Breast Cancer

Question 1

Anatomy of the Breast/Breast Tissue

Answer 1

Lymph Nodes

Question 2

Benign Breast Disorders

↠ Breast infections: mastitis/breast abscess

↠ Fibroadenoma

↠ Fibrocystic

Answer 2

↠ Ductal ectasia

↠ Intraductal papilloma

↠ Gynecomastia

Question 3

Mastitis/abscess

• Most lumps completely benign & caused by variety of conditions
• Is an inflammatory condition of the breast that occurs most freq in lactating women
  > Breasts are not completely emptying during breastfeeding; milk becomes stagnant & infected

Question 4

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• Most common in teens & through 30’s
• Is a benign lump of connective tissue; lumpy breasts
• Can occur anywhere on & vary in size
• Solid, slowly enlarging, benign masses
• Round, firm, easily movable, non-tender & clearly delineated from surrounding tissue

Answer 4

fibroadenoma

Question 5

Fibrocystic breast disorders

• Common; in women 20-50 y.o.
• Usually pre-menopausal; thought to be an imbalance b/t norm estrogen/progesterone ratio
• Breast pain; tender lumps; or areas of thickening; in UOQ
  > Menstrual cycle changes can inc sx’s; sx’s dec >menses & esp menopause

Answer 5

• Treat = heat; dec caffeine; oral contraceptives may be helpful

Question 6

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Is usually seen in women approaching menopause

Duct in the breast becomes clogged, dilated, inflamed
May be some nipple d/c & usually warm compresses if needed & abx help

Answer 6

Ductal ectasia

Question 7

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Is a benign breast problem of women approaching menopause

Mass that’s hard w/irregular borders & tender to touch
May have some nipple d/c & some enlarged axillary nodes & edema
Usually just a duct that’s blocked
- Warm compresses & abx

Answer 7

Ductus stasis

Question 8

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Is inappropriate lactation from someone who’s not breastfeeding, not pregnant, not postpartum
- Can be clear or milky; may be bloody
- Usually by a hormonal disruption of some sort
* Reglan has a s/e of this (↑)

Answer 8

Galactorrhea

Question 9

Reglan (metoclopramide)

• Dopamine antagonist
• anti-emetic & gut motility stimulator

Answer 9

• Treat GERD
• Treat gastroparesis in DM pts

Question 10

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Is a wort-like growth found in the mamillary ducts; is a benign tumor
- Women 40-55 y.o.
- May have bloody or serous d/c from nipple
- Usually can’t palpate any masses w/this

Answer 10

Intraductal papilloma

Question 11

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Occurs in perimenopausal women
Is just a mass in the duct; is benign but may need surgical intervention to remove if causing problems

Answer 11

Aductal papilloma

Question 12

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Is inappropriate breast development in males; a benign cond of breast enlargement
- Bilateral; in adolescent or elderly men d/t lack of muscle & inc fat
- d/t physiological, age-dependent, obesity, hepatic failure, hyperthyroidism, (testicular) tumors, cancer, rx’s (i.e., estrogen)
> Correct the underlying problem

Answer 12

Gynecomastia

Question 13

Fibrocystic Collaborative Management

↠ Hormonal management
↠ Vitamins C, E, & B-complex
↠ Diuretics (provide relief of breast swelling <menses)
↠ ? avoidance of caffeine/reduction of dietary fat

Answer 13

↠ Mild analgesics (e.g., NSAIDs, ibuprofen, naproxen)
↠ Limiting salt intake
↠ Well padded supportive bra
↠ Heat/ice

Question 14

Breast Cancer Risk Factors

• Female
• Increasing age
  > Beginning menopause @ an older age
• Hormonal
  > Beginning your period @ a younger age (<12)
• Late or no pregnancies
  > 1st child >30 y.o.
• HRT
  > May affect the estrogen-progesterone balance

Answer 14

• Personal & family hx
  > LCIS; atypical hyperplasia of the breast
  > A majority of ppl dx’d w/breast ca have no family hx
• Genetic mutations (BRCA-1 & BRCA-2)
• Exposure to ionizing radiation
• Obesity/inactivity
• Alcohol intake

Question 15

Health Promotion

• Decrease alcohol consumption
• Exercise
• Decrease fat intake

Answer 15

• Ideal weight
• Breast self-exam (BSE)
• Mammogram
• Clinical breast exam

Question 16

BSE

• Provide teaching
• Best performed 5-7 days >1st day of menses or once monthly for postmenopausal women

Answer 16

• Review the feel of the normal breast tissue & identify changes
• Routine BSE helps pts become familiar with their own “normal”

Question 17

Mammogram

• The ACS still recommends that women 40-44 should have the choice whether or not to have a mammogram

Answer 17

• All women should be familiar w/the known benefits, limitations, & potential harm linked to breast ca screening

Question 18

Women __ and older should switch to mammograms q2yr, or can continue yearly screening

Screening should continue as long as woman is in good health & is expected to live 10 yrs+

Answer 18

55

Question 19

Women age __ to __ should get mammograms every yr

Answer 19

45-54

Question 20

Breast Cancer

Relevant Cues
> Presence of a new mass or lump

Management/Take Action
> Diagnostic tests incl mammography, US, MRI, biopsy
> Lab data incl a CBC w/plt, LFTs, & cxr

Answer 20

Treatment
> Surgery, chemotherapy, & radiation

Surgery alternatives
> Breast conservation therapy (lumpectomy), or total mastectomy

Treatments for in situ lesions
> Lobular carcinoma in situ is not considered invasive but does inc chances of developing invasive breast ca; surgery may be an option
> Ductal carcinoma in situ (DCIS) has surgical treatment

Question 21

Pathophysiology

• Cells can invade nearby tissues & spread to other areas through the bloodstream & lymphatic system
• Breast ca can be divided into a series of categories r/t size, spread to lymph nodes, & distant spread of breast tumor to oth tissues (metastasis)

Answer 21

• 1st category incl in situ lesions of ductal carcinoma in situ (DCIS) & lobular carcinoma in situ (LCIS)

Question 22

Clinical Manifestations/Relevant Cues

↠ Cancerous masses are typically hard, irregular, & painless but may be soft or rounded & tender

↠ Are sometimes changes in the breast shape or swelling

↠ Skin changes like peeling, flaking, pitting, dimpling, or redness

Answer 22

↠ May be nipple changes like inversion, thickening of tissue, or drainage

Question 23

Management/Take Action

☀ A baseline bone scan & liver scan may be obtained if pt is found to have skeletal sx’s or abn LFT’s

☀ CT of abdomen & bone scan also

Question 24

Taking Actions

Treatment
> Surgery, chemotherapy, & radiation

Surgery alternatives
> Breast conservation therapy (lumpectomy), or total mastectomy

Answer 24

Treatment for in situ lesions

Question 25

___ requires surgical treatment Lesions thought to be large (>4 cm) require mastectomy

Answer 25

Ductal carcinoma in situ (DCIS)

Question 26

___ is another type of noninvasive dz Cells look like ca cells & are contained within the lobules (milk-producing glands) of the breast This is not considered ca but does inc the pt's risk for developing invasive breast ca Usually dx'd

Answer 26

LCIS

Question 27

* Treatment for intermediate-stage & advanced-stage cancers (operable) > Preoperative neoadjuvant chemo - 1st line of treatment unless pt has underlying comorbids that preclude use of chemo

Answer 27

When treatment is given

Question 28

* Treatment for locally adv/inoperable cancers > Neoadjuvant chemo & possible radical mastectomy

Question 29

* Treatment for local recurrence & systemic metastases > Tumor not initially operable, chemo considered

Answer 29

> When work-up demonstrates that recurrence of tumor is confined to breast alone, a course of curative therapy is started > For pts that've undergone initial breast conservation therapy, a complete mastectomy is next step. If tumor isn't initially operable, chemo may be considered

Question 30

Breast Cancer in Men > 1% > Hard, painless subareolar mass > Usually found @ a later stage than women (poorer prognosis)

Answer 30

Common Sites of Metastasis * Bone (spinal cord, skeleton, ribs) * Brain (HA, sensory loss, seizures, hemiparesis) * Lung (sob, tachycardia, non-productive cough) * Liver (jaundice, pain) * Bone marrow (anemia, infection, bleeding)

Question 31

Relevant Cues: S/S * Lump (single, firm, painless) * Nipple d/c * Dimpling * Nipple retraction * Induration * Edema, erythema

Answer 31

Staging * Tumor is staged according to extent of what's happening; permits an accurate definition of dz extent; allows for more acc prognosis ? extends to chest wall or skin ? any axillary or lymph node involvements ? fixed or mobile ? has metastasized

Question 32

Stage ___ ductal carcinoma in situ (DCIS), or the lobular carcinoma in situ (LCIS)

Answer 32

0

Question 33

Stage __ and __ Is the extent of spread to lymph/axillary nodes

Answer 33

2, 3

Question 34

Stage ___ 2cm or less, no lymph involvement, no metastasis

Answer 34

1

Question 35

Stage ____ Tumor of any size w/direct extension to chest wall or skin & w/distant metastasis

Answer 35

4

Question 36

Surgical Therapy * Breast conservation * Mastectomy

Answer 36

↠ Lumpectomy vs mastectomy will depend on not only tumor size & node involvement but MD & pt preference ↠ Breast conservation, preservation will make a wide excision of tumor & lymph node dissection; may be used w/radiation therapy > For when you want to preserve as much breast tissue as possible (stages 1 & 2) > Contraindicated in those w/an intolerance to radiation, pregnancy, or pre-existing rheumatic disorders like lupus or arthritis S/e = breast pain, soreness, edema, skin reactions, arm swelling, sensory changes in breast & arm, fatigue, hematomas, infection, impaired mobility & prolonged treatment

Question 37

Mastectomies can be radical, simple, or modified radical

Question 38

Preoperative Nursing Diagnosis * Deficient knowledge * Anxiety/Fear * Risk for ineffective coping

Question 39

Preoperative Interventions * Review & reinforce info on treatment options * Prepare pt regarding what to expect before, during, & >surgery * Inform pt regarding surgical drains, arm/shoulder mobility, & ROM exercises * Maintain open communication

Answer 39

* Provide pt w/realistic expectations * Support coping * Involve or provide info for supportive services & resources * Support pt decisions

Question 40

Postoperative Nursing Diagnoses * Disturbed body image * Impaired skin integrity * Pain

Answer 40

* Deficient knowledge * Risk for injury * Self-care deficit - Breast prostheses

Question 41

Postoperative Interventions * Teaching is very important * Inform pt re: common postop sensations * Maintain privacy * Provide info * Support, coping & adjustment * Provide counseling & referral * Monitor for potential complications

Answer 41

Postoperative Care * Avoidance of using the affected arm for BP management, giving inj or drawing of blood * Careful monitoring of VS * Comfort measures * Mobility & diet * Breast reconstruction * Care of drainage tubes

Question 42

Nursing Diagnoses ↠ Acute pain r/t surgical procedure ↠ Anxiety r/t situational crisis & unpredictable outcome ↠ Disturbed body image r/t perceived effects of mastectomy ↠ Impaired physical mobility r/t weakness & muscle loss ↠ Ineffective therapeutic regimen management r/t lack of knowledge re: dz

Answer 42

Evaluating Outcomes ↠ Survival ↠ Prolonging life ↠ Eliminating or limiting chemo & radiation s/e ↠ Wound healing ↠ Absence of infection ↠ Emotional stability ↠ Support systems