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Flashcards in breast cancer Deck (37):
1

age

1. Increased number of mutagenic changes over a long lifespan
2. Increased number of older women

2

familial history

Accounts for 5-10% of cases (BRCA I & BRCA II genes)
Earlier onset than non-inherited breast cancer

3

Gender

1. 99% of cases are women
2. 1% of cases are men

4

Menstrual history

1. Early menarche, late menopause
2. Nulliparous or 1st child after age 30
(Earlier breast development with pregnancy protects from cancer)

5

hormone therapy

Menopausal Hormone Therapy (MHT) following menopause shows slight increases risk for reproductive cancers (breast cancer) and CAD

6

obesity

1. Especially after menopause
2. Can cause stimulating effect on breast cancer growth (estrogen stored in adipose tissue)

7

radiation exposure

Survivors of Hiroshima show increased cancers, including breast

8

previous risk of breast cancer

Increased risk of cancers in the opposite breast

9

Benign breast disease

Fibrocystic disease NOT associated with breast cancer

10

epidemiology

Most Common Cancer in Women: Accounts for about 1/3 of all cancers in women; Approx. 1 in 8 chance of developing
Worldwide problem: Highest in US, Western Europe
Incidence rates have increased since 1980s, while deaths have decreased
Breast Cancer in Blacks: Often diagnosed later, poorer survival rates

11

prognostic indicators

Staging: according to TNM
Tumor size: 2 cm or less without nodes has best prognosis
Increased axillary node involvement increases risk of distant metastases
Cell Activity:
Fraction of tumor cells in synthesis phase: fast growing with poorer prognosis
Improved prognosis if 10 or more receptors on cell for estrogen (ER+) or progesterone (PR+)
These tumors respond to hormonal manipulation

12

breast comprised of

Ducts (milk producing glands)
Lobules (milk passageways)
Stroma: Fatty tissues and ligaments

13

carcinomas

Tumors arise in ductal or lobular tissue

14

carcinoma in situ

When confined to lobule or duct

15

DCIS Ductal carcinoma in situ

most common
Pre-cancerous
Found on mammogram
Non invasive

16

breast cancer can be divided into 4 quadrants

Upper outer quadrant most common site for cancer

17

clinical manifestations
malignant

1. Shape more difficult to define
2. Less mobile (becomes fixed to chest wall)
3. Can cause retraction and dimpling

18

clinical manifestations
benign

1. Well defined edges
2. Encapsulated
3. Freely moveable

19

characteristics of nipples

pain, scaly-ness ulceration, retraction/deviation at odd angle, or spontaneous discharge

20

dimpling of skin

Peau d’orange appearance

21

lump

irregular, star shaped
often not tender

22

mammography

1. Can detect breast cancers before they are palpable
2. Cannot always differentiate malignant from benign
3. Not 100% guarantee

23

clinical breast exam

ACS (American Cancer Society) recommends annual mammogram and clinical breast exam for women past age 40yrs.

24

breast ultrasound

Can determine size, differentiate fluid filled cyst from solid lesion

25

breast biopsies

Fine needle aspiration: cysts vs. solid tumors
Core biopsy: takes tissue sample
Incisional removes some of tumor
Excisional removes all of tumor

26

diagnostics to determine metastasis

1. Bone Scan
2. Bone Marrow Biopsy
3. Liver Scan
4. CXR- chest x-ray
5. Other

27

surgical removal is the mainstay

Localized disease: lumpectomy with removal of tumor and margin of tissue; separate incision to determine nodal involvement

28

sentinel node biopsy

inject radioactive dye or blue dye near tumor; identify first node or “sentinel” node to contain dye
- Fewer nodes removed for pathology

29

mastectomy

Simple: removal of breast
Modified radical: removal of breast and lymph nodes
Radical: removal of breast, nodes, and muscle

30

postoperative care

1. Arm on affected side: movement limited for 24 hours; Hand exercises may be started
2. Elevate arm on affected side- to promote venous return
3. Jackson Pratt drain may be placed if lymph nodes or tissue removed
4. TEACH: no BPs, injections, watches, lifting on affected side
5. Avoid burns, injuries to affected side- trauma wont drain well
RATIONALE: avoid trauma that may lead to infection when lymph removed

31

lymphedema

1. Lymph system is a one way vascular system to drain interstitial tissue fluid back to venous system
2. Occurs with increased removal of nodes/tissues

32

radiation

1. Standard use following lumpectomy (5-6 weeks) to irradiate any remaining cells
2. May be used pre-op for large tumors
3. Requires close follow-up
4. SE: redness, dryness, itching, edema, tenderness, and fatigue (bone marrow suppression)

33

hormonal therapy

1. Competes for estradiol binding sites on ER+ cells
2. Greatest benefit in women past age 50
3. Decreases recurrence rate

34

hormonal therapy side effects

1. Hot flashes
2. Nausea
3. Fluid Retention
4. Vaginal Discharge
5. Increased risk of endometrial cancer
6. Amenorrhea

35

area of metastases

1. Bone
2. Lung
3. Liver
4. Brain

36

treatment for advanced disease

Palliative Radiation for areas of metastases

37

Recurrence of breast cancer

1. Usually within 2-8 years
2. The earlier the recurrence, the graver the prognosis