breast 2

nursing diagnoses for masectomy

1. Atriskforinfection,r/t surgical incision 2. Ineffectivetissue perfusion, r/t edema 3. Acute pain, r/t surgical intervention 4. Disturbedbodyimage,r/t surgical removal of breast 5.Decisionalconflictabout treatment, r/t concerns about risks and benefits 6. Interrupted family processes, r/t effect of surgery 7. Fear, r/t disease process/prognosis 8. _______________

prognosis after Breast Cancer

5-Year Survival (%) 10 year survival Stage 0 95 90 Stage I 85 70 Stage II 70 50 Stage III 55 30 Stage IV 5 2

the patient is lying in bed after a mastectomy. How does the nurse position the patient? a) Head of bed up at least 30 degrees with the affected arm elevated on a pillow. b) Supine body position with the affected arm positioned straight by the side. c) Any position that is most comfortable to the patient. d) Side-lying position with the unaffected side down towards mattress.

A

lymph Node Assessment and Removal Sentinel (SLNB)

AKA: sentinel lymph node dissection This newer procedure offers a less traumatic alternative for determining whether the cancer has spread beyond the breast. The SLNB procedure focuses on finding the specific lymph nodes (sentinel nodes) that are first to receive drainage from the breast tumor. SLNB is most appropriate for women with early-stage breast cancer with clinically negative axillary nodes

Aromatase Inhibitors

Acts on body fat sources of estrogen in post menopausal women Inhibits conversion of androgen to estrogen Side effects: • Loss of bone density • Osteoporosis Faslodex (Fulvestrant)

stem cell transplantation

Autologous or allogeneic stem cell transplantation from bone marrow is an option for patients at high risk for recurrence or with advanced disease

postoperative care plan

Avoid using affected arm for Positioning for comfort and to facilitate drainage: • HOB elevated 30 degrees • Arm elevated on pillow Assess for pain: analgesics as prescribed Assess incision and skin flap for integrity: • Bleeding, hematoma • Infection signs and symptoms: • Poor tissue perfusion Ambulation with arm support Regular diet • BP readings Injections Blood draws • • Vital signs: Report temp >100.4 • Every30minx2 • • Every 1hour x2 Every 4 hours Dressing: Assess bleeding & JP drainage flow, amount, color Monitor amount and color drainage

health maintenance during chemotherapy

Avoiding infection • Hand washing • Avoidcrowds • Vigilantfors/sinfection:check temperature every day at same time, CVAD site, mouth sores, sore throat • Denture care every meal, mouth rinses • Nutrition:proteinand fluids/avoid alcohol

hormal therapy: Selected Estrogen Response Modifiers

Block effects of estrogen in Estrogen Receptor positive women Tamoxifen taken for 5 years for risk reduction Side effects: • hot flashes • weight gain • Endometrial cancer • • Thromboembolic events

Cancer that recurs within two years after the initial treatment tends to be more aggressive than cancer that recurs later. Local Recurrence

Breast cancer most commonly recurs locally—in or near the site of the original tumor, for example in or around the scar.

second primary cancer

Cancer in a different part of the breast or in the contralateral (opposite) breast may be a new cancer, This cancer may be an entirely different cell type and may be treated successfully with surgery alone, depending on the stage and tumor type. The biopsy may or may not be able to determine whether the new tumor is recurrent disease or a second primary, but it will help determine the treatment.

how chemotherapy works

Cells go through several steps in the process of cell division. Chemotherapy drugs interfere with various parts of this cycle, making it difficult for the cells to reproduce and for the tumor to grow. The faster the growth, the more opportunity the chemotherapy drug has to disrupt the cycle. Chemotherapy treatment affects both normal cells and cancer cells, but because cancer cells generally divide more rapidly, and are less effective at self-repair, they are more affected by the therapy than normal cells. As a result, more cancer cells than normal cells are killed. With proper choice and timing of chemotherapy, the tumor can be destroyed without excessive damage to normal tissues. There are dozens of different chemotherapy drugs, each designed to interfere with a different part of the cell's duplication process. By using a combination of two or three different drugs, it is possible to affect several phases of the duplication cycle and increase the effectiveness of the treatment.

long term effects of radiation therapy

Chronic Lymphedema • Cardiovascular Secondary malignancies

The American Society for Clinical Oncology (ASCO) recommends that patients see their doctor immediately if any of the following symptoms occur and/or persist: These symptoms might not signal a recurrence of cancer, but they call for prompt evaluation.

Chronic bone pain or tenderness (persistent) Skin rashes, redness, or swelling (persistent) New lumps in the breasts or chest Changes in the breasts Chest pain and any shortness of breath (persistent) Abdominal pain (persistent) Changes in weight, especially weight loss when not intentional

when Cure Is No Longer Possible

Collaborative Care • Social work • Counseling • Psychotherapy Peer support groups • Chaplains • Family • Healthcare • Hospice

what kills more women than breast cancer?

Colorectal cancer and it is the only cancer that can be detected early enough to be completely cured by surgery alone.

which intervention is priority in the nursing care plan for a patient after a modified radical mastectomy? A) B) C) D) Position the patient on the affected side to aid with gravity flow of drainage from the incision site. Immobilize the arm on the affected side for the first 24 hours postoperatively. Assess the patient for anxiety because it can impede the healing process. Teach the patient signs and symptoms of infection and how to monitor for altered wound healing.

D

What should be included in a male exam?

Examination of male breast and axilla The nipple and areola are inspected for masses and nipple discharge

lymph Node Assessment and Removal Axillary (ALND)

Involves removal of a large number of axillary lymph nodes for examination by a pathologist. Formerly a part of all breast cancer surgeries, axillary dissection has been replaced in many cases by a newer procedure called sentinel lymph node biopsy.

recurrent breast cancer choice of treatment depends on several factors including but not limited to?

Location and size of the new tumor(s) Length of time since the initial cancer diagnosis Degree of lymph node involvement Whether distant organs are involved

nuring management potential complications

Lymphedema

lymphedema Initialgoal:

Maintain integrity of skin and underlying structures, reducing fluid volume • Massageandmanual drainage • Compression sleeve with selected range of pressures while awake • Intermittent pneumatic compression devices

complemENTARY AND ALTERNATIVE MEDICINE (CAM)

Nutritional supplements Dietary changes Herbal supplements Exercise, yoga, tai chi Meditation/Relaxation Massage Acupuncture Guided imagery Prayer

Metastatic Disease (Distant Metastasis)

Once breast cancer has spread to distant organs (stage IV), cure is no longer possible. However, palliative care measures, including radiation, chemotherapy, hormone therapies, targeted therapies, and bisphonates, can significantly improve survival length and quality of life. The most common sites of metastasis for breast cancer are the bone, brain, lungs, and liver. Breast cancer that metastasizes to the bone can be treated with targeted radiation therapy, either stereotactic external beam or with radiopharmaceuticals. Therapies such as zolodronic acid (Zometa, a bisphosphonate) and Denusamab can help reduce the pain of bone metastases, strengthen bones, and decrease morbidity due to skeletal-related events (SREs) (Hartmann & Loprinzi, 2012). There may be the need for surgical intervention, in some cases for rod placement, to either treat or prevent fracture in large, weight-bearing bones that are affected by disease. Patients with cancer in the bone should be cautioned about the increased risk of fracture. Metastatic cancer that develops in the brain or around the spinal cord can also be treated to improve quality of life. Steroid medications can be given to decrease pain, swelling, and neurological symptoms. Whole brain radiation or localized brain radiation (Gamma Knife treatment) can be used to treat women whose cancer has spread to the brain.

Palliative Care

Palliative care can be offered during this time. Palliative care specialists work together with the healthcare team, such as nurses, nutritionists, social workers, chaplains, pharmacists, and others, to focus on creating an individual plan to address any lasting treatment side effects, pain, emotional aspects, and other concerns of the cancer patient. The idea is to treat the whole person—including the physical, emotional, social, and spiritual aspects. Palliative care is often confused with hospice care, which is provided for people who have a terminal diagnosis. Palliative care can be provided at any time during a cancer diagnosis, not just at the end of life. The inclusion of palliative care may include positive benefits such as: The ability to fully complete treatment Improved quality of life during treatment Increased ability to perform daily activities Living longer Improved ability to deal with the emotions Increased connection to social support Fewer hospitalizations

breast reconstruction For the majority of women with breast cancer, body-image change is a very important issue. Whether or not to have reconstructive surgery or use a breast prosthesis after a mastectomy is a highly personal decision.

Pre and Post Expander and Implant

bilateral mastectomy,

Some women with cancer in one breast may choose to have the other breast removed at the time of their mastectomy

psychosocial issues

Support/Relationships Husband Physical scars Body image Communication of feelings both negative and positive Threat to sexuality Concerns about childbearing Teaching Avoid sexual intercourse for 4-6 weeks Use of birth control during therapy Community resources at local, state and national levels American Cancer Association

Modified Radical Mastectomy

This procedure removes as much of the breast tissue as possible, including the nipple and the areola, and a number of axillary lymph nodes, but not the muscles. Used when tumor > 5 cm

chemotherapy

Usually a combination of agents Via Central venous access device (port-a-cath)

Regional Recurrence

When breast cancer cells have spread to the adjacent lymph nodes (usually in the axilla) or to the chest wall,

local recurrence diagnostic

When recurrent cancer is confirmed, the physician orders blood tests and a bone scan to determine whether the cancer has spread beyond the breast. Any cancer that recurs locally is regarded as aggressive and resistant to treatment. When cancer recurs locally after lumpectomy, mastectomy is the preferred treatment.

postoperative

When the procedure is completed, one or two tubes called drains will be placed under the skin to help remove the fluid that accumulates at the site of surgery.

Surgery Whether it precedes or follows systemic therapy, however, it depends on a number of factors including?

a cornerstone of treatment for breast cancer. the stage of the cancer, the age of the patient, and the preferences of the treatment team.

Women with breast cancer may have

a lumpectomy or one of three types of mastectomy (surgery to remove the breast).

Wellness also includes grieving one's losses, whether the loss of a breast, loss of a relationship, or loss of the sense of control. It means seeking support when one needs it. Many women continue with a support group after treatment has ended. Others seek individual counseling and psychological support. Many women find further healing by helping others who are just starting on their cancer journey. The best outcome in the "new normal" for patients is a lifestyle that has changed to a healthier one and an attitude that has changed to one of ongoing appreciation where each day is viewed as a gift. Symptoms That Require Attention When walking the tightrope between fear of recurrence and getting on with life, each new ? This is normal, but it can also be immobilizing.

ache or pain can trigger anxiety.

many women, especially those who have not reached menopause, may need to consider

adjuvant systemic therapy:chemotherapy, hormonal therapy, or targeted biological therapy such as Herceptin.

how to detect cervical cancer,

annual PAP smears especially in younger women. This is also a highly curable cancer when caught early, but it can be very deadly if not.

Lymph nodes filter out foreign substances, such as

bacteria and cancer cells, as part of the body's immune system.

Chemotherapy Inform patient about side effects

cardiotoxic effects Alopecia Nausea Vomiting Mucositis Bone marrow suppression • Fatigue • SOB • Chronic cough Edema Infertility

Encourage expression of feelings

communicating their love for others, forgiveness, and/or gratitude)

Patients should be encouraged to focus on wellness—taking good care of body, mind, and spirit—by ?

eating a healthy diet, getting enough sleep and exercise, paying attention to symptoms, and getting regular checkups.

Cancer reminds us to take care of unfinished business, not only in personal relationships but also in practical matters, sometimes referred to as? Although family and friends may be uncomfortable with these discussions, they can be reassuring to the patient.

getting one's affairs in order

radical mastectomy

involves removal of the entire affected breast, the underlying chest muscles, the lymph nodes under the arm (axillary node dissection), along with some additional fat and skin.

simple mastectomy

involves the removal of the breast tissue, skin, areola, and nipple, but not the lymph nodes. This procedure is generally used when axillary lymph nodes do not need to be removed, as evidenced by a negative sentinel node examination.

modified radical mastectomy

involves the removal of the entire breast, including the skin, areola, and nipple, along with the axillary lymph nodes, but leaves the chest wall muscles intact.

Gynecomastia

is the firm enlargement of glandular tissue beneath and immediately surrounding the areola

Recurrent breast cancer treatment

local/regional or systemic and can range from surgery alone to high-dose chemotherapy.

dietary recommendations related to breast disease

low fat diet Vitamins & Minerals • • Echinacea • Boost/Ensure Inform about evidence suggesting a relationship between dietary intake of soy and breast cancer risk • • • Vitamin C & E St. John's Wart Garlic extract

regional recurrence treatment

may require surgical treatment and/or localized radiation therapy as well as systemic treatment

she may need only surgery and perhaps radiation therapy depending on

patient's age, general health, and the size, type, and stage of the tumor

Encourage quality time with family

plan a trip or outing that they have always wanted to take together

Cancer casts a long shadow. Anyone diagnosed with cancer lives with the possibility of recurrence. Although many women survive breast cancer and live out a normal lifespan, others do not. That is why each new pain or other symptom brings forth the fear of recurrence or metastasis until the symptom disappears or is found to be something other than cancer. Learning to live with uncertainty is part of recovery from cancer, and it is different for each individual. Healthcare providers can help reduce the fear and anxiety associated with cancer survivorship by providing

practical information to patients.

When efforts to slow cancer growth are no longer effective, emphasis shifts from cure or control of the cancer to providing comfort and symptom management with a goal of ?

providing the best quality of life possible during the time remaining for the patient.

how often are radical mastectomies used today?

rarely used today. This type of mastectomy is generally limited to cases when cancer has spread to the chest wall muscles.

early radical mastectomy was based on the mistaken belief that the more tissue removed, the better the chances of curing the cancer. This procedure caused so much deformity, that women feared it as much as the cancer itself. Today it is used how often?

rarely used, and only for very extensive cancers that spread to the muscles.

Patients can choose from a variety of reconstruction techniques that offer pleasing cosmetic results. Essentially: A mastectomy is a general term for

removal of the breast. A mastectomy may be performed when a lumpectomy is not possible or based on the preference of the woman.

prophylactic (

removal of the other breast preventive measure. reduces the risk of breast cancer recurrence, but it is not an absolute guarantee because of the systemic nature of the disease.

early radical mastectomy

removed the entire breast, the lymph nodes in the armpit, and one of the major muscles of the chest wall

There are three types of mastectomy:

simple, modified radical, and radical.

These guidelines do not take into account a patient's hormone receptor status. This is significant because hormone receptor-positive cancers are ? As the population of cancer survivors grows, additional research may lead to more accurate and specific guidelines (Margethaler et al., 2012). Other Cancer Screenings Breast cancer patients also need to stay current with screenings for other types of cancer. For example, depending on age and family history, patients should also have a colonoscopy to screen for colon cancer. Education Encouragement Referrals: support groups, reliable websites Know symptoms needing attention Health care resources after discharge -personal and community support-provide accurate and current information Many support groups nationally and locally offering support and guidance

slower growing and may take longer to recur.

Patients with recurrent or metastatic breast cancer need support and understanding more than ever, not only from family and friends but from health professionals as well. They need to be able to talk openly about their cancer, their feeling and concerns, their care preferences, and their decisions about ending treatment. Helping patients and their family members change their focus from seeking cure to seeking the best comfort and quality-of-life measures with end-of-life care is paramount. Because this can be very stressful for some people, they may require support from various resources,

such as social work, certified counseling/psychotherapy, peer support groups, and chaplains.

Breast reconstruction

surgical procedure performed by a plastic surgeon and may require a longer recovery than mastectomy alone. Reconstruction can be performed at the same time as a mastectomy (immediate reconstruction), or it can be done later (delayed reconstruction). Immediate reconstruction may not be possible if the tumor is advanced and radiation is recommended. With immediate reconstruction, chemotherapy treatments are usually delayed for at least 2-3 weeks after surgery. There are options available with reconstructive surgery, but they are not all appropriate for every candidate. Basically, there are two categories: implant-based reconstruction and autologous tissue reconstruction (e.g., the transverse rectus abdominus myocutaneous flap, or TRAM flap). For both implant-based and autologous reconstruction, the areola and nipple can be reconstructed using a specific surgical technique and tattooing, which can look quite realistic. However, patients should be aware there will be no return of erogenous feeling to the reconstructed nipple. Autologous transplants have a higher and longer rating of satisfaction in acceptable appearance than do implants (Platt et al., 2011). As a first step in the reconstruction process, most women need to undergo tissue expansion to stretch the skin for placement of an implant. The process begins with the insertion of a temporary implant called a tissue expander. The implant can be placed at the time of mastectomy or later if delayed reconstruction is chosen. Over a period of months, sterile saline is injected into the tissue expander in order to slowly stretch the skin of the chest where the implants will be placed. After the tissue expansion is complete, a second surgery removes the tissue expander and a breast implant is placed. Breast implants may be filled with either saline or silicone gel. Nipple reconstruction can also be accomplished with the new breast mound after a period of healing is allowed. Although a diagnosis of cancer can feel like an urgent situation, there usually is time to talk about, research, and consider treatment options. Ideally, once a definitive diagnosis is made and the need for a mastectomy is determined, the patient will discuss reconstruction options with the breast surgeon and the plastic surgeon. Women who are exploring their options for surgery should be encouraged to have someone with them and to take notes when consulting with the breast and plastic surgeons. Some examples of important questions and points for consideration include: Am I a candidate for breast reconstruction? When is the best time to have this done? What type do you think is the best for me and why? How long will I be in the hospital? How long is total recovery time? Will I need help at home after surgery? How many of these procedures have you done? What are some of the possible complications? Do you have pictures I can see of some of the final results? What is the average cost? Does insurance usually cover this? Will my new breast look and feel different from my other breast? When will I be able to exercise again? Are there any restrictions? (Hartmann & Loprinzi, 2012) It is very helpful to view photos of other women post-reconstruction in order to have a realistic expectation of possible outcome. It is also beneficial to speak to other women, such as in an in-person or online support group, about their experiences, both positive and negative. Some women may prefer to forego reconstructive surgery altogether and choose an external prosthesis. Many prosthetics, or breast forms, are available today for both lumpectomy and mastectomy patients. They can look quite natural under clothing and serve to help a woman feel balanced in her appearance. There are also a number of products available to accommodate breast forms, such as mastectomy bras, active wear, lingerie, and swimwear Breast forms may also be worn on a temporary basis between mastectomy and reconstruction surgeries, especially when prolonged treatment time is required during the interim.

Lymph nodes and the lymph vessels drain

the excess fluid that is not absorbed by blood vessels.

For many women, making the decision to stop cancer treatment that is no longer working can be a powerful step to be free

the side effects of treatment and take control of their lives.

Lymph nodes are part of the immune system and linked by

tiny vessels within the entire lymphatic system.

Mastectomy, or surgical removal of the breast,

treat invasive breast cancer

In the 1970s and 1980s, research proved that there was no advantage in removing the chest muscles. This led to the modified radical mastectomy that is

used today

Self-efficacy is the confidence to produce desired effects by one's own actions. In one study on breast cancer survivors, self-efficacy is defined as one's confidence in the ability to manage symptoms and emotions related to having breast cancer, including the ability to ask for help, knowing how and when to report symptoms, and doing what is important after breast cancer treatments are completed. Overall, the study found women ages 45 or younger had greater fear of recurrence than older survivors, especially if their self-efficacy was low. By providing education, encouragement, and referrals to both support groups and reputable websites, nurses can help increase self-efficacy?

which may help decrease fear and anxiety associated with recurrence risk

Encourage time with friends

who are supportive

If breast cancer recurs, it usually happens ? and is most often suspected or discovered by women themselves. Routine Follow-Up Care Two major entities, the American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN), have issued guidelines for surveillance of breast cancer patients after curative-intent treatment. ASCO guidelines include: History and physical exam every 3-6 months for 3 years, then every 6-12 months for 4-5 years, then annually thereafter Annual mammogram starting 6-12 months after completion of chemotherapy Annual gynecological examination for patients taking hormonal therapies or AIs Regular bone mineral-density testing for patients taking AIs NCCN guidelines mirror ASCO except they recommend a history and physical exam every 4-6 months for 5 years, then annually thereafter. Both guidelines recommend referral for genetic counseling for familial cancers. Both guidelines do not recommend any other routine laboratory tests or imaging unless abnormalities are detected with history and physical or mammogram because more intense surveillance has not been shown to improve overall survival.

within the first five years after diagnosis

Create a living legacy to leave for family members

writing letters or recording family stories or videotaped messages

End of life planning:

• Advance directives • Do not resuscitate • Legalissues • Wills/estate planning • Hospice • Organ donation • Funeral and memorial

lymphedema causes

• Arm injury on affected side Management Causes • Inflammatory changes • Aging • Spread of metabolic disease • Tumor in upper outer quadrant • Implanted CVAD • Scarring from chemotherapeutic agents

nuring management Monitoring/Management

• Assess tissue perfusion and capillary refill • Arm exercises and elevating arm above heart several times per day • Teach: prevention of trauma to affected arm

lymphedema management NO:

• BP • Blood draws • Vaccinations • Cuts, injuries to prevent infection • Avoid constricting garments • Compression sleeve or glove • Extreme increases in temperature

lymphedema

• Complains of heaviness or ache • Tightness feeling more pronounced skin folds • Jewelry or clothing tight • Inspect skin of skin color, texture, integrity • Measure circumference of extremities prior to surgery or radiation and at intervals to compare

adjuvant Therapy Targeted therapy

• Drugs target specific characteristics of cancer cells • Herceptin: HER2 gene • Avastin:inhibitstumorgrowth factor and stopping formation of blood vessels that nourish tumor • Fewer side effects because it does not harm normal, healthy cells • Side effect risk: cardiotoxocity

ways to Maintain Hope and Connection to Others

• Family time (trips, outtings) • Focus on pain symptom relief/comfort • Communication • Legacycreation • Friends

short term effects of radiation therapy

• Fatigue • Skinreactions • Arm Swelling • Lung, nerve damage • Redness • • Bruising • BreastPain • Infection

psychosocial Issues: support

• Gather information • Consider treatment options • Stress there is support • Patients make individual choices • The journey is personal and unique Record keeping: • Treatments • Procedures • Medications • Appointments • Labs/Diagnostics • Insurance • Legal • Journal

lumpectomy

• If the tumor is small and confined to a single location in the breast, breast- conserving surgery, also called a lumpectomy. • The goal of this relatively simple procedure is to remove the whole tumor, while conserving as much breast tissue as possible. • A margin of normal breast tissue is also removed to make sure no malignant cells are left behind.

Recurrent Breast Cancer

• Local • Regional • Metastatic • Surgery • Highdosechemotherapy • Palliativecare

manamgement SE of ,Chemotherapy

• Nausea and vomiting • Alopecia • Peripheralneuropathy • Cognitiveimpairment • Myelosuppression • Fatigue • Anti-emetics • Wigs, short haircut • Dosereduction • Rest, support coping • s/s of anemia, infection- • Hematapoieticgrowthfactorsto minimize neutropenia and anemia • Avoid crowds, wear mask, hand washing • Correctcachexia,depression, insomnia, electrolyte imbalances

goals

• Patient verbalizes understanding of disease, diagnosis, treatment options, and prognosis • Patient demonstrates reduced level of anxiety evidenced by use of positive coping strategies • Patient verbalizes feelings related to body image changes and accesses available resources to assist in related lifestyle adjustments • Patient verbalizes adequate pain control on a 0-10 pain scale and demonstrates effective use of pain management techniques

radiation therapy

• Radiationtherapyuses high-energy beams to destroy cancer cells. • Thebeamsresemblethe X-rays that are used to create an image of the chest, or of a broken bone. • Fortreatmentpurposes, the rays are of higher intensity.

treatment for breast cancer

• Surgery • Radiation Therapy • Chemotherapy • Hormonal Therapy

psychosocial Issues: Discussions

• Telling family and friends • Informing an employer • HIPAA

male breast cancer risk factors

• Undescended testicles • Orchiectomy • Infertility • Gynecomastia • Mastitis • Chest wall trauma • BRCA1mutation manifestations • Painless sub-areolar lump • Nippleretraction • Localizedpain • Nippleulceration • Bleeding/discharge

patient Education for Skin Reactions to Radiation

• Wash the radiated area gently with warm (not hot) water and a mild soap such as Ivory, Pears, or Neutrogena • Don't shower more than once per day; limit baths to twice weekly for less than 30 minutes per bath • Avoid rubbing, scrubbing, or scratching the skin • Be careful not to wash off the ink markings needed for radiation therapy • Wash off any lotions or creams from sites prior to RT, as their presence can intensify burns • Gently pat skin dry after bathing • Avoid deodorant or talcum powder on the radiated side • Wear soft clothes and use cotton sheets • Avoid adhesive tape, bandages, or other types of sticky tape on the treatment area • Avoid chlorinated swimming pools and hot tubs during radiation treatment • Always protect the radiated area from exposure to the sun or tanning beds, even after treatment ends • Promptly report pain, swelling, exudate, or other skin changes to the primary care provider

follow up care

• • • • • Education • Encouragement • Referrals: support • groups, reliable websites • Know symptoms needing attention ReviewChart73-4 Recovery from Breast Cancer Surgery Ignatavicius p. 1607 increase self efficacy Focus on wellness Counseling Rash, abdominal or bone pain, swelling, redness, edema, new lumps or changes, weight loss Surveillance,screenings

surgery and chart

•Lumpectomy •Modified Radical Mastectomy •Radical Mastectomy (rare) Reconstruction

adjuncts to surgery

•Radiation Therapy •Chemotherapy •Hormonal Therapy All are options for adjuncts to surgery depending on stage of cancer