Week Six Flashcards
What are risk factors for breast cancer?
- Gender
- Increasing age = >50 years
- Exposure to chest radiation at a young age
- Smoking
- Personal or family history of breast cancer
- History of benign breast disease
- Hormonal influences that promote breast maturation (HRT)
What should you watch out for breast cancer?
- A lump or mammographic abnormality in the breast, most often in the upper, outer quadrant of the breast
- If palpable, usually hard and may be irregularly shaped, poorly delineated, non-mobile and non-tender
- Presence of mastalgia
- Nipple changes or discharge
- Inflammatory breast cancer may make the breast look red, warm and gives it a thickened appearance
- Breast develops ridges and small bumps that look like hives
- Strong family history of breast Ca
What are indications for a referral for breast cancer?
- Distinct breast mass
- Persisting asymmetrical breast nodularity
- Nipple discharge, particularly if over 50 years old
- Severe mastalgia (becoming increasing noted as an independent risk factor)
- Nipple changes
- Strong family history of breast or ovarian cancer
What occurs after a breast cancer referral?
- Clinical assessment (medical history, risk factors and physical examination)
- Radiology (ultrasound +/- mammography)
- Pathology (fine needle aspiration cytology (FNA); core biopsy or open surgical biopsy are sometimes required)
What are the grades for tumour?
- Grade 1: Well differentiated
- Grade 2: Moderately differentiated
- Grade 3: Poorly to very poorly differentiated
- Grade 4: Very poorly differentiated
What is nursing management for the peri-diagnosis phase?
Assess the client concerning:
- Coping with her need for the procedure
- Ability to process information about the procedure
- The possible implications of the results
- Anxiety and fear level
- Psychosocial support
- Knowledge about the diagnosis and treatment options
- Fear of any adverse effects of treatment
What are nursing diagnoses for breast cancer?
- Risk for ineffective coping r/t ….
- Anxiety r/t…
- Fear r/t …
- Deficient knowledge about: e.g. procedure/diagnosis of breast conditions/treatment options
- Acute pain r/t…
- Impaired skin integrity r/t…
- Risk for infection r/t….
- Risk for impaired adjustment r/t…
- Deficient knowledge about pain management, exercises, complications, etc
What is treatment for breast cancer?
- Surgery
- Chemotherapy
- Radiation therapy
- Hormonal therapy (Tamoxifen)
- Herceptin
- Antiglycolytic therapy
What is the first option treatment for breast cancer?
Surgery:
- Total mastectomy and axillary clearance
- Partial mastectomy, axillary clearance and radiotherapy (breast conservation treatment)
- Sentinel node biopsy helps decide if axillary dissection may be avoided
What consists of breast reconstruction following a mastectomy?
- Transverse rectus abdominis myocutaneous flap (TRAM flap)
- Latissimus dorsi flap
- Expandable prosthesis
- Breast prosthesis
What is nursing care following breast surgery?
- Pain management
- Wound care (flap care, infection)
- Lymphoedema
- Impaired body image
- Risk for developing post-operative complications
What is adjuvant therapy?
- Radiotherapy (DCIS after excision)
- Hormone/Endocrine Therapy:
1. Aromatase inhibitor
2. Tamoxifen
What does an aromatase inhibitor do?
Stop the male hormone to turn into oestrogen
What does Tamoxifen do?
Block estrogen, hormone therapy
What are types of chemotherapy?
- Systemic therapy
- Monoclonal antibodies/Immune Therapy
What is an example of systemic therapy?
- Taxane: Paclitaxel (Taxol);
- Docetaxel (Taxotere)
What is an example of Monoclonal antibodies / Immune Therapy?
Trastuzumab: Herceptin – binding to HER2 protein
What is nursing management for the peri-treatment phase?
Nursing assessment: - History taking - Physical discomfort - Self-care ability - Psychosocial aspects - Supportive care Nursing diagnoses: - Physiological concerns as a result of treatment - Psychosocial and emotional needs - Functional impairment
What can go wrong with the prostate?
- Non cancerous enlargement (BPH)
- An inflammation or Infection (Prostatitis)
- Prostate Cancer
What are symptoms of prostate problems?
- Needing to urinate more often, especially at night
- Needing to rush to the toilet
- Difficulty starting to pass urine
- Straining or taking a long time to finish passing urine
- A weaker flow
- A feeling that the bladder has not emptied properly
- Dribbling urine
- Pain when passing urine or with ejaculation
- Blood in semen (rare)
Why are symptoms a poor indicator of cancer?
80% of cancers are found in the peripheral zone, away from the urethra
What are predisposing factors for prostate cancer?
- Age
- Family history
- Ethnicity
What are benefits of prostate cancer testing?
- Men can be reassured prostate cancer is unlikely to be present if PSA and DRE normal
- If testing indicates that cancer is present it is likely to be early stage, meaning chance of cure is greater
- If a man is found to have localised, low risk prostate cancer he has the option of entering an active surveillance programme
What are risks of prostate cancer testing?
- PSA and DRE testing can produce false positives due to calcifications on the prostate, prostatitis, UTI, BPH, recent ejaculation and cycling
- PSA testing can also produce false negatives when the prostate cancer releases no or low PSA
What are risks of prostate biopsy?
- False negatives
- Infection / sepsis
- Transient haematuria
- Transient haematospermia
What does an abnormal PSA test indicate?
Does not confirm prostate cancer, it merely means further diagnostic testing is required
What are risks of curative treatments for prostate cancer?
- All curative treatments have a risk of ED
- Prostatectomy also carries risk of incontinence
- External Beam Radiotherapy carries risk of rectal bleeding, LUTS and radiation induced second malignancy (1-3%)
- The incidence and degree of these treatment side effects are affected by co-morbidities including diabetes, obesity, respiratory problems and cardiovascular disease
What is screening for prostate cancer?
- Digital Rectal Examination (DRE)
- PSA Blood Test
What is Digital Rectal Examination (DRE)?
- Sensitivity ~ 60%; i.e. negative DRE does not exclude cancer, positive DRE does not confirm cancer
- Abnormal DRE requires referral to urology (nodule/ asymmetry) regardless of PSA
What is PSA blood test?
PSA is:
- Produced only by epithelial cells in the prostate gland
- Appears to have a role in liquifying semen
- An imperfect screening test
Why is PSA an imperfect screening test?
- Significant biological ‘daily’ variation
- Other causes of transient elevation (prostatitis, UTI, IDC, infarct, BPH, ejaculation)
What is the criteria for PSA results needing investigation?
- Men aged below 70 years with a score greater than 4.0
- Men aged 71-75 years with a score greater than 10.0
- Men aged greater than 76 years with a score greater than 20.0
