boobs - 1247

DO

(do/not)s of lymphedema insect repellant gloves when gardening cooking mitt clean and dry electric razor

measures to decrease lymphedema:

*Semi-fowlers position with arm on affected side elevated on a pillow, never dependent. *Isometric exercises. exercises are to prevent contractions and muscle shortening, maintain tone and improve circulation

Hormonal therapy- Aromatase inhibitors

*intervenes w/aromatase, an enzyme needed for synthesis of estrogen *used in post menopause women *more effective that tamoxifen in preventing breast cancer recurrence

Radiation therapy

*primary radiation therapy -usually preformed after local excision of breast mass -breast is radiated daily over ~5 to 6 weeks -"boost" tx may be given to full breast following primary dose *intraoperative radiation therapy -single intense dose delivered to surgery site in the operating room

Hormonal therapy- estrogen receptor blocker

*removes or blocks source of estrogen, reducing estrogen available for tumor, promoting rumor regimen

Palliative radiation therapy

*used to stabilize symptomatic metastatic sessions in such sites as; bone, soft tissue, brain, chest *releves pain *successful in controlling recurrent or metastatic disease for long periods

complications of breast reconstruction:

-Capsular formation; part of bodies natural defense mechanism to form a fibrous capsule around the implant -Infection -Hematoma -Skin ulceration -hypertropic scar formation

S&S of breast cancer

-detected as a lump -Abnormality on mammography -If palpable, irregular shaped, poor delineated, nonmotile and tender -may have nipple discharge -nipple retraction -dimpling

Estrogen and progesterone receptor sites

-helpful in deciding about tx and prognosis

Cell-proliferatiovie indicates

-indirectly measure the rate of tumor cell proliferation -% of tumor cells in the synthesis phase of the cells cycle is important for proliferation -pts w/cells that have high s-phase have increased risk for recurrence and early cancer death

Breast conservation therapy

-involves removal of entire tumor wit a margin of normal tissue -Radiation therapy is delivered to a boost to tumor bed -evidence of systemic disease ma warrant chemotherapy before radiation

diet and pt teaching about breast lumps

-low salt & fat -no chocolate or caffeine reduction of chocolate and caffeine can reduce cystic pain

Surgical Therapy

-most common option for respectable breast cancer -breast conservation surgery with radiation therapy -modified radical mastectomy with or w/o reconstruction

Changes in breast S&S

-palpable lumps that are round, well-delineated and freely movable -Lumps increase in size premenstrual -tenderness -pain -nipple discharge-rare

Breast diseases dx

-ultrsound -biopsy; fine needle aspiration/excisional

Chemotherapy

-use of cytotoxic drugs to destroy cancer cells -BC is one of the solid tumors that is most responsive to chemotherapy -give preoperatively in some patients to decrease size of primary tumor

which 2 stages use a conservative surgical therapy.

1,2 usually chemo and radiation will be admin before, during and after.

Risk factor of BRCA gene

BRCA 1 & BRCA 2 are human gene that belong to a class of gene known as tumor suppressors -the normal BRCA1 &2 help ensure the stability of cell's genetic material (DNA) and help prevent uncontrolled cell growth -Mutation of these genes has been linked to development of hereditary breast and ovarian cancer -a woman's lifetime risk of developing breast and/or ovarian cancer is greatly increased of she inherits a harmful mutation in BRCA 1 & 2.

Definitive dx for Fibroadenomas requires

FNA, core, or surgical biopsy and tissue examination

self breast exams should be performed _______________________.

Monthly right after menses when no tenderness. or first of the month is no menses.

Does having a fibrocystic breast condition increase a women's risk for development of breast cancer?

No, fibrocystic changes ALONE are not associated with breast cancer..

Immunotherapy and target therapy

Perception is a monoclonal antibody to HER-2 *once the antibody attaches, it is taken to cells and eventually kills them *it can be used alone or in combination with other chemotherapies *SEventricular dysfunction and congenital HF

Sediment Lymph node dissection- lymphatic mapping and sentinel lymph node dissection (what is the abbreviation)

SLND is used to diagnose breast cancer. blue dye is used. -help surgeon identify lymph nodes that drain first from tumor site -Radioistope and/or blued dye is injected into tumor -Lymph nodes dissected and sent to lab for analysis -if negative, no further axillary surgery is needed -if positive, a complete ALND may be done

patient with co-existing conditions may not be a candidate for

Surgery

HER-2 receptor

a prognosis indicator -it is present in healthy and cancer cells but tumor cells have more than normal -overexpossion is associated with usually aggressive tumor growth, greater risk for recurrence, and poor prognosis

genetic assay

are factors that influence prognosis (HER)

mammograms

are not used to determine fibrocystic changes because it only shows up as dense masses. not definitive some women breast is so dense that it is difficult to obtain a good scan

additional measure to decrease lymphedema:

avoid constriction -no BP or restrictive clothing or blood draws -compression, wrap arm distal to proximal -massage therapy -diuretics

fibroadenoma

benign breast lump 15-40 yo women may indicate increase sensitivity to estrogen diagnostic: US or biopsy fine needle aspiration or excision pt. teachings: wear supportive bra diet: low salt, no chocolate, cola, caffeine meds: antiestrogen, diuretics, analgesics annual visits and monthly SBE

fibroadenoma or fibrocystic changes does not increase..

chances of breast cancer

radiation S&S

fatigue skin changes breast edema bodily fluids not radioactive but maintain distance

breast cancer risk factors

female >50yo family hx obesity hormonal factors (post menopause, no preg, first child after 30. high fat diet alcohol radiation exposure mutated BRCA GENEs (1&2)

ongoing survivorship care involves:

follow up exam q3-6months for first 5 years monthly BSE reporting changes images routinely done

HER2 negative

good prognosis

complications of lymphedema

heaviness pain impaired motor function in arm numbness paresthesia of the fingers cellulitis and progressive fibrosis

Fibrocystic Breast Disease is caused by?

high estrogen and low progesterone

High-Dose brachytherapy

internal radiation delivered through seeds in a balloon cath. treatment lasts 4-5 days Balloon Cath is placed within the lumpectomy site. A tiny radiation seed (A) is inserted into the balloon, connected to a machine called an after load (C), and delivers that radiation.

Radical mastectomy

involves removal of breast and axillary lymph nodes with preservation of the pec major muscle. may do reconstruction.

cancer appearance

irregular shape poorly delineated nonmobile nontender nipple discharge dimpling

fibrocystic breast disease

is due to excessive fibrous tissue, hyperplasia, proliferation of mammary ducts and cyst formation. RT high estrogen and low progesterone

Aspiration or surgical biopsy

is indicated for tx Fine needle aspiration is performed by inserting a needle into lesion to sample fluid from a breast cyst, remove cells from intercellular spaces, or sample cells from a solid mass. Less invasive and less pain.

Ultrasound

is useful in differentiation a cystic mass from solid masses

complications of lymph node removal

lymph edema

SE of aromatase inhibitors

menopause

gynecomastia

non inflammatory enlargement of breast, most common breast problem in men. does not increase chances of breast cancer. usually temp and benign

biopsy

only definitive test for breast cancer

HER2 positive

poor prognosis, more receptors than normal

postop exercises are started in the hospital.

postop exercises are started in the hospital. isometric and progressing to ROM. admin analgesics 30 mins prior.

reconstruction involves tissue expanders

reconstruction involves tissue expanders which are gradually filled with water weekly to stretch the skin and muscles.

Tx options for breast cancer

surgery radiation therapy chemotherapy Hormone therapy Biologic and targeted therapy

biologic and targeted therapies kill..

the cell. Herceptin is an antibody to HER2.

breast cancer most often occurs in

the upper outer quadrant because this location is the most granular tissue

post mastectomy pain syndrome involves:

unbearable itching tingling shooting or prickling pain

Do not's of lymphedema

venipunctures injections heavy lifting cut cuticles

Fibrocystic Nrg care

vitamin E,A and B complex -anti estrogen -Diuretics -Analgesics -remind pt to have yearly follow-up

fibrocystic mass

well rounded well delinated freely movable tender nipple discharge rare