Women's Health Flashcards
Lymph Drainage
Lymph vessels carry clear fluid called lymph
Vessels lead to small round organs (nodes)
Nodes trap bacteria, cancer cells and other harmful substances
Lymph system destroys the harmful substances through phagocytosis
The lymph is eventually taken to the subclavians where it joins the circulation and is filtered through the kidneys
Benign & Malignant Diseases - Scope of the problem
Benign breast disease (BBD) occurs in over 50% of women
- Benign breast conditions include: Cysts, tumors, masses, nipple discharge, infection, duct inflammation
Benign Breast Masses: Fibrocystic changes Fibroadenomas Lipomas Intraductal papillomas Mammary duct ectasia Mastitis Breast trauma Fat necrosis Ductal ectasis
Presenting Signs/Symptoms: Nipple fissure Lumps* Breast Discharge* Bleeding or Bloody Nipple Discharge Skin changes* Breast pain* Breast Infections - Mastitis - Lactational Abscess
Breast cancer – most common cancers in women in the US except for skin Ca
- Second leading cause of death
- Chance of getting it is 1 in 8, dying from it is 1 in 35
- Women of different ages have different risks
Breast assessment
Health History & Clinical S/S
Physical Assessment: Female Breast
- Inspection
- Palpation
Physical Assessment: Male Breast
- Inspection
- Palpation: Male conditions of the breast include: Gynecomastia (male breasts) and Male Breast Cancer
Diagnostic Evaluation of breasts
Mammography: What Mammograms Show: - Difference between breasts - Comparison of past mammograms to present Lumps – Size, shape and edges - Benign S/S - Cancer S/S Calcifications - Macrocalcifications - Microcalcifications - Dietary calcium does not affect
Other diagnostic evaluations: Tomosynthesis Galactography Ultrasonography MRI Self-Breast Examination Procedures for Tissue Analysis
***Cannot diagnose breast (all) cancer without a biopsy!
Evaluating Abnormalities:
Biopsies
- Core needle biopsy- Can be done in office or hospital, Done with special coring needle (Cutting edge), U/S guided needle biopsy
- Stereotactic biopsy- Stick the needle vertically through the mammogram plate until we get to the cancer using ultrasound to visualize (sometimes called a lumpectomy)
- Fine needle aspiration- can be done in the office, accomplished with a needle and syringe
- Surgical (open) biopsy: Day surgery, Removal of all or part of lump, Needle localization
- Punch biopsy
Biopsy results usually in 7-10 days
Tests for estrogen & progesterone receptors- if they have the estrogen receptor, their cancer might be “inheretid”
Symptom evaluation
- Nipple discharge – Galactorrhea, false discharge, serous - discharge, milky discharge
- Skin changes and breast pain
Will be put the patient on tomoxafin to keep estrogen levels down- will have hot flashes
Breast Health Teachings
Fluctuating hormone levels during monthly cycle causes changes in breast tissue
- Following period, hormones down – tissue smooth/ nontender
- Mid cycle, estrogen up breasts more sensitive
- End cycle, progesterone up, breasts swollen, tender and may have palpable nodules
- ***Breast exams – one week following period
- Left breast usually larger
- Breasts don’t reach full size until early 20s
- With age come the loss of milk glands and shrinkage of collagen – sag
- Sleeping on side with pillow to support the breast provides best position for maintaining shape and contour over time
- Regular exercise can strengthen pectorals, creating natural lift and reducing sagging
- Implants- health risks related to deflation, leaking and wrinkling – also scar tissue may tighten around implant, causing breast hardening
Lifestyle Choices: Alcohol consumption Weight maintenance - Exercise - Diet Smoking Screenings - Breast Exams - Mammos - Tomosynthesis
malignancies
Risk Factors:
Modifiable:
- No children or not having children before age 30- by not reducing the number of menstrual cycles
- Postmenopausal estrogens & progestins over 5 years
- Failing to breastfeed for up to a year after pregnancy
- Alcohol consumption- boosts estrogen level in bloodstream
- Smoking
- Obesity & high-fat diet- fat cells produce & store estrogen - more fat cells create higher estrogen levels
- Sedentary lifestyle & lack of physical exercise
- 75% of all women with newly diagnosed breast cancer have no known risk factors
Non-modifiable
- Gender
- Age
- Genetic mutations- BRCA-1 And BRCA-2genes
- Family hx of breast cancer
- Personal hx of breast cancer
- Race- higher in Caucasian women, but African-American women are more likely to die of it
- Previous abnl breast biopsy
- Exposure to radiation
- Previous breast radiation
- Early menarche- less than 12 or late onset of menopause above 55years, = increased lifetime estrogen exposure
Malignant Conditions of the Breast:
Carcinoma in Situ (noninvasive):
- Ductal Carcinoma in Situ
- Lobular Carcinoma in Situ
Invasive Carcinoma
Infiltrating Ductal Carcinoma
- Breast is super hard
- Spreads to bone, lung, liver, and brain
Infiltrating Lobular Carcinoma
- Spread is slower
- Breast you will feel a thickened area
Medullary Carcinoma
- Capsulated, don’t want to break skin to spread cells around
- Well defined borders so we will be able to confidently say we got it all
Mucinous Cancer
Tubular Ductal Cancer
- slow growers
- Good prognosis
Inflammatory Carcinoma
- Localized with redenned area
- Breasts will enlarge, get hard, inverted nipple, orange peel skin, fast grower
Paget’s Disease
- Nipple, areola
- Itches, flaky
Breast Cancer
Role of hormones- dependent on estrogens- does not cause cancer, just supports it
- Started periods early and ended late have more of a chance because you have more expsure to estrogens
- Large amount of babies, or pregnancy early on in life protected from breast cancer
- Genetics- BRCA-1 and BRCA-2
Risk Factors
- Never had kids
- Obesity because fat cells hold estrogen
Protective Factors
- Vigorous exercise – delays periods, shorter periods, irregular periods, decrease in ovulaton, decrease in body fat
- Breastfeeding- delays ovulation
Staging:
Stage 1: Tumors are less than 2 cm in diameter and confined to breast.
Stage 2: Tumors are less than 5 cm in diameter, or tumors are smaller with mobile axillary lymph node involvement
Stage 3a: Tumors are greater than 5 cm, or tumors are accompanied by enlarged mobile axillary lymph nodes fixed to one another or to adjacent tissue
Stage 3b: More advanced lesions with satelite nodules, fixation to the skin or chest wall, ulceration, edema, or with supra-cervicular or intra-clavicular nodule involvement
Stage 4: All tumors with different metastases
T = tumor size, spread N = nodes M = metastasis Progresses from Stage I to Stage IV Stage 0 = noninvasive
Disease Prognosis Indicators
- Cancer stage- stage at diagnosis, will always be that stage
- Cancer type
- Tumor size
- Lymph node involvement
- Hormone receptor levels
- Presence of HER2/neu
- Recurrance- if you have 0 nodes, 10% chance of recurrance, 1-3 nodes 12-20% chance of recurrance, 4-9 nodes 30-35%, >10 nodes greater than 50%
Medical & Surgical Management of breast cancer
- Radiation – bathe with mild soap, no tight clothes, nothing on the skin, can shrink the tumor so it is easier to get in surgery
- Chemotherapy- depend on whether she is pre or post menopausal
- Hormonal Therapy- depend on whether she is pre or post menopausal (Withdrawal)
- Targeted Therapy
- Drug
- Rehabilitation
Breast-conserving surgery (lumpectomy, wide excision of the tumor, partial mastectomy, segmental mastectomy)
- Done with radiation
Simple Mastectomy: Remove the breast
Modified Radical Mastectomy: Taking breast and nodes
Bone marrow suppression: Tired
Radical Mastectomy: Breast, nodes, chest muscle
Surgery/Reconstructive
- Prosthetics, Dressings- several hemavacs, suction devices
- Sometimes do it right away, sometmes wait until later
- Will go home with drains- need to watch for large amount of blood
- Need to turn, cough, deep breathe
Nursing Management
Relieving pain and discomfort Maintaining skin integrity Promoting positive body image Promoting positive adjustment and coping Rehabilitation Potential Complications - Lymphedema- swelling of the arms - Hematoma- can turn into an absess
Teach
See the Provider When: Lump in or near breast or underarm Thick or firm tissue in or near breast or underarm Nipple discharge or tenderness Inverted nipple Itching or skin changes – reddness, scales, dimple or pucker Change is size or shape Do self breast exam after period
If notice a lump on one side, check the other side and if the same probably OK
Men
Gynecomastia
Male Breast Cancer
- Less than 1% of all breast CA
- Ages 60-70
At Risk:
Radiation
Estrogen administration
Diseases associated with hyperestrogenism i.e. cirrhosis, Kleinfelters
Familial tendencies i.e. sisters, aunts etc.
BRCA2 mutation
Types: Infiltrating ductal = most common Intraductal Infammatory Pagets Lobular
Staging - Same as female – usually diagnosed later but prognosis the same
