BreastCancer

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NurseFaith
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285983
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BreastCancer
Updated:
2014-10-16 11:44:44
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Breast Cancer
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Breast Cancer
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  1. BREAST CANCER
    •The most common malignancy in women (except skin cancer)

    •Second only to lung cancer as leading cause of death

    •Can also occur in men (2,000 cases every year)

    •Currently 2.5 million women in the US have survived breast cancer

    •5 year survival rate in women with localized breast cancer and no node involvement is 98%!

    •Mutations in the BRCA1 gene may cause as many as 10-40%

    • •Most arise from the epithelial lining of the milk ducts.  May be “in situ” (just inside the
    • duct) or invasive (grown through the duct and into tissue)
  2. Risk factors for Breast Cancer
    • Family history,
    • Estrogen
    • Obesity,
    • Sendentery life style,
    • Increasing age,
    • Hormone replacement with just estrogen
  3. How is breast cancer dx:
    • •Lump or abnormality on mammogram.  Most often the cancer is in the upper outer quadrant of the breast. If palpable, usually hard and may be irregularly shaped, poorly delineated, non-mobile and
    • non-tender

    •Diagnosed with mammogram, ultrasound or CT or MRI of the breast to see lymph nodes and possible metastases
  4. Most Important Prognostic Factor of Breast Cancer
    lymph node involvement
  5. Biopsy of the breast cancer will determine:
    The grade of the cancer and if cells are hormone sensitive or not
  6. Treatment of Breast Cancer
    •Survival rates are about the same for modified radical mastectomy or lumpectomy with radiation

    Lumpectomy= removal of entire tumor along with margin of normal surrounding tissue (radiation to entire breast)

    Mastectomy= removal of the breast and axillary nodes but preservation of pectoralis major muscle (done if tumor is large)

    •In surgery, the sentinel lymph node is removed and pathologist looks at it while the patient is in the OR.  If cancer cells are present, then 12-20 axillary nodes are removed
  7. Accumulation of lymph fluid in soft tissues...can result from excision of lymph nodes
    Lymphedema

    • •When axillary nodes cannot return lymph fluid to the central circulation, fluid accumulates in the arm, causing obstructive pressure on the veins and venous return (swelling, heaviness, pain, impaired motor
    • function, numbness in fingers and hand)
  8. S/S of lymphedema
    Swelling, Heaviness, Pain, Impaired Motor Function, Numbness in fingers and hand
  9. Removal of the entire tumor along with a
    margin of normal surrounding tissue.  Radiation to the entire breast with a boost to the tumor bed
    Lumpectomy
  10. Removal of the breast and axillary nodes but preserves the pectoralis major muscle. Done if the tumor is too large to excise with
    good margins
    Mastectomy
  11. Women with hx of breastcancer will have to have followup mammograms how often?
    Monthly BSE and lifetime follow up with mammograms
  12. Hormone therapy for breast cancer (if cancer cells are estrogen receptor positive)...can block source of estrogen and promote tumor regression
    Nolvadex
  13. Biologic and Targeted therapy of Breastcancer...attaches to antigens in breast cancer cells and is taken into the cells and eventually kills them
    Avastin (angiogenesis inhibitor)
  14. Nursing care after breast surgery:
    Pain management-- most pain from lymph node removal

    J-P tubes left in place

    *Restoring affected arm to full function (to prevent contractures and muscle shortening as well as lymphatic stagnation)

    Flex arm on a pillow to provide elevation

    Begin wiggling fingers, moving wrist and elbow slightly even in PACU

    Progressive increases in activity and exercises (but give pain meds 30 min prior!) 

    ***GOAL is full ROM within 4-6 weeks
  15. Prevention of Lymphedema:
    Never leave arm dependent (prop even when sleeping

    No BP or venipuncture or injections in affected arm

    Instruct to protect arm from even minor injury

    Decongestive therapy with massage may be done if lymphedema is severe

    Jobst stocking type sleeve may be worn for compression
  16. Breast cancer develops in ____% of women
    12
  17. Risk factors for breast cancer:
    Risk increases as you age

    5-10% hereditary (genetic mutation), multiple first-degree relatives with early onset

    Birth Control/Hormonal therapy

    Early Menstrual Cycle (before 12)

    Dense breast tissue- more fibrous, less fat

    Greater death rates in African American

    Greater death rates are attributed to later stage and poorer areas
  18. Types of Breast Cancer
    Ductal Carcinoma in Situ (DCIS)-- inside milk ducts without invading surrounding tissue

    • Invasive Cancers:
    • žInfiltrating Ductal Carcinoma (Most common)= tumor arises from the duct system and invades surrounding tissues.

    žInfiltrating Lobular Carcinoma= Tumor arises from the lobular epithelium...thickening in the breast.

    žMedullary Carcinoma= Often in women < 50yrs old; tumor encapsulated in duct.

    Mucinous Carcinoma= Often in postmenopausal women > 75yrs.

    Tubular Ductal Carcinoma

    Inflammatory Carcinoma

    Paget's Disease
  19. Most Common Invasive Breast Cancer (80%): (tumor arises from duct system and invades surrounding tissues)
    Infiltrating Ductal Carcinoma
  20. Invasive cancer that arises from lobular epithelium, leading to thickening in the breast
    Infiltrating Lobular Carcinoma (10-15%)
  21. Invasive Cancer that occurs in women <50...tumor is encapsulated in the duct (favorable prognosis)
    Medullary Carcinoma
  22. Invasive cancer often in postmenopausal women (<75 yrs)...slow growing (more favorable than others)
    Mucinous Carcinoma
  23. Invasive cancer where axillary metastases is very uncommon...usually excellent prognosis
    Tubular Ductal Carcinoma
  24. Invasive cancer that is rare and aggressive...with diffuse edema and "orange peel" skin
    Inflammatory Carcinoma
  25. Invasive cancer that shows as scaly, erythematous, pruritic lesion of the nipple...often represents DCIS of the nipple but may be invasive
    Paget's Disease (2% of dx cases favorable if no lump felt)
  26. Clinical Manifestations of Breast Cancer:
    Lump usually in upper outer quadrant (non-tender, fixed, hard and irregular)

    Benign breast disease (diffuse breast pain and tenderness with menstruation)

    Advanced disease symptoms: skin dimpling, nipple retraction, skin ulceration
  27. Assessing/Dx Breast Cancer:
    • Biopsy
    • Chest Xray
    • CT
    • MRI
    • PET
    • Bone scans
    • Blood work (CBC, CMP, tumor markers)
  28. Modified Radical Mastectomy
    Treatment for invasive breast cancer

    Removal of breast tissue with nipple and areola

    Portion of axillary lymph node removed in axillary lymph node dissection (ALND)
  29. Total Mastectomy
    • May be performed as prophylactic measure
    • Treatment for noninvasive breast cancer
    • Breast tissue removed with nipple and areola
    • No lymph node removal
    • May be done in conjunction with sentinel lymph node biopsy (SLNB)
  30. Breast Conservation Treatment:
    Lumpectomy, wide excision, partial or segmental mastectomy, quadrantectomy

    Complete removal of tumor with clear margins while preserving the breast

    Treatment of both invasive and non-invasive cancers
  31. SLNB (sentinel lymph node biopsy)
    • First node in lymphatic basin
    • Node identified with radioisotope dye
  32. Post-Op Complications for Breast Surgery
    • Lymphedema
    • Limited arm mobility
    • Seroma or hematoma formation (12 hrs after surgery...compression wraps!)
    • Altered sensations
  33. Post-Op Exercises to teach pt after surgery
    • Shoulder external rotation/abduction
    • Should internal rotation
    • Diagonal wall climbing
    • Pectoral stretch

    *hold each 5-10 sec, do 10 reps 1-2 times day
  34. Do not use a heating pad on affected breast/extremity due to:
    altered sensations
  35. Axillary Lymph Node Dissection PostOp Arm/Hand Care:
    • Avoid BPs/sticks in affected arm
    • Use sunscreen/insect repellants
    • Wear gloves when gardening
    • Wear cooking mitts
    • Avoid cutting cuticles (push back instead)
    • Use elctric razor for armpits
    • Avoid lifting >5-10lbs
    • Immediate attention to trauma/breaks in skin
  36. JP drainage care:
    • Empty and Measure fluid
    • Milk clots through the tubing
    • Report observations to physician/nurse (sudden change in drainage/color)
    • Care of insertion sites per MD order
    • Identify readiness for removal (Output <30ml for 24hrs)
  37. Hormonal Therapy Drugs:
    • Tamoxifen
    • Anastrolzole
    • Letrozole
    • Exemestane
  38. S/E of Hormonal Therapy
    • Hot flashes
    • Vag dryness
    • N/V
    • Musculoskeletal sx
    • Risk of endometrial cancer
    • Risk for clots
    • Risk for osteoporosis/fractures
  39. Preventative Strategies:
    • MRI
    • Mammogram-- yearly
    • Clinical Breast exams-- twice a year

    Evista (chemoprevention)

    Prophylactic mastectomy

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