WEEK 6 Breast Disorders Flashcards
1
Q
What are the 2 Healthy People 2020 Objectives for BREAST CANCER?
A
- ↓ female deaths from breast cancer
2. ↑ proportion women who receive a breast cancer screening based on most recent guidelines
2
Q
What are the 2 Healthy People 2020 Objectives for PROSTATE CANCER?
A
- ↓ deaths from prostate cancer
- ↑ proportion of men who have discussed with their HCP whether or not to have a prostate-specific antigen (PSA) test to screen for prostate cancer
3
Q
Fibroadenoma is a __ breast disorder
A
benign
4
Q
In Fibroadenoma, there is a __, __ __ __ mass. This mass is: (6)
A
solid
slowly enlarging benign
round firm easily movable rubbery non-tender clearly delineated from surrounding tissue
5
Q
Fibroadenoma is usually located in the __ __ __ of the breast
A
upper outer quadrant
6
Q
When is Fibroadenoma most common?
A
It is most common during reproductive years
7
Q
There is an immediate fear of an increased risk for breast cancer for these women who have Fibroadenoma. The chances of breast cancer are __ __
A
very small
8
Q
what is a cyst?
A
a fluid filled mass
9
Q
what does fibrosis mean?
A
the thickening and scarring of connective tissue, usually as a result of injury
10
Q
In Fibrocystic Breast Condition, there are fibrocystic changes of the breast involving which 3 areas?
A
- lobules
- ducts
- stromal tissues
11
Q
Fibrocystic Breast Condition is most common in…
A
premenopausal women between 20 and 50 years of age
12
Q
Fibrocystic Breast Condition is possibly caused by the…
A
imbalance in normal estrogen-to-progesterone ratio
13
Q
Does fibrocystic breast condition increase the risk of breast cancer?
A
NO
14
Q
Describe the characteristics of fibrocystic breast condition. (7)
It contains:
What other symptoms are there?
A
- fibrosis and cysts
- rubbery, ill-defined
- painful/tender
- increased tenderness and size PRIOR to menstruation
- symptoms increase in the premenstrual phase
- also freely movable
- symptoms usually resolve during menstruation
15
Q
What are the diagnostic studies for fibrocystic breast changes? (4)
A
- Aspiration biopsy
- Needle biopsy
- Mammography
- Ultrasound
16
Q
If fibrocystic breast changes are very troublesome, __ __ is an option
A
surgical removal
17
Q
Other collaborative care measures for patients with fibrocystic breast changes include __ __, __ __ __, and __.
A
supportive undergarments
OTC pain relievers
hormones
18
Q
What specific hormones are prescribed for patients with fibrocystic breast changes?
A
oral contraceptives
19
Q
How do oral contraceptives help patients with fibrocystic breast changes? What should you watch out for when giving oral contraceptives?
A
- oral contraceptives balance hormone levels and symptom management
- Watch out for DVTs for people greater than 35, PE, CVA
20
Q
What is the point of doing an aspiration biopsy for a patient with fibrocystic breast changes?
A
To check and see if there are cancer cells in the fluid
21
Q
Patients with fibrocystic breast changes should consume less __. Decreasing this ___ can lower symptoms like __.
A
caffeine
premenstrually
inflammation
22
Q
Patients with fibrocystic breast changes should take __ and have a low __ diet or take __
A
vitamins
Na+
diuretics
23
Q
Breast cancer is the __ leading cause of DEATH for women.
A
2nd
24
Q
Deaths from breast cancer have __ since __.
A
decreased
1990
25
African American women have more __ breast cancer EVEN IF detected early
aggressive
26
What are complications of breast cancer? (4)
1. Invasion of lymph channels causing skin edema
2. Metastasis to lymph nodes
3. Bone, lungs, brain, liver - sites of metastatic disease from breast cancer
4. Ulceration of overlying skin
27
Breast cancer occurs __% in the upper outside quadrant,. This quadrant has the highest breast cancer occurrence b/c...
50%
that's the location with the majority of glandular tissue
28
In breast cancer, the tumor is: (4)
1. regularly shaped
2. poorly delineated
3. nonmovable
4. nontender
29
What does noninvasive breast cancer mean? How many percent of breast cancers are noninvasive?
the cancer stays within the duct
20%
30
What does invasive breast cancer mean?
it penetrates surrounding tissue
31
Which of the following is a risk factor for developing breast cancer?
1. Age greater than 35 years
2. Early menopause less than age 45
3. First birth less than age 20
4. Early Menarche less than age 12
4 Early menarche b/c of prolonged exposure to estrogen
32
What are risk factors for breast cancer?
1. Gender
2. Age 55 years or older
3. Inherited mutations BRCA 1 or 2
4. Family hx
5. Race and Ethnicity
6. Dense Breast tissue
7. Previous hx breast CA
8. Early menarche (12 y/o)
9. Late menopause (greater than 55 y/o)
10. Previous chest radiation (esp. adolescence)
11. Diethylstilbestrol (DES) exposure
33
An individual with inherited mutations BRCA 1 or 2 has an __ lifetime risk of breast cancer
80%
34
A person with a family history of breast cancer has a __-__% risk
20-30%
35
A person with a family history of breast cancer relating to a 1st degree relative:
1. ) mother/sister/daughter - has a __X risk
2. ) father/brother - what's the risk?
3. ) two 1st degree relative has a __X risk
1. 2
2. unknown
3. 5
36
Breast Cancer Risk Factors: Race & Ethnicity:
White ->
Black ->
White: has a greater risk of developing breast ca
Black: has a greater risk of dying
37
What is DES? What does it stand for?
it's a synthetic estrogen
| Diethylstilbestrol
38
When were women given DES? Why were they given DES?
during the 1940s -1970s to reduce complications and complications
39
Do having kids or not having kids pose as a risk factor for breast cancer? why?
not having kids
| you are not breastfeeding
40
Does having the first child after the age of 30 or before 30 pose as a risk factor for breast cancer?
AFTER age 30
41
__% of women who get breast cancer do not have a family history
85
42
Postmenopausal women who are on __ __ also have a risk for breast cancer
hormonal therapy
43
What type of modifiable risk factors are there for breast cancer? (4)
1. excess alcohol intake
2. lack of physical activity
3. birth control
4. being overweight or obese
44
__-___ lesions such as __ __ and __ lesions such as __ are also breast cancer risk factors
non-proliferative; ductal ectasia
| proliferative; fibroadenoma
45
Why are being overweight/obese or lacking physical activity or being over age 55 risk factors of breast cancer?
Fat tissue holds estrogen especially when ovaries stop working
46
What are 4 factors with unclear effects on breast cancer risk?
1. diet and vitamin intake - vitamin D and calcium
2. chemicals in the environment
3. tobacco smoke
4. night work
47
What are 4 disproven or controversial breast cancer risk factors?
1. Antiperspirants
2. Bras
3. Induced abortion
4. Breast implants
48
BRCA1 and BRCA2 are __; it is their __ that is abnormal
normal
| mutation
49
When an individual inherits a mutated copy of __ __ from a parent, the individual has a __ risk of breast cancer
either gene
| high
50
BRCA1 mutations have a lifetime risk as high as __%. The average risk is __-__%
80%
55-65%
51
BRCA2 mutations have a lifetime risk around __%
45%
52
In the United States, BRCA mutations are more common in __ __ of __
Jewish people ; Ashkenazi
53
BRCA1 and BRCA2 gene mutations occur more so in __ __ origin than in other racial and ethnic groups, but they can occur in __
Eastern Europe
anyone
54
__ testing can be done to determine if an individual has a BRCA1 or BRCA2 mutation.
Genetic
55
Inheriting a mutated copy of a gene is more of a risk factor for __ women than __ women
younger; older
56
Noninvasive breast cancer comprises __% of all breast cancer
20
57
What are the two types of noninvasive breast cancers?
1. Ductal carcinoma in situ (DCIS)
| 2. Lobular carcinoma in situ (LCIS)
58
Ductal carcinoma in situ (DCIS) tends to be __ and may progress to __ if untreated
unilateral
| invasive
59
Lobular carcinoma in situ (LCIS) is actually a risk factor for developing __ __. This is NOT a __ __.
breast cancer
premalignant lesion
60
Although the management of DCIS can be controversial, patients should discuss treatment options with their health care provider, including: (4)
1. breast-conserving treatment (lumpectomy)
2. mastectomy with breast reconstruction
3. radiation therapy
4. hormone therapy (tamoxifen [Nolvadex], anastrozole [Arimidex])
61
No __ or __ treatment is indicated for LCIS.
surgical; radiation
62
__ __ may be used as a preventive measure to reduce breast cancer risk for some patients
hormone therapy
63
What is the most common type of breast cancer?
invasive ductal carcinoma
64
What are the three types of invasive ductal carcinoma?
1. medullary carcinoma
2. tubular carcinoma
3. colloid (mucinous) carcinoma
65
Medullary carcinoma comprises __% of all breast cancers and are seen in women in their __ __ and __.
15%
| late 40s and 50s
66
Tubular carcinoma comprises __% of all breast cancers, are seen in women older than __, and has an __ __.
2
50
excellent prognosis
67
Invasive ductal carcinoma is also called:
infiltrating ductal carcinoma
68
Invasive ductal carcinoma starts in the __ __ then breaks through the walls of the duct invading the surrounding tissues and sometimes...
milk duct
| metastasizing to other parts of the body
69
Medullary carcinoma manifests with cells that resemble those of the __ of the __
medulla; brain
70
Colloid (mucinous) carcinoma comprises __% to _% of all breast cancers. The tumor produces __. In most cases, there has been a __ __.
1-2
mucus
favorable prognosis
71
What are clinical manifestations for breast cancer? (9)
1. single lump, mass, or mammography abnormality
2. painless, hard, irregular edges are more likely to be cancerous
3. can be tender, soft or rounded
4. orane peel appearance
5. swelling of all or part of a breast
6. skin irritation or dimpling
6. breast or nipple pain
7. nipple retraction (turning inward)
8. redness, scaliness, or thickening of nipple or breast skin
9. a discharge other than breast milk, e.g., clear or bloody
72
Skin dimpling on a breast is a result of __ or __ __.
| Pulling that surrounding tissue ___ from lesion
fibrosis; breast cancer
inward
73
What type of breast cancer is the most aggressive, most malignant, and fast growing?
inflammatory breast cancer
74
Inflammatory breast cancer has a high risk for __ .
metastasis
75
In inflammatory breast cancer, lymph channels in the skin of the breast become __ by __ __.
blocked ; cancer cells
76
In inflammatory breast cancer, the breast looks __, feels __. The breast skin has a __ appearance resembling an __ __ (__ __)
red; warm
thickened
orange peel
(Peau d'Orange)
77
Sometimes in inflammatory breast cancer, the breast develops __ and __ __ that look like __.
ridges; small bumps; hives
78
Of all breast cancers, only __% occur in men. It usually presents as a __, __, __ mass. Often a widely spread disease because it is usually...
hard, painless, subareolar
detected at a later stage than in women
79
What are the risk factors of breast cancer for men? (3)
1. hyperestrogenism
2. family history of breast cancer
3. radiation exposure
80
What is the age of onset for men with breast cancer?
65-70 years old
81
Breast cancer in men occur around the __. Men can have __ __, __, or __. Men overall have a slightly __ __ __ than women
areolar
nipple discharge, retractions, erosions
lower survival rate
82
According to the American Cancer Society Guidelines for the Early Detection of Cancer, __ mammograms are recommended starting at age __ and continuing for as long as a woman is in __ __
yearly
40
good health
83
According to the American Cancer Society Guidelines for the Early Detection of Cancer, clinical breast exams (CBE) should be done about every __ years for women in their __ and __ and every year for women __ and over
3
20s and 30s
40
84
Women should know how their breasts __ __ and __. Breast self-exam (BSE) is an option for women starting in their __.
normally look; feel
20s
85
The United States Preventative Services Task Force (USPSTF) __ screening mammography for women aged __ to __ years
BIENNIAL
50 - 74 years
86
The USPSTF concludes that the current evidence is __ to assess the additional benefits and harms of screening mammography in women 75 years or older.
insufficient
87
The USPSTF recommends against teaching __ __ __ ( __).
breast self-examination (BSE)
88
The decision to start regular, biennial screening mammography before the age of 50 years should be an __ __ and take patient __ __ __, including the patient's values regarding specific benefits and harms.
individual one
| context into account
89
The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) ...
beyond screening mammography in women 40 years or older
90
What diagnostic studies are done for breast cancer? (8)
1. Aspiration biopsy
2. Needle biopsy
3. Mammography
4. Ultrasound
5. Ploidy status
6. Axillary (underneath arm) Lymph Node vs. Sentinel Lymph Node Dissection
7. Tumor size: Larger the tumor, the poorer the prognosis
8. Stages: TNM (Tumor, Lymph Node, Metastasis) classification
91
What is Ploidy Status?
It is a diagnostic study for tumor differentiation and abnormality. It correlates with tumor aggressiveness.
92
What is the ultrasound used to look for in breast cancer?
lesions, fluid
93
What is a mammogram used to detect for breast cancer?
for suspicious lump/s and to measure the lump/s
94
If you have more than __ lymph nodes involved, you have an increased risk for _.
4
| recurrence
95
What are the two types of surgical therapies for breast cancer?
1. Lumpectomy
| 2. Modified radical mastectomy
96
In lumpectomy, it is normally done for stage __ to __. It conserves the __ and __. It involves the removal of tumor with small amounts of __ __. This is a __ __ __ procedure. IT also involves removing __ __ __.
___ vs. ___
```
1; 2
breast; nipple
normal tissue
same day ambulatory
palpable lymph nodes
```
ALND (axillary lymph node dissection) vs. SLND (sentinal lymph node dissection
97
In modified radical mastectomy, there is the removal of __ and __ __ but conserves the __ __
breast; axillary nodes
| pectoralis muscle
98
In radiation therapy for treating breast cancer, the primary treatment lasts __ -__ __.
5-6 weeks
99
Radiation therapy for breast cancer can be used to (2):
1. shrink a large tumor size to operable size
| 2. palliative treatment for pain
100
What is brachytherapy ?
radiation directly to the area it's supposed to go compared to whole chest radiation
101
Radioactive seed/catheters have a very __ exposure to radiation to other people. Are bodily fluids radioactive? These patients will have to limit __ and interaction with __ __ and __.
low
no
visitors; pregnant women; children
102
What does chemotherapy for breast cancer involve? When can chemotherapy be administered?
cytotoxic drugs used to destroy cancer cells
it can be administered pre- & post-op
103
What is pre-op chemo called? What is its purpose?
neoadjuvant chemo ; given prior to surgery and may be given to attempt to shrink the cancer so that the surgical procedure may not need to be as extensive
104
What is adjuvant chemo?
given to destroy microscopic cells that may be present after the known tumor is removed by surgery and to prevent possible cancer reoccurrence
105
What is induction chemo?
given to induce a remission; commonly used in the treatment of acute leukemias
106
What is consolidation chemo?
given once a remission is achieved. The goal is to sustain a remission. May also be called intensification therapy. Commonly used in the treatment of acute leukemias
107
What is maintenance chemo?
give in lower doses to assist in prolonging a remission. Used only for certain types of cancer, most commonly acute lymphocytic leukemias and acute promyelocytic leukemias
108
What is 1st line chemo?
Chemo that has, through research studies and clinical trials, been determined to have the best probability of treating a given cancer. This may also be called standard therapy.
109
What is 2nd line chemo?
given if a disease has not responded or reoccurred after 1st line chemo. 2nd line chemotherapy has, through research studies and clinical trials, been determined to be effective in treating a given cancer that has not responded or reoccurred after standard chemo. May also be referred to as salvage therapy.
110
What is palliative chemo?
Given specifically to address sx management without expecting to significantly reduce the cancer
111
When should a prophylactic oophorectomy be done?
if there is a BRCA gene mutation - which can help reduce the risk of breast cancer
112
What medication is used during hormonal therapy?
Tamoxifen Citrate (Novaldex) - which blocks estrogen
this is an selective estrogen receptor modulator (SERM)
113
Who gets hormonal therapy? (3)
1. post-menopausal women without lymph node involvement
2. BRCA 2 mutation
3. individuals with increased risk for breast cancer
114
Hormonal therapy is a prevention method for individuals in the __ __ category
high risk
115
What are side effects of hormonal therapy? (4)
1. hot flashes
2. n/v
3. blood clots
4. endometrial cancer
116
In a modified radical mastectomy, what parts are removed? what are left intact?
Breast tissue, nipple, and lymph nodes are removed
Muscles are left intact
117
In a simple mastectomy, what are removed? what are left intact?
Breast tissue and (usually) nipple are removed
Lymph nodes are left intact
118
In a lumpectomy with lymph node dissection, what are removed? what are left intact?
The tumor and lymph nodes are removed
Other tissue are left intact
119
Name 5 nursing diagnoses for breast cancer:
1. anxiety
2. ineffective coping
3. decisional conflict
4. fear
5. disturbed body image
120
What are 2 collaborative problems of breast cancer nursing diagnoses?
1. potential for metastasis
| 2. potential for lymphedema
121
What can the post-op breast cancer patient experience? (3)
1. acute pain
2. sexual dysfunction
3. disturbed sleep
122
A pt had a simple mastetomy this morning. Which of the following should be included in her nursing care?
1. complete bed rest for 24 hours
2. NPO with IV fluids for the 1st 48 hours
3. Position on operative side for 1st 24 hours
4. Keep PCA controller within easy reach for 1st 24 hours
4. PCA (patient controlled analgesia) – pre-set with continuous dose, or we can set so pt gets a bolus dose – we can set a limit – pt can push every 10 minutes for example
123
What should be included in the nursing management of a post op breast cancer patient?
1. Assess LOC, V/S
2. Assess bleeding (dressing, drains)
3. Avoid BP, injections, lab draws on AFFECTED arm
4. Remember ambulation & diet
5. Postmastectomy exercises
6. Discuss Breast reconstruction
7. Discuss adjuvant therapy- chemotherapy or radiation after surgery
124
During post op nursing management of the patient with breast cancer, it is important to monitor __ __, __ __, __, and __
vital signs
O2 sat
RR
BP
125
__ __ is especially important for breast cancer post op patient under general anesthesia and pain medications (opioids like morphine)
respiratory rate
126
Pain medications can lower __ and __
RR & BP
127
For the nursing management of post op breast cancer pt, do FREQUENT __ __
PAIN assessments
128
The lymph nodes are in charge of filtering __, ___ and putting __ back into the circulation. IF you have lymph nodes removed, that is going to increase what two things?
Because of this, __ measurements might be inaccurate
fluid, microorganisms
fluid
amount of fluid in the extremity, risk for infection
BP
129
For the post op breast cancer patient, do not use __ or __ in the incision area until the area is healed
lotions
| deodorants
130
What are 4 post-mastectomy exercises?
1. Wall hand climbing
2. Rope turning
3. Rod or broomstick lifting
4. Pulloy tugging
131
Tell me about wall hand climbing.
Stand facing the wall with feet apart and toes as close to the wall as possible. With elbows slightly bent, place the palms of the hand on the wall at shoulder level. By flexing the fingers, work the hands up the wall until arms are fully extended
132
Tell me about rod or broomstick lifting.
Grasp a rod with both hands, held about 2 feet apart. Keeping the arms straight, raise the rod over the head. Bend elbows to lower the rod behind the head. Reverse maneuver, raising the rod above the head, then return to the starting position
133
Tell me about rope turning.
Tie a light rope to a doorknob. Standing facing the door. Take the free end of the rope in the hand on the side of surgery. Place the other hand on the hip. With the rope-holding arm extended and held away from the body (nearly parallel with the floor), turn the rope, making as wide swings as possible. Begin slowly at first; speed up later.
134
Tell me about pulley tugging.
Toss a light rope over a shower curtain rod or doorway curtain rod. Stand as nearly under the rope as possible. Grasp an end in each hand. Extend the arms straight and away from the body. Pull the left arm up by tugging down with the right arm, then the right arm up and the left down in a see-sawing motion.
135
For the post op breast cancer patient:
You can get a soft ball and squeeze ball while watching tv or move fingers up and down the wall to:...
DO THESE __ __ surgery!
move fluid and prevent lymphedema!
SOON AFTER
136
For the post op breast cancer patient:
| You should avoid __ __ for a __ months! Do this __ __ surgery!
heavy lifting
couple
SOON AFTER
137
For the post op breast cancer patient:
Pt can wear __ __ over their arm if lymphedema occurs. Educate the pt on protecting the __! Wear __ when gardening, __ when cooking
compression stockings
gloves
mittens
138
What should you teach to the post op breast cancer patient upon discharge?
1. psychosocial
2. Infection - observe incision
3. incisional and drain care (Jackson Pratt) - can have these drains 1-3 weeks - check drainage insertion site
4. less than 24 ml over a 24 hr period
5. exercises - stay away from moderate exercise/heavy lifting
6. lymphedema
7. health promotion
8. follow up care - CBE, self BE
9. Sexuality
10. cover chest with pillow
11. take birth control for child bearing age b/c of birth defect risk in chemo and radiation
