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Flashcards in Women's Health Deck (11):
1

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

2

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

3

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

4

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

5

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

6

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

7

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%

8

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

9

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

10

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

11

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