Chapter 6: Disorders of the Breast
Mammography
-xray pictures of bare breast while it is compressed between two plastic plates. - "gold standard" screening method. - don't wear deodorant or powder the day of (will have calcium spots on appear picture)
Surgical Options
-Breast Conserving: least invasive -Mastectomy: removal of all breast tissue, nipple and areola.
Chemotherapy
-use of drugs that are toxic to ALL cells and interfere with a cells ability to reproduce. -tx usually last about 3 to 6 months. -Side effects: N/V, diarrhea, constipation, hair loss, weight loss, stomatitis, fatigue, immunosuppression.
Benign Breast Disorder
-Non cancerous, not life threatening. -can cause pain/discomfort. -Many woman believe that all lumps are cancerous, but actually more than 80% of lumps discovered are benign and need no treatment.
Breast Cancer Risk Factors
-aging (>50 yrs) -gender (female) - genetic mutations -hx of cancers -family hx -race (caucasian) -Exposure to radiation -Early menarche or later onset of menopause ( increased estrogen exposure over a lifetime) Modifiable risk factors: -not having children or not having them until age 30. -post menopausal (use of estrogen and progesterone) -failing to breast feed until after1 yr -Alcohol -Smoking -obesity -Sedentary lifestyle.
Immunotherapy
-attempt to stimulate the body's natural defenses to recognize and attack cancer cells. -Trastuzumab: first antibody approved for breast cancer.
Fibroadenomas
-benign sold breast tumor, most common in ages 15 to 35. -can be stimulated by external estrogen, progesterone, lactation, and pregnancy. -round, firm, moveable, palpable, rubbery, well delineated, single lesion. -Diagnostic: mammogram, aspiration and biopsy, "watchful waiting". (stop growing and shrink on their own.)
Radiation
-high energy waves to destroy cancer cells that might have been left behind in the breast. -Side effects: inflammation, edema, anorexia, swelling, heaviness of breast, sunburn like skin, fatigue.
Mastitis
-infection or inflammation of the connective tissue in breast that occurs primarily in lactating or engorged woman. -lactational types: one or more of the ducts drain poorly or become blocked, resulting in bacterial growth. (staph, influenza, strept), damaged or cracked nipples, irregular or missed feedings, not emptying breast completely, poor latch and transfer of milk, illness, oversupply, tight bra, stress/fatigue. -nonlactational types: (duct ectasia) milk ducts becomes congested with secretions and debris, resulting in inflammation. -Signs: wedged shaped, warmth, redness, swelling, cracked nipple, breast engorgement.
Diagnostics
-mammography -MRM (magnetic resonance mammography) -fine needle aspiration biopsy -stereotactic needed guided biopsy -Sentinel Lymph node biopsy -Hormone receptor status
Fibrocystic Breast Changes
-represent a variety of changes in the glandular and structural tissues of the breast. -Affects 50-60% of woman in their life. Most common in woman ages 20-50. -The cause of fibrocystic changes is related to the way breast tissue responds to monthly levels of estrogen and progesterone. Causing them to swell. -One or both breasts. -S/Sx: round, smooth, several lesions, cyclic, palpable, tenderness. -Diagnostic/tx: Aspiration and biopsy.
Stages of Breast Cancer
0: in situ, early 1:localized tumor < 1 inch in diameter. 2: tumor 1-2 inches in diameter, spread to axillary lymph nodes. 3: tumor 2 inches or larger, spread to other lymph nodes and tissue. 4: Cancer has metastasized to other parts of the body.
Relieving Symptoms of Fibrocystic Breast Changes
Wear extra supportive bra, take oral contraceptives to stabilize monthly hormones, Eat a low fat diet, Apply heat to breasts, take diuretics, reduce salt intake, use thiamine and vitamin E therapy.
Hormonal therapy
block or counter the effect of estrogen. - (SERM) selective estrogen receptor modulators: (raloxifene, tamoxifen) to decrease the amount of estrogen.
Breast Cancer
neoplastic disease in which normal body cells are transformed into malignant ones.
