Week 11 - Breast Cancer Flashcards
what things occur w cancer cells (5)
- poor differentiated
- uncontrolled & unregulated growth of cells
- cells are abnormal
- invade and infiltrate other tissues (metastasis)
- can recur (after remission)
the diagnosis of cancer is focused on (7)
- health history (carcinogens)
- family history
- physical exam
- CXR
- CT
- blood work
- biopsy
what is the most definitive diagnostic test for breast cancer
- biopsy
treatment options for cancer are based on..
-biopsy results –> cancer staging
what is the goal of cancer treatment (3)
- cure
- control
- palliation
how is cancer cured & controlled (3)
- surgery to remove or debulk tumour
- chemo
- radiation
can be a combo
what is the goal of supportive & palliative care for cancer
- goal is to relieve or control symptoms
- optimize QOL
what are some examples of supportive & palliative care for pts w cancer (3)
- colostomy to prevent bowel obstruction
- laminectomy to relieve spinal cord compression
- debulking of tumor, radiation, chemo to relieve pain or pressure
what are some risk factors for breast cancer (8)
- age 50 or older
- personal history
- family history
- alcohol intake
- sedentary lifestyle
- weight gain during adulthood
- dietary fat intake
- exposure to ionizing radiation
what are symptoms of breast cancer (5)
- hard, irregular shaped lump that is nonmobile & nontender
- clear or bloody nipple discharge
- nipple retraction
- dimpling/pulling in of skin
- possible rash or skin changes
what is the main complication of breast cancer
- recurrence that can be local/regional near the masectomy site or distant
what is included in diagnostic studies for breast cancer (5)
- mammography
- MRI
- physical exam
- US
- biopsy
what is the treatment for breast cancer
- directed by stage and type
- surgery = primary
- combined w drug therapy, chemo, and radiation
what are different types of surgeries for treatment of breast cancer (5)
- lumpectomy
- radical mastectomy
- axillary node dissection (ALND)
- modified radical mastectomy
- sentinal lymph node dissection (SLND)
what is a lumpectomy
- breast conserving surgery
- removal of the entire tumour along w a marigin of normal surrounding tissue
- may also remove some lymph nodes
what is required post-lumpectomy
- radiation to the entire breast + a boost to the tumour bed
what are contraindications to a lumpectomy (4)
- breast too small in relation to tumour size
- masses in more than one quadrant
- masses in the same breast quadrant
- central location of the tumour near the nipple
what is the goal of a lumpectomy
- maximize cancer treatment and cosmetic outcome w minimal risk
what is the benefit to a lumpectomy
- the breast and nipple and preserved
what may make a mastectomy a better option over a lumpectomy (2)
- contraindications to radiation therapy –> ex. active lupus, prior radiation therapy in the radiation field
- contraindications to lumpectomy (as previously discussed)
what are disadvantages to a lumpectomy (2)
- increased cost of surgery + radiation over surgery alone
- possible s/e of irradation
what is a modified radical mastectomy
- removal of the breast and axillary nodes
- spares the pectoralis major muscle
when is a modified radical mastectomy preferred over lumpectomy
- if tumour is too large to excise w adequate margina
- if tumour is so large it will produce a poor cosmetic result
what is a radical mastectomy
- removal of the entire breat, entire chest wall, and all nodes (not often done)
what is a radical mastectomy
- removal of the entire breat, entire chest wall, and all nodes (not often done)
when a mastectomy is preferred, patients have the option of _____? when can this be performed
breast reconstruction
- can be performed simultaneously w surgery (more common d/t only one surgery, anasthesia needed once, one postop period)
- or delayed until postop recovery is done
what is the main indication for reconstructive breast therapy (3)
- self-image
- regain sense of normality
- assist in coping w loss of a breast
what impact does breast reconstruction have on the nipple
- cannot restore lactation, nipple sensation, or nipple erectility
- can have nipple reconstructed or tattooed
what are different types of breast reconstruction (3)
- breast implants & tissue expansion
- DIEP flap
- nipple areolar reconstruction
describe the procedure of breast implants
- involves the placement of breast implants (sacs filled w saline or silicone gel) into a pocket under the pectoralis muscle
why might tissue expanders bc required w breast implants
- many pts who have undergone mastectomy have insufficient tissue = implant may cause tight or firm reconstruction
- tissue expander is used to stretch the skin & muscle at the masectomy site before insertion of implants
describe the procedure of tissue expansion for breast implants
- the tissue expander is gradually filled by weekly injections of sterile water or saline = stretch the skin & muscle
- once the tissue is adequately stretched, the expander is surgically removed and a permanent implant is inserted
- some expanders stay in place and become the implant
what is a DIEP flap
- use of autologous tissue to re-create a breast mound
- involves fat, skin, and blood vessels cut from the wall of the lower abdomen and moved up to reconstruct the breast
- no muscle is cut or removed
- then, blood vessels of the flap are carefully reattached to blood vessels in the chest wall
what is nipple-aerolar reconstruction
- procedure that gives the reconstructed breast a more natural appearance by reconstructing a nipple from the opposite breast or a small flap of tissue from the reconstructed breast
- may be tattooed on
what is an auxillary node dissection
- procedure done before the yr 2000
- involves the removal or 12-20 nodes on the same side as the breast cancer
what is sentinal lymph node dissection
- removal of nodes that drain from the tumour and sent to pathology (1-4)
- if 1 or more sentenil cells contain malignant cells, ALND is generally recommend
what is the benefit of SNLD
- lower rates of lymphede,a
what is lymphedema
- accumulation of lymphatic fluid in soft tissue d/t the excision or irradication of lymph nodes
what does lymphedema lead to
- axillary lymph cannot return fluid to central circulation bc of removal of nodes or damage from radiation
- fluid accumulates in the arm = obstructive pressure on the veins and venous return
what are signs of lymphedema (4)
- heaviness
- pain
- impaired motor function in the arm
- numbness and paraesthesis in the fingers
what nursing interventions can help prevent lymphedema (4)
- affected arm should not be dependent (even during sleep) –> elevate arm
- no BP, venipuncture, and injections on affected arm
- no elastic bandages in early postop (inhibit collateral lymph drainage)
- protect the arm from trauma or sunburn
when lymphedema is acute, what treatment is involved (5)
- massage therapy
- compression bandage and pneumatic compression sleeve
- elevation
- isometric exercises
- diuretics
describe follow up r/t surgeries for breast cancer (3)
- pt must be monitored for rest of their life at regular intervals
- usually professional exams after 6 months for 2 years, then annually
- recommended that pt performs regular self examination
what is postmasectomy pain syndrome
- pain that occurs after a mastectomy or axillar node dissection that persists beyond the normal 3 month healing time
what are signs of post-masectomy pain syndrome (5)
- chest and upper arm pain
- tingling sensations down the arm
- numbness
- shooting, prickling pain
- unbearable itching
what adjuvant therapies are used for breast cancer (3)
- local radiation
- chemo
- oral meds
when might radiation be used (3)
- primary treatment to prevent local breast recurrences after breast-conserving therapy
- adjuvant therapy after masectomy to prevent local & nodal recurrences
- palliative treatment for pain
brachytherapy
- internal radiation used for early stage breast cancer
what is the goal of systemic therapy (chemo, hormone therapy)
- destroy tumour cells that may have spread to distant sites
what oral meds might be used as adjuvant therapy for breast cancer (3)
- hormonal therapy
- estrogen receptor blockers
- biological & targeted therapy
what is included in nursing care from the time between diagnosis of breast cancer and selection of a treatment plan (5)
- help the pt accurately explore the advantages and disadvantages of options
- provide info relevant to the decision
- support the pt
- review postop care & exercises
- explain the recovery period
what are the main priorities for nursing care after a mastectomy (4)
- care for incisions
- control pain
- restore arm mobility
- adjuvant therapy
what is included in care for incisions after a masectomy (4)
- monitor & prevent infection
- monitor for any bleeding
- will have drains in place for at least 5 days
- teach pt how to care for drains at home
why are drains in place post-masectomy
-drains are placed under the incision to drain any accumulating fluids (blood, lymph) while theyre healing
when are drains removed post-mastectomy
- after a couple weeks –> when less than 30 ccs in 24 hr period for 2 consecutive days
describe the drainage post-op (4)
- red at first
- then pink
- then apple juice color
- the nothing/minimal
why is it important to restore arm mobility post-mastectomy (3)
- prevent contractures & muscle shortening
- improve lymph & blood circulation = prevent lymphedema
- gradual increase of function over 4-6 weeks
what nursing interventions are involved in restoring arm mobility post-mastectomy (7)
- place in semi-fowlers with the arm on the affected side elevated on a pillow
- flex and extend the fingers
- postop arm & shoulder exercise gradually w surgeons direction
- analgesics 30 min before exercise
- interventions to prevent lymphedema (mentioned earlier)
- warm water to relax muscles and reduce pain
- teach pt when to seek medical attention (increased pain, infection)
what is included in psychosocial care for pts breast cancer (7)
- sensitivity to the pts efforts to cope
- safe enviro to discuss feelings
- help identify sources of support & strength
- encourage her to identify and learn coping strengths
- promote communication between the pt & their friends and fam
- provide accurate and complete answers to questions
- offer info about community resources
a nursing diagnosis post mastectomy or lympectomy is impaired physical mobility. what nursing interventions are done for this (4)
- initiate pain control measures before exercise
- instruct pt on passive, assisted, or active ROM exercises
- incorporate ADLs into exercise protocol
- use motor activites that require attention to & use of both sides of body
a nursing diagnosis post-mastectomy & lumpectomy is acute pain. what nursing interventions are done for this (7)
- assess pain
- explore pt factors that worsen or relieve pain
- teach use of nonpharm techniques for pain
- provide optimal pain relief
- use pain control measures before pain becomes severe
- elevate affected limb 20 degrees or higher
- support arm & limit activity to prevent tension of suture line
a potential complication post-mastectomy or lumpectomy is lymphedema. what nursing interventions are done for this (5)
- assess for signs
- instruct pt about self-care strategies and precautions to reduce risk
- do not perform venipunctures, injections, BP measurements on affected arm
- avoid dependent arm position
- use compression bandage if ordered
