Module 8: Breast Disorders/Reproductive CXR Flashcards
Breast anatomy
Tissues:
Glandular /lobules (milk)
Fatty
Connective/fibrous
Anatomy:
Lobes (15-20)
Lobules (small sections of tissue)
Nipple/areolae
Blood vessels, lymph vessels, nerves (immune system)
What is Mastalgia?
It is defined as breast pain and there are two kinds:
•cyclic mastalgia is associated with menstrual cycle.
Tx: compression, ice, analgesics & anti-inflammatory meds
•non-cyclic mastalgia is NOT related to menstrual cycle
Dx: diagnostics done if lump is found upon examination
Benign breast disorder: fibrocystic
know all info on this slide for test
•Most common breast disorder
•can occur in one or both breasts
•Frequently seen in women between ages 30-50
•May be due to heighted response of estrogen & progesterone (may become worse when on period)
•Pain d/t inflammation, edema & fibrosis
•Palpable lumps are round, well delineated, moveable*
•Usually increased in size before menstruation
•Not associated with increased cancer risk*
•Mammogram or biopsy
How to do a self-Breast exam
•3-5 days after period
•In front of mirror
•raising hands
•in the shower & laying down
•use pads of fingertips
•motions: top & bottom, circles, wedges
Benign Disorders- Fibroadenoma
•usually single lump on one side
•Benign tumor of the breast
•Most common in women under age
30
•May be causes by increased estrogen sensitivity
•Firm, painless, rubbery, easily moveable under skin (distinguishing factors)
•Slow growing (may increase in size in pregnancy)
•Mammogram and ultrasound
•Biopsy or removal
•Cryoablation or radiofrequency ablation
Benign Breast Disorders- Intraductal Papilloma
Benign tumor that grows in the mammary duct
•Usually unilateral*
•Occurs most often in women ages 30-50
•Can cause clear to bloody discharge* (distinguishing factor)
DX:
•Mammogram and ultrasound
•Needle biopsy
•Duct removal
Benign Breast Disorder- benign Ductal Ectasia
One or more milk duct widens, walls of the duct thicken, & the duct may fill with fluid, becoming clogged
•Occurs in perimenopausal women (before or around menopause)
•Nipple discharge common
•Other signs:
•Swelling, redness, & tenderness around nipple & areola (burning/itching type pain/inflammatory signs)
•Inverted nipple
•May lead to infection (removal of infected duct, antibiotics, warm compress)
Benign Breast Disorder- Male Gynecomastia
Noninflammatory enlargement of 1 or both breasts in males (imbalance of estrogen/testosterone)
•Usually temporary
•Can occur in puberty or older age
•Can be a manifestation of another problem or drug use
•Tumors, hyperthyroidism, liver disease, malnutrition
•Steroid use, marijuana, spironolactone can cause this disorder
Gero natural aging occurrences (breasts)
Pendulous breasts (low hanging/sagging)
•Loss of subcutaneous fat
•Loss of structural support
•Atrophy of mammary glands
•Decreased tissue density
•Increased incidence of breast cancer
•Encourage annual mammogram
•Mastopexy (breast lift surgery)
What are the 6 Benign Breast Disorders in this module?
•Mastalgia
•Fibrocystic Breast
•Fibroadenoma
•Benign Ductal Ecstasia
•Intraductal Papilloma
•Gynecomastia
•Table 51.1 common benign disorders
Warning signs of Breast cancer (what you see visually?)
•change in breast size or shape
•Lump, hard knot or thickening inside the breast or underarm area
•Swelling, Warmth, redness, or darkening of the breast
•dimpling or puckering of the skin (attach or pulling structures inward)
Warning signs of Breast Cancer (what to they feel?)
•New pain in one spot that doesn’t go away
•Nipple discharge that starts suddenly
•itchy, scaly sore, or rash on the nipple
•Pulling in of your nipple or other parts of the breast
Breast Cancer Screening Guideline
•Age 40 should have the opportunity to begin screening if wanted
•Age 45 should begin yearly mammograms
•Age 55 Transition to every other year
•Age 55+ continue to have regular mammograms
What is Mammography?
•Test of choice for screening to find disorders/suspicious findings
•Digital or 3D mammography
•Screening = pictures
•Diagnostic Mammogram = more pictures/in-depth to look at abnormal findings
•Ultrasound can see more structure
Breast Density & screening
Breasts that are more dense are harder to detect cancer in. It’s harder to see on the screening
What are the screening Barriers?
•Pain & embarrassment
•Fear of a cancer diagnosis
•Lack of health insurance
•Lack of knowledge about screening
•Lack of trust in doctors or hospitals
•Language barriers
•No transportation
What are the risk factors for Breast Cancer?
Hereditary:
•Being born female
•Age (50-60’s menopausal)
•Race & Ethnicity
•Inheriting certain genes (BRCA 1&2)
•Family History of breast cancer
•Personal history of breast cancer
Lifestyle Factors:
•Drinking alcohol
•Being overweight or obese (excess circulation of estrogen stores in fat tissue)
•Not being physically active
•Smoking
Hormone Related:
•Not having children or breastfeeding (increases life span of hormones -not stopping cycle because of pregnancy)
•Birth Control
•Hormone therapy after menopause
What are BRCA Mutations?
“BRCA mutations contribute to cancer”
•Oncogenes increase cell division & growth
•Tumor Suppressor cells make division stop.
(In Cancer one of these things is broken)
The BRCA gene creates a protein that fixes double stranded breaks in DNA. The protein that repairs DNA damage changes shape and is non-functional. This can increase cancer risk.
How to minimize cancer risks
•Maintain a healthy weight
•Physical activity
•Avoid or limit alcohol
•Smoking cessation
•Routine self-examination, MD visits, and yearly mammograms
•Genetic testing & counseling
•Preventative surgery for those at very high risk
Breast CXR in males
•1 in 1,000 men will be diagnosed with breast cancer
•May form in the ducts or lobes
•Risk factors: increased estrogen, family history, radiation exposure
Breast CXR in males s/s
•Men in BRCA-positive families should consider genetic testing
•Signs & Symptoms:
•Painless lump or thickening of breast tissue
•Changes to the skin and nipple
•Discharge
Diagnostics for Breast CXR
•Mammography
•Ultrasound (Distinguishes fluid vs. solid)
•Biopsy
•Fine needle aspiration
•Core needle biopsy (hollow needle, takes cells out)
•Surgical biopsy
•Lymph node biopsy
•MRI
What is sentinel lymph node Biopsy
They take the closest lymph node to the issue of possible cancer
Types of Breast CXR
Ductal carcinoma is 80% of invasive CXR
“Best” place to get CXR is ‘in situ’ because it means it hasn’t spread.
•ductal breast CXR
•Mixed tumor breast CXR
•Inflammatory breast CXR (fast growing, high risk, often mistaken for an infection. When not responding to antibiotics this is investigated)
•lobular Breast CXR
CXR Staging
1-4 stages with different sections in between. A Pt doesn’t just jump from one stage to the next
0 is “in situ” with no lymph node involvement or metastasis. This is the best stage and very treatable. Survival rate is 100%
4 is metastatic spread to different parts of the body and the survival rate is 16%
Breast CXR TX procedures
Treatment based on stage
•Surgery
•Breast-conserving
•Mastectomy
•Chemotherapy (effects whole body)
•Radiation (shrink cell in local area)
•External beam
•Brachytherapy
•Hormone therapy (won’t give if Pt is hormone +)
Example: Tamoxifen (estrogen receptor Antagonist)
External Beam Vs Brachytherapy
External Beam= Radiation
Brachytherapy= catheter conforms the shape of the excision cavity and radiation via seeds 2X/day for 5 days. Once tx is finished the device is removed
Mastectomy vs lumpectomy
Mastectomy= removal of breast
Lumpectomy= tumor removal with margins
Mastectomy Types test
Total (simple) Mastectomy: takes full breast, lymph nodes are NOT removed
Modified Radical Mastectomy:
Takes Breast AND lymph nodes but LEAVES pectoral muscle
Post mastectomy nursing care
Lymphedema can occur anytime after axillary node dissection
elevate affected side w/wrist higher than elbow
* No BP, injections or venipunctures on affected side.
•Watch for S & S of edema on affected arm.
•Flexion and extension exercises of the hand in recovery
•Abduction and external rotation arm exercises after wound has healed.
• Assess dressing for drainage.
• Assess wound drain for amount and color.
• Provide privacy when client looks at incision.
•Chemotherapy
Breast Reconstruction Types
Implants w/silicone/saline
Tissue Flap Procedures (TRAM is most common)
Nipple reconstruction
Tissue Flap Procedures
•Uses autologous tissue to create a breast mound (most common TRAM*)
•Tissue taken from abdomen, back, thighs, or buttock
•Pedicle: tissue stays attached to the muscle and is tunneled under the skin to the chest
•Free flap: tissue is completely separated
Mammoplasty
Breast Augmentation
•Breast Reduction or enlargement
•Relieves physical discomfort : back, neck, and shoulder pain
•Can improve psychologic health: self-esteem, self-image, & comfort in own clothes
•Possible complications: loss of sensation, infection inability to breast-feed, scarring, difficult wound healing, uneven breast size or shape
Psychosocial support for breast CXR
•Provide a safe environment
•Identify sources of support
•Encourage patient to identify and learn personal coping strengths
•Promote communication
•Answer questions
•Make resources available
What to know for the test for breast CXR
Pathophysiology
•Risk Factors
•Breast Cancer Screening Recommendations
•Diagnostic Studies & Staging
•Treatment Options
•Surgical Treatment
•Lumpectomy vs. Mastectomy
•Mastectomy Types
•Care of the Mastectomy Patient
•Reconstruction Options
•Tamoxifen medication treatment
Testicular CXR
Germ cell tumors = 90% of CXR
•seminomas (less aggressive)
•nonseminomas
stromal Tumors (hormone producing cells)
•Leydig cell (androgens)/ Benign
•Steroli cell -Benign (but if spreads, doesn’t respond well to Tx)
Testicular CXR- causes/risks
•Caucasian males have higher risk
•An undescended testicle
•Family history of testicular cancer
•Orchitis
•HIV infection
•Maternal Exposure to exogenous estrogen
•Previous history of testicular cancer
Testicular CXR S/S
•Lump or swelling in the testicle
•Heaviness or aching in scrotum
•Breast growth or soreness
•Low back pain or abdominal pain (late signs)
Testicular CXR- Diagnosis
•Ultrasound of the testicles (visualizing the lumps)
•Serum tumor markers – AFP, LDH, HCG (markers a produced by tumor!)
•Imaging to assess for metastatic disease
Testicular CXR TX
Surgery – inguinal orchiectomy
•Radiation (seminomas)
•Chemotherapy
•Cryopreservation of sperm pre-treatment
Testicular CXR -Orchiectomy
Testicle removal
Post-op care:
•ice pack (20 min) to ease swelling
•Snug underwear (compression)
•Pain medication
Endometrial CXR Anatomy
Uterus has two parts:
•Body
•Cervix
•Uterus has two main layers:
•Myometrium
•Endometrium
Endometrial CXR Overview
The most common type of gynecologic cancer
•Most are adenocarcinoma*
•Start in the gland cells that like the organ
•Type 1 endometrial cancer – usually not aggressive (cause: too much estrogen)
•Type 2 endometrial cancer – have a poorer outlook (likely to spread/grow)
•If not diagnosed endometrial cancer can invade the myometrium & lymph nodes
Endometrial CXR Risk factors
•Family history - HNPCC*** (colon CXR)
Screening can be done. Increases risk
•Obesity (excess estrogen in fat cells)
•Exposure to estrogen
•Early Menarche, Late Menopause, Never being Pregnant (more periods, more overall exposure to estrogen)
•Increased Age
•Diet & Exercise
•Type 2 diabetes
Endometrial CXR -Diagnosis
No routine screening is available
Hysteroscopy scope into vagina/cervix to look at uterus
•Ultrasound
•Biopsy
•Genetic testing
•Lynch Syndrome (HNPCC)
•Women who have Lynch syndrome may benefit from a yearly biopsy
Endometrial CXR - TX
•Total Hysterectomy
•Radiation
•External beam & brachytherapy
•Chemotherapy
•Targeted Therapy
•Hormone therapy
•Immunotherapy (boosts own immune system)
Cervical CXR
Two parts & two cell types:
•Endocervix (in) -glandular cells
•Exocervix (out) - squamous cells
Types of cervical CXR:
•adenocarcinoma (endo)
•squamous cell (exo) -most common **
Cervical CXR -Risks TEST
***Human papillomavirus (HPV)
•HPV is the biggest risk for cervical CXR **
•Sexual history (how # partners)
•Weakened immune system
•Long-term use of oral contraceptives
•Multiple pregnancies
•Smoking
•STDs (Chlamydia infection)
•Family history
Cervical CXR -vax/screening
•Pap test (if + will do colposcopy)
•HPV test
•Colposcopy (visualize cervix)
•HPV Vaccine
•Recommended for children between 9-12 y/o
Cervical CXR -TX
Surgery:
•cryosurgery (freezing), laser ablation (removing cells w/o cutting tissue)
•excisional surgery (conization)
Surgery for invasive cervical CXR:
•Hysterectomy
•Trachelectomy (band placed so pregnancy can be “held in”)
Immunotherapy, chemo, radiation
Ovarian CXR
The deadliest gynecologic cancer
•Mainly develops in older women
•Tumor types:
•Epithelial tumors (skin cells covering ovaries)
•Germ cell tumors (produces eggs)
•Stromal tumors (estrogen/progesterone)
•Tumors can be benign or malignant
Ovarian CXR- Risks
Family history – HNPCC or Breast CA
•Hereditary gene mutations
•BRCA1 & BRCA 2
•Increased Age
•Obesity
•Having children later or never having a full-term pregnancy
•Hormone therapy after menopause
•Fertility treatment
•Protective effects: Pregnancy, breastfeeding, contraceptives
Ovarian CXR- Diagnosis
•Routine Pelvic Exams
•Genetic testing
•Transvaginal ultrasound
•CA-125 Blood test
•Biopsy
•Imaging to see if cancer has metastasized
•Staging is determined by: Tumor size (T), spread to lymph nodes (N), & spread (metastasis)(M).
Ovarian CXR- TX
Surgery:
•Hysterectomy with bilateral salpingo-oophorectomy (BSO)
•Removal of the omentum
•Lymph nodes
•Debulking if cancer has spread
•Radiation
•Chemotherapy/ Targeted Therapy
•Hormone therapy
Vaginal CXR
•Rare form of cancer
•Occurs mainly in older women
•Squamous cell carcinoma 9 of 10 cases
•Vaginal intraepithelial neoplasia (VAIN)
•Risk factors: HPV, cervical CA, HIV, smoking
•Treatment: Laser, radiation, surgery
Vulvar CXR TEST
Symptoms: pain, itching or burning, bleeding, & discharge*
•Rare form of cancer located on the outside vaginal structure
•Occurs mainly in older women
•Vulvar intraepithelial neoplasia (VIN)
•Risk factors: HPV, HIV, smoking
•Treatment: surgery (laser), vulvectomy (removal of cancerous section/reconstruction might be wanted)
Hysterectomy types TEST
Partial hysterectomy (uterus)
Total Hysterectomy (uterus, cervix)
Radical Hysterectomy with Bilaterial salpingo-oophorectomy (uterus, cervix, ovaries, fallopian tubes, lymph nodes) -most invasive!
Hysterectomy approaches TEST
•Abdominal incision (go through abdomen and removal)
-laparoscopic, small incision in the navel. might remove through vaginal canal
Vaginal Hysterectomy (normally for uterine prolapse pt’s. go through vaginal canal and removal)
Hysterectomy post-op care TEST
Specific to this surgery:
•Monitor vaginal bleeding (Packing)
•Assess abdomen/incisions
•Maintain hydration
•Remove the Foley and monitor 1st void
Normal post op care:
•Cough and deep breathe…anesthesia, pneumonia
•Walk, walk, walk: Decrease DVT risk, bowel peristalsis
•Control pain: PCA to PO meds
•Control Nausea
•Psychosocial adjustment varies greatly
Post-op concerns for ovary removal TEST
•Early surgical menopause (deprives body from hormones which leads to a/s: hot flashes, depression/anxiety, heart disease, memory problems)
•Loss of libido
•Vaginal dryness
•Osteoporosis
•Estrogen replacement if under 50
Hysterectomy-Discharge instructions TEST
•Average hospital stay 2-3 days
•Six weeks pelvic rest (no intercourse)
•No heavy lifting
•Vaginal bleeding
•Kegel exercises (strengthen pelvic floor)
•Constipation
•DVT risk
•Sexual function (temporary loss of vaginal sensation)
