UNMC PCC 3 Final Exam Breast Cancer

inflammatory breast cancer

-aggressive and fast growing -metastasis when found, poor prognosis -often mistaken for mastitis because of skin involvement making skin look red, inflamed, warm, and takes on thick orange peel appearance (peau d'orange)

Nursing Care Mastectomy

-assess coping (anxiety, fear), offer sense of control -assess support -pain management and education -drain management and education -infection education for signs to look for -restoring arm function and exercises to improve blood/lymph flow and prevent contractures -discharged 24-48 hours after sx unless complications arise

Nursing Care Lymphedema

-axillary nodes cannot return lymp fluid to central circulation causing swelling -no BPs, venipuncture, or IVs in affected limb -elevation -exercise -decongestive therapy (massage, compression stockings)

invasive lobular carcinoma

-breaks out of lobules and metastasizes -often not detected by mammography, when detected it is large enough to detect and cause more problems

Surgery

-breast conserving (lumpectomy) -lymph node removal and analysis -mastectomy -reconstructive

ER+ cancer treatment

-can be treated with anti-estrogen (hormone therapy) -better prognosis than (ER-) -accounts for 70-80% -progesterone receptor positive (same idea)

drug therapy

-chemotherapy -hormone therapy -immunotherapy and targeted therapy

Mammography

-digital -3D (standard), better if pt has dense breast tissue -if clinical findings are suspicious and mammogram is normal, an US or MRI performed -high risk women can have mammogram and MRI

General Risk Factors

-female -advancing age (after 60 increases dramatically) -excess weight gain during adulthood -obesity -sedentary lifestyle -smoking -alcohol use -dietary fat intake -radiation exposure -combined hormone therapy (increased risk after 2 years use and having larger more advanced cancer at diagnosis) -estrogen therapy alone for longer than 15 years -oral contraceptive use, decreases when stopped and risk gone after 10 years of stopping

Male risk factors

-heavy alcohol use -chronic liver disease -obesity (all lead to increased estrogen levels) -aging -family hx/genetics -radiation exposure -Klinefelter Syndrome

Survivorship

-largest group of cancer survivors -H&P 1-4 times a year as appropriate for 5 years -need to be 5 years without cancer or new growths to be considered cancer free

noninvasive breast cancer treatment

-lumpectomy w/wo radiation -total mastectomy w/wo sentinel nodes biopsy -hormone therapy

Psychosocial support

-provide safe environemnt (allow emotion wo judgement or feeling rushed) -identify sources of support and strength (family, Komen foundation, friends) -assess and foster coping skills -answer questions -offer resources and local support

Paget's Disease

-starts in ducts and spreads to nipple and areola -prognosis is good when confined to nipple -present with itching, burning, or blood discharge from nipple

Options for reconstruction

-tissue expansion (makes room for future implant) -breast implants -tissue flap procedures -restores symmetry, preserves body image -based on individual perception and values

Additional diagnostics

-tumor size and cellular differentiation -estrogen and progesterone receptor status to determine prognosis and tx -cell-proliferation indices -genomic assay for pronostic indicator and HER2

Early CM

-visible lump -dimpled or depressed skin -bloody discharge -color or texture change -nipple change ex. inversion

Duration of chemo

16 weeks, lasts 4 hours get Zofran and IV fluids ahead of time for nausea and dehydration

•A client with breast cancer has returned to the room following a right total mastectomy. The nurse should: •A. Elevate the client's right arm on pillows (prevents lymphedema) •B. Place the client's right arm in a dependent sling •C. Place the client's right arm across her body •D. Keep the client's right arm on the bed next to her

A. Elevate the client's right arm on pillows (prevents lymphedema)

•The nurse is teaching a client who suspects that she has lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: •A. Chest X-ray •B. Fine needle aspiration (biopsy for malignancy) •C. Mammography (can detect abnormality) •D. Breast self examination

B. Fine needle aspiration (biopsy for malignancy)

ideal cancer type

ER+, PR+, HER2+ targeted therapy capable of blocking receptors

least ideal cancer

ER-, PR-, HER2- more aggressive, poorer prognosis do not respond to hormone therapy or HER-2 therapy chemo is only treatment option

You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. Which recommendations you would include? (select all that apply) a. Women over age 55 may have biennial screening. b. Screening should end when the women reaches age 65. c. Women aged 45 to 54 years should be screened annually. d. Regular screening mammography should start at age 45 years. e. Clinical breast examinations can be used if the woman has average risk.

a. Women over age 55 may have biennial screening. c. Women aged 45 to 54 years should be screened annually. d. Regular screening mammography should start at age 45 years.

When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is a. being a woman over age 60. b. experiencing menstruation for 30 years or more. c. using hormone therapy for 5 years for menopausal symptoms. d. having a paternal grandmother with postmenopausal breast cancer.

a. being a woman over age 60.

A patient with breast cancer has a lumpectomy with sentinel lymph node biopsy that is positive for cancer. You explain that, of the other tests done to determine the risk for cancer recurrence or spread, the results that support the more favorable prognosis are (select all that apply) a. well-differentiated tumor. b. estrogen receptor-positive tumor. c. overexpression of HER-2 cell marker. d. involvement of two to four axillary nodes. e. aneuploidy status from cell proliferation studies.

a. well-differentiated tumor. b. estrogen receptor-positive tumor.

Preoperatively, to meet the psychologic needs of a woman scheduled for a simple mastectomy, you would a. discuss the limitations of breast reconstruction. b. include her significant other in all conversations. c. promote an environment for expression of feelings. d. explain the importance of regular follow-up screening.

c. promote an environment for expression of feelings.

pathophysiology

can be slow to rapid growing

papillary

cells are finger-like projections coming from it

tubular

cells look like tubes, elongated

metastatic

common sites are bone, liver, lung, brain, and lymphatic system

You are caring for a patient with breast cancer following a simple mastectomy. Postoperatively, to restore arm function on the affected side, you would a. apply heating pads or blankets to increase circulation. b. place daily ice packs to minimize the risk for lymphedema. c. teach passive exercises with the affected arm in a dependent position. d. emphasize regular exercises for the affected shoulder to increase range of motion.

d. emphasize regular exercises for the affected shoulder to increase range of motion.

prognosis

depends on characteristics and stage as well as: -estrogen receptor status -progesterone receptor status -human epithelial growth factor receptor 2 (HER-2) status; HER-2 is a protein that helps regulate cell growth

noninvasive breast cancer

ductal carcinoma in situ (DCIS) -tends to be unilateral (one breast) and may progress to invasive in untreated

radiation therapy

external, brachytherapy (early stages, radiation seeds implanted), palliative for pain control

Genetics

family hx of cancer -especially if family member also had ovarian cancer, was premenopausal, had bilateral breast cancer, or is first-degree relative -having any first-degree relative with breast cancer, especially at young age, doubles risk -up to 10% of all of breast cancer are hereditary

ductal carcinoma

from epithelial lining of ducts

lobular carcinoma

from epithelium of the lobules

Phantom breast pain

happens after mastectomy pain in removed breast

Estrogen receptor positive cancer (ER+)

has estrogen receptors (proteins) on outside of cells that attract estrogen which fuels its growth

Tamoxifen

hormone therapy for ER+ women can be used in high-risk women preventatively SE=irregular vaginal bleeding, DVT, PE, stroke, irreverisble changes in visual acuity

invasive

invading through the wall of the duct

Axillary lymph node analysis

looking for spread of known cancer -sentinel -mapping -axillary lymph node dissection

Paget's disease treatment

lumpectomy mastectomy radiation

sentinel lymph node biopsy

lymph node(s) that drains first from tumor site radioisotope is injected into area, nodes cancerous will light up blue and dissected for biopsy

duct

milk passages that connect the lobules and the nipple estrogen deals with the milk duct and growth/production more estrogen in lifetime=increased risk of cancer

lobules

milk-producing glands

Brachytherapy

minimally invasive, length of tx vaires, multi-catheter or balloon catheter

metaplastic

mixed tissues or cells

Trastuzumab (Herceptin)

monoclonal antibody to HER2 once the antibody attachs to antigen, it is taken into cells and blocks ability to proliferate can be used alone or in combination with other chemotherapies SE=flu-like symptoms (fever, chills, myalgia), damage to heart

invasive ductal carcinoma

most common cancer -starts in milk ducts and spreads through walls into surrounding tissues -subcategories: medullary, tubular, colloid, papillary, and metaplastic

Breast cancer most often occurs in...

most often in the upper outer quadrant of the beast, which is location of glandular tissue can also develop in axillary area called the "tail of Spence"

Biopsy

provides definitive diagnosis -fine needle aspiration: biopsy with small sample of cells, US guided -core needle biopsy: more accurate, use US/MRI or stereotactic mammography to guide, used with palpable lump -vacuum-assisted: use to pull out sample -excisional: used as surgical approach in OR if multiple areas of concern

External radiation

radiation used as adjuvant to surgery

palliative radiation

radiation used for symptom management

medullary

soft, gray, fleshy material looks like a brain

Post-Breast Therapy Pain Syndrome

take drugs like lyrica or gabapentin to help dole nerve pain from constant procedures and manipulation of breast

negative receptor treatment

targeted therapy will not work due to lack of receptor use chemo

HER2+

too much growth promoting protein so cancer will grow excessively *responsive to targeted therapy

colloid

tumor is mucusy

BRCA1

tumor suppressor gene mutation carries 41-90% lifetime chance of developing breast cancer

BRCA2

tumor suppressor gene carries same risk as BRCA1 when mutated (41-90% lifetime chance of developing breast cancer)

Doxorubicin (Adriamycin)

used in combination therapy -can cause necrosis if comes out of veins, cytotoxic, so use port or central line SE=HF, cariotoxicity, arrhythmias, "Red Devil" causing pinkish-red pee and burns

in situ

within the duct tumor has not gone through any walls or metastasized still in primary/original place

age 55 and older

women can switch mamograms every 2 years, or can continue yearly screening screening should contine as long as a woman is in good health and is expected to live 10 more years or longer

ages 45-54

women should get mammograms every year

ages 40-44

women should have choice to start annual breast cancer screening with mammograms if they wish to do so