Unit 8 - Breast Cancer

Question 1

_____ out of _____ women have breast cancer

Answer 1

1 out of 8

Question 2

Most common cancer in women in US other than skin cancer

Answer 2

breast cancer

Question 3

2nd leading cause of cancer related death in women in US

Answer 3

breast cancer

Question 4

T/F: death rates are going down since 1989 (early detection)

Answer 4

T

Question 5

Breast Cancer begins as a single, transformed cell, often _____ dependent

Answer 5

hormone

Question 6

T/F: breast cancer may remain noninvasive, without spreading (metastasizing) for long periods of time

Answer 6

T

Question 7

Categories of breast cancer:

- carcinoma of mammary ducts

Answer 7

tiny tubes that carry milk from lobules to nipples

Question 8

Categories of breast cancer:

- carcinoma of mammary lobules

Answer 8

milk producing glands

Question 9

Carcinoma of mammary ducts:

- invasive (or infiltrating) ductal carcinoma (IDC) grown out of ducts =

Answer 9

into nearby breast tissue

Question 10

Carcinoma of mammary lobules:

- invasive (or infiltrating) lobular carcinoma (ILC) grown out of…

Answer 10

the lobules and into the nearby breast tissue

Question 11

Sarcoma of the breast:

• most _____/many histological types
• terminal section of breast _____ _____
• can metastasize to other sites -> _____ or _____ system

Answer 11

• most adenocarcinomas/many histological types
• terminal section of breast ductal tissue
• can metastasize to other sites -> bloodstream or lymphatic system

Question 12

Lifetime risk of men getting breast cancer

Answer 12

1/10th of 1% = 1 into 1,000

Question 13

Over _____ men die from breast cancer in the US each year

Answer 13

400

Question 14

Staging system of classifying breast cancer

Answer 14

TNM

• Tumer: size
• Nodes: lymph node involvement
• Metastasis: distant

Question 15

TNM provides important information for decision making about _____ _____

Answer 15

treatment options

Question 16

TNM is used as basis for _____

Answer 16

prognosis

Question 17

Two breast cancer susceptibility genes

Answer 17

• BRCA1

- BRCA2

Question 18

BRCA1 and BRCA2 are both known as _____ _____ _____

Answer 18

tumor suppressor genes

Question 19

_____-_____% of women with breast cancer though to be hereditary

Answer 19

5-10%

Question 20

Inherited gene mutations are in every cell of the body and can be passed on to children. These mutations can increase the risk for developing cancer and are responsible for the cancers that run in some families. For example, the BRCA genes (BRCA1 and BRCA2) are tumor suppressor genes. Mutations in these genes can be inherited from parents. When they are mutated, they no longer _____ _____ _____, and cancer is (less, more) likely to develop.

Answer 20

suppress abnormal growth

more

Question 21

Acquired gene mutations are changes that take place during a person’s life. These changes only affect the cells that grow from the one cell where _____ _____ _____ (but this can mount up to a large tumor over the course of years); most cases of breast cancer are caused by these types of changes
BRCA1 or BRCA2:
Women with inherited BRCA1 Although in the US, BRCA mutations are found most often in _____ _____ of Ashkenazi (Eastern Europe) origin, they are also seen in _____ _____ or BRCA2 mutations also have an increased risk for developing _____ cancer as well as some other cancers.

Women and Hispanic women and can occur in any racial or ethnic group.

Some of the other genes in which mutations can lead to inherited breast cancer, include PTEN, CHEK2, TP53, ATM, CDH1, PALB2, and STK11, but these are all much rarer than _____ mutations.

Answer 21

the changes began
Jewish women
African-American
ovarian 
BRCA

Question 22

Having one _____-_____ relative (mother, sister, or daughter) with breast cancer _____ a woman’s risk.

Having _____ first-degree relatives with breast cancer increases her risk about _____-fold.

Although the exact risk is not known, women with a family history of breast cancer in a father or brother also have an _____ risk of breast cancer.

Altogether, less than _____% of women with breast cancer have a family member with this disease. (As a result, t’s important to note this means that over _____% of women who get breast cancer do not have a family history of this disease.)

Answer 22

first-degree
doubles

2
3

increased

15
85

Question 23

T/F: A woman with cancer in one breast has an increased risk of developing a new cancer in the other breast or in another part of the same breast.

Answer 23

T

Question 24

Women diagnosed with certain benign (non- cancerous) breast conditions may have an _____ risk of breast cancer.

Non-cancerous breast conditions that cause cell growth in the breast are (more, less) closely linked to breast cancer risk than others.

Answer 24

increased

more

Question 25

Women who had radiation to the chest for another cancer as a child or young adult are at a _____ _____ risk than those who did not. Women who, as children or young adults, had _____ _____ to the chest area as treatment for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) are at much higher risk for breast cancer. This varies with the patient's _____ when they had radiation. The risk of developing breast cancer appears to be highest if the radiation was given during _____, when the breasts were still developing.

Answer 25

much higher radiation therapy age adolescence

Question 26

_____ is used to help relieve symptoms of menopause and to help prevent osteoporosis (thinning of the bones). There are 2 main types of PHT: _____ and _____ (known as combined PHT) and estrogen alone (known as estrogen therapy (ET)). Use of combined PHT increases the risk of breast cancer. The increased risk is seen after as little as _____ years of use. The increased risk from combined PHT appears to apply only to current and recent users. A woman's breast cancer risk seems to return to that of the general population within 5 years of stopping _____ PHT. The use of estrogen alone (does, does not) appear to increase the risk of developing breast cancer

Answer 26

PHT estrogen progesterone 2 combined does not

Question 27

From the 1940s through the 1960s some pregnant women were given the drug _____ (DES) because it was thought to lower their chances of losing the baby (miscarriage). These women have a slightly increased risk of developing breast cancer. Women whose mothers took DES during pregnancy may also have a slightly (lower, higher) risk of breast cancer. Using oral contraceptives or the injectable contraceptive DepoProvera _____ breast cancer risk. The risk returns to normal within _____ years of stopping the pill and within 5 years of stopping DepoProvera. When thinking about using these drugs, women should discuss all of the risks and benefits as well as their other risk factors for breast cancer with their health care team. At least part of this is because invasive breast cancer increased by 0.5% per year in _____ _____ women, although why this is the case is not known. Asian, Hispanic, and Native American women have a (lower, higher) risk of developing and dying from breast cancer.

Answer 27

diethylstilbestrol higher increases 10 African American lower

Question 28

Women with denser breast tissue (as seen on a mammogram) have more glandular tissue and less fatty tissue, and have a higher risk of breast cancer. Unfortunately, _____ breast tissue can also make it harder for doctors to spot problems on mammograms. Having the first full term pregnancy before age _____ and having many term pregnancies reduces breast cancer risk. (A pregnancy that isn’t carried to term does not have this protective effect.) Pregnancy reduces a woman's total number of lifetime menstrual cycles, which may be the reason for this effect. Another factor may be the change in breast tissue that occurs in pregnancy to get ready for breastfeeding.

Answer 28

dense | 30

Question 29

Women who have had more menstrual cycles because they started menstruating at an early age (before age 12) and/or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer. This may be related to a higher lifetime exposure to the hormones _____ and _____. Especially if breastfeeding is continued for _____ year or more. One explanation for this possible effect may be that breastfeeding reduces a woman's total number of lifetime menstrual cycles (similar to starting menstrual periods at a later age or going through early menopause).

Answer 29

estrogen and progesterone 1

Question 30

Before menopause the ovaries produce most _____, and fat tissue produces a (small, large) amount. After menopause (when the ovaries stop making estrogen), most of a woman's estrogen comes from _____ _____. Having more fat tissue after menopause can _____ estrogen levels and increase the likelihood of developing breast cancer. The connection between weight and breast cancer risk is complex. For example, the risk appears to be _____ for women who gained weight as an adult but may not be increased among those who have been overweight since childhood.

Answer 30

estrogen small fat tissue increase increased

Question 31

Compared with non-drinkers, women who consume _____ alcoholic drink a day have a very (small, large) increase in risk. Those who have 2 -3 drinks daily have _____% higher risk than women who don’t drink alcohol. If asked: In the United States, a standard drink is equal to 13.7 grams (0.6 ounces) of pure alcohol, or 12 ounces of beer 8 ounces of malt liquor 5 ounces of wine 1.5 ounces or a “shot” of 80-proof distilled spirits or liquor (such as gin, rum, vodka, or whiskey)

Answer 31

1 small 20

Question 32

_____ _____is a drug that blocks some of the effects of estrogen on breast tissue. It can lower the risk of getting breast cancer in women who are at increased risk for the disease.

Answer 32

Tamoxifen

Question 33

_____ also blocks the effect of estrogen on breast tissue. It’s approved to help reduce breast cancer risk in women past menopause who are at high risk for breast cancer. Studies are looking at other drugs, too.

Answer 33

Raloxifene

Question 34

Preventive surgery for women with very high breast cancer risk: - For the few women who have a very high risk for breast cancer, _____ surgery may be an option.

Answer 34

prophylactic

Question 35

_____ (_____) _____ _____: removing both breasts before cancer is diagnosed.

Answer 35

Preventive (prophylactic) bilateral mastectomy

Question 36

_____ _____ (_____ _____): Women with a BRCA mutation may reduce their risk of breast cancer by 50% or more by having their ovaries surgically removed. This is because the surgery removes the main sources of estrogen in the body (the ovaries).

Answer 36

Prophylactic oophorectomy (ovary removal)

Question 37

Prevention of Breast Cancer: - Limiting exposure to _____ _____ - Limiting alcohol to _____ drink per day - Maintaining _____ _____ within normal limits - Engaging in _____ activities - Refraining from _____ - Avoiding exposure to environmental _____ and _____ - Limiting _____ therapy Early detection: cannot prevent breast cancer, but it is essential to _____ client’s risk of mortality and promoting positive outcomes

Answer 37

- Limiting exposure to risk factors - Limiting alcohol to one drink per day - Maintaining body weight within normal limits - Engaging in physical activities - Refraining from smoking - Avoiding exposure to environmental pollution and radiation - Limiting hormone therapy Early detection: cannot prevent breast cancer, but it is essential to reducing client’s risk of mortality and promoting positive outcomes

Question 38

When women should begin annual mammogram screening

Answer 38

40-44

Question 39

When women should have annual mammogram

Answer 39

45-54

Question 40

When should women switch to mammograms every 2 years or continue yearly. Screening should continue as long as a woman is in good health and is expected to live at least 10 years more.

Answer 40

55

Question 41

Warning signs.clinical manifestations of breast cancer: - _____ lump in breast - Most often _____ _____ quadrant - Area with most _____ tissue - Abnormal nipple _____ - Rash around the _____ area - Nipple _____ - _____ of the skin - Change in _____ of the nipple - Nipple pain, scaliness, ulceration, skin irritation, discharge - Usually _____, some women report a burning or stinging sensation - Many women have no manifestations; tumors detected by _____ - Most breast cancers found by women (breast self-examination [BSE] or in a shower) or by partners

Answer 41

- Nontender lump in breast - Most often upper outer quadrant - Area with most glandular tissue - Abnormal nipple discharge - Rash around the nipple area - Nipple retraction - Dimpling of the skin - Change in position of the nipple - Nipple pain, scaliness, ulceration, skin irritation, discharge - Usually painless, some women report a burning or stinging sensation - Many women have no manifestations  tumors detected by mammography - Most breast cancers found by women (breast self-examination [BSE] or in a shower) or by partners

Question 42

Research (has, has not) shown a clear benefit of physical breast exams done by either a health professional or by yourself for breast cancer screening

Answer 42

has not

Question 43

MRI (is, is not) generally recommended as a screening tool by itself, because although it is a sensitive test, it may still _____ some cancers that mammograms would detect. • MRI is more expensive than _____. Most major insurance companies will likely pay for these screening tests if a woman can be shown to be at high risk, but it's not yet clear if all companies will do so (often Medicaid does not cover screening MRI).

Answer 43

is not miss mammography

Question 44

Targeted therapy for HER2-positive breast cancer. For about 1 in 5 women with breast cancer, the cancer cells have too much of a growth-promoting protein known as _____/neu (or just HER2) on their surface. ... Trastuzumab can be used to treat both _____ and _____ stage breast cancer Drugs for target growth of new blood vessels / cell division etc.

Answer 44

HER2 early late

Question 45

Radical mastectomy: a pink highlighted area indicates tissue removed at mastectomy - B axillary lymph nodes: - C axillary lymph nodes: - D axillary lymph nodes: - E _____ lymph nodes - F _____ _____ lymph nodes

Answer 45

- B axillary lymph nodes: levels I - C axillary lymph nodes: levels II - D axillary lymph nodes: levels III - E supraclavicular lymph nodes - F internal mammary lymph nodes

Question 46

Pharmacologic therapies: - oral medication - interferes with estrogen activity

Answer 46

Tamoxifen citrate (Nolvadex)

Question 47

Pharmacologic therapies: | - immunotherapy, used to stop growth of tumors that express the HER2/neu receptor

Answer 47

Trastuzumab (Herceptin)

Question 48

Pharmacologic therapies: - standard of care/majority of cases with axillary node involvement - late metastatic cancer, chemotherapy becomes primary treatment - adjuvant systemic therapy combining other pharmacologic agents with chemotherapy has extended cancer-free survival

Answer 48

Chemotherapy

Question 49

Nursing Diagnosis for Breast Cancer: - risk for _____ - risk for _____ - anxiety - _____ conflict - disturbed _____ _____ over loss of a breast - acute _____

Answer 49

- risk for infection - risk for injury - anxiety - decisional conflict - disturbed body image over loss of a breast - acute pain

Question 50

Nursing intervention: - encourage a _____ rich diet - tell women to avoid _____, talcum powder on the affected side until incision completely heales

Answer 50

protein | deodorants