity and mortality
29
Q

Nursing Management: Assessment and Analysis

A
  • initial clinical manifestations are associated with the presence of a tumor, noting a lump in the breast, skin changes and nipple changes
  • later manifestations associated with treatment
  • due to the killing of all rapidly dividing cells, chemotherapy may result in hair loss, nausea, vomiting, mouth pain, diarrhea or constipation, peripheral neuropathy, rash, and nail changes
  • decreased WBC count
  • lymph node removal may result in lymphedema or swelling of the arm on the affected side due to blockages in lymph flow
  • radiation causes skin changes: irritation, redness, itchiness, or burning
  • breast swelling
  • nonproductive cough with lung an infiltrate
30
Q

Nursing Interventions: Assessments

A

> Vital Signs

  • elevated BP and rapid pulse can be a sign of pain or anxiety
  • elevated temperature and pulse indicative of infection

> Pain
-should verbalize their pain on a rating scale to help understand their pain level and to ensure adequate treatment

> Daily weight

  • give an idea of the nutritional status
  • drastic weight loss indicates a nutritional deficit

> Intake and Output
-allows evaluation for tolerance of oral liquids and foods and an evaluation of vomiting

> Wound evaluation
-good wound evaluation detects the early signs of infection such as redness, warmth, and increased or purulent drainage

> Skin evaluation
-inspect any radiated skin for radiation side effects such as irritation, redness, itchiness, or burning

> Monitor CBC and metabolic profile
-due to its cytotoxic effects, chemotherapy may result in decreased WBC counts, decreased hemoglobin and hematocrit, and elevations in liver enzymes

> Assess mood and nonverbal cues

  • at great risk for psychological issues
  • patients with depression are often withdrawn or offer other nonverbal cues that indicate pain, depression, and anxiety
31
Q

Nursing Interventions: Actions

A

> Give chemotherapeutic drugs as ordered
-indicated for invasive breast cancer

> Give pain medications as ordered
-provides pain relief allowing the patient to more fully participate in activities of daily living

> Give antiemetics as ordered
-help to relieve nausea and vomiting, promoting adequate nutritional intake

> Have the patient cough and deep breathe postoperatively
-prevents atelectasis and pneumonia

> Keep the wound clean and dry
-aids in wound healing and helps prevent infection

> Encourage Verbalization
-important to actively involve patients in their care

32
Q

Teaching

A 
>explain treatment course
>medications and treatment side effects
>wound care
>nutritional counseling
>support groups
>breast cancer screening with mammography
33
Q

Breast Cancer Screening with Mammography

A
  • women ages 40-44 may begin annual screening
  • women ages 45-54 should have annual screening
  • women ages >55 can maintain yearly or move to biannual; screening should continue as long as the woman is in good health
34
Q

Evaluating care outcomes

A
  • adequate treatment
  • those with advanced-stage cancer are still able to achieve prolongation of their life while balancing quality of life
  • patient undergoing treatment will have immediate needs associated with surgery, chemotherapy, and radiation
  • the well managed patient should be able to manage any nausea and vomiting in a way that allows her to maintain adequate nutrition and weight
  • surgical sites should heal without infection
  • scarring and lymphedema should be kept to a minimum through appropriate therapy
  • psychosocial support provided throughout tx helps to manage anxiety and depression
35
Q

Breast Cancer Tx Options

A
  • Breast Conservation Surgery (lumpectomy)
  • Modified radical mastectomy
  • Axillary lymph node staging
  • Chemotherapy
  • Radiation Therapy
36
Q

Breast Cancer Tx Options: Breast conservation surgery (lumpectomy)

A

removes only the involved breast tissue and a minimal surrounding margin with the best possible cosmetic preservation of the breast

  • option in early-stage disease or advanced disease that has been reduced by chemotherapy
  • used in conjunction with postoperative radiation and chemotherapy
37
Q

Breast Cancer Tx Options: Modified Radical Mastectomy

A

removal of the entire breast tissue

  • option in early-stage disease or more advanced disease that has been reduced by chemotherapy
  • used in conjunction with chemotherapy and may or may not require postoperative radiation
38
Q

Breast Cancer Tx Options: Axillary lymph node staging

A

removal of axillary lymph nodes

  • done with invasive breast cancer and some noninvasive
  • recent advances allow for removal of only the first lymph node from the tumor (sentinel node)
  • other nodes are then removed only if the sentinel node is positive
39
Q

Breast Cancer Tx Options: Chemotherapy

A

drugs used to treat cancer

-may be used prior to surgery or after

40
Q

Breast Cancer Tx Options: Radiation Therapy

A

radiation directed at the tumor and surrounding tissue to treat cancer
-typically done after surgery for lumpectomy or inflammatory breast disease, for recurrence, or for palliation in advanced disease

41
Q

Breast Cancer: Risk factors, S/S, and Metastasis

A 
>Risk Factors: 
endocrine disrupters:
-early menses
-late menarche
-nulliparity and
-late first child
-genetic propensity (BRCA1, BRCA2)
-obesity, high-fat diet

> S/S:

  • breast mass
  • axillary node enlargement
  • asynchrony of breasts
  • nipple discharge

> Metastasis
-bone, lung, lymph nodes, liver, brain

Nursing 271 (208 decks)

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