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75 Cards in this Set
- Front
- Back
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Describe 5 stages of Tanner breast development
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Stage 1- prepubertal breast
Stage 2- breast budding Stage 3- further enlargement and areola darkening Stage 4- nipple and areola form secondary mound Stage 5- cont dev of larger breasts |
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What are Am. Cancer socity recommendations?
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mammography at 40, breast exam every 3 years for 20-30s, breast self-exam in 20s,
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What are abnormal breast findings?
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retraction signs- dimpling, creasing, changes in breast contour or nipple, fibrosis or scar tissue formation, flattening nipple
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What are the s/s of malignant breast tumor?
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single mass/lump, nontender, irreg shape, firm/hard/embedded
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What are the s/s of benign breast mass?
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single or multiple lumps on one or both breasts, tender, tenderness that inc with premens, round, soft or firm, mobile
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What are the s/s of benign breast lump?
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single mass age 15-35, nontender, round or lobular, firm, mobile, not fixed, no premens changes
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What are s/s of increased venous prominence?
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can signal increased blood supply required by tumor, esp if unilateral
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What are s/s of peau d'orange?
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edema and pitting of the skin that results from neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, skin pores enlarge, skin is thick, immobile, hard--advanced breast cancer
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What is the significance of nipple inversion?
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normal if long standing, fibrosis and malignant if recently developed
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Describe acute mastitis?
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(inflammation of the breasts)
assoc with lactation but can occur at any age, nipple cracks or abrasions noted, breast skin reddened and warm to touch, tender, systemic signs include fever and increased pulse |
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Describe paget disease
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malignancy of mammary ducts, erythema of nipple and areola, thickening, scaling, and erosion of nipple and areola
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When are breast self examines best to do?
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5-7 days after menses
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Should men perform breast self examines?
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yes, if they have a family hx of breast cancer
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When should one start having mammograms and what is it the equivalent to?
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every year at 40 or 10 years earlier then the youngest family member developed breast cancer
1 hour of sun exposure |
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What is galactography?
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injection of radiopaque material and followed by a mammogram
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What is ultrasonography?
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use of sound waves to distinguish fluid-filled cysts from other lesions
often used for <35 |
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How is an MRI used for breast cancer detection?
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IV of gadolinium is given to improve visibility
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List the types of percutaneous biopsies?
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fine-needle aspiration, core needle biopsy, stereotactic core biopsy, ultrasound-guided core biopsy, MRI guided core biopsy
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List the types of surgical biopsies?
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excisional biopsy- lumpectomy (entire mass and some surrounding areas removed), incisional biopsy- portion is removed for tests, wire needle localization- aids surgeon in location to excise area
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What can nipple discharge be associated with?
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carcinoma, papilloma, pituitary adenoma, cystic breasts, medications
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What nipple discharge can indicate problems?
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green- infection
sponaneous, persistant, unilateral bloody- wartlike growth in duct lining (intraductal papilloma) |
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What is a nipple fissure and how does it occur?
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longitudinal ulcer that may develope for breastfeeding
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What is mastitis?
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inflammation or infection of breast tissue common in breastfeeding women
transfer of microorganisms- treat with antibiodics tough, painful, discharge |
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What is a lactational abscess?
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tender and redness caused by acute mastitis, drainage may be required
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What is mastalgia?
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breast pain, normal with hormone fluctation, rarely indicative of cancer
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What are breast cysts?
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fluid-filled sacs that dev as breast ducts dilate, 30-55 perimenopausal, estrogen related, do not increase risk of breast cancer
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What is fibroadenomas?
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firm, round, movable, benign tumors, nontender
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What is benign proliferative breast disease and the 2 causes?
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atypical hyperplasia- abn inc in ductal or lobular cells in the breast
lobular carcinoma in situ- proliferation of cells within the breat lobules *both increase breast cancer risk |
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What is cystosarcoma phyllodes?
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rare fibroepithelial lesion that grows quickly but malignancy is rare
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What is fat necrosis?
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history of trauma, non malignant
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What is gigantomastia or marcomastia?
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overly large breast, reduction mammoplasty is usually only treatment
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What is superficial thrombophlebitis?
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preg, trauma, breast surgery that causes pain and redness from superficial thrombophlebitis in the vein that drains the outer part of the breast.
Treatment is analgesics and heat |
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Describe ductal carcinoma in situ
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proliferation of malignant cells inside the milk ducts without invasion into the surrounding tissue
breast cancer stage 0-lumpectomy |
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Describe infiltrating ductal carcinoma
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most common breast cancer, tumor arises from duct system and invades surrounding tissue, solid irreg mass
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Describe infiltrating lobular carcinoma
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arise from lobular epithelium and occurs in thickening in the breast
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Describe medullary carcinoma
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tumors that grow in capsule inside a duct
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Describe mucinous carcinoma
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mucin producer, slow growing, tumor, postmenopause
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Describe tubular ductal carcinoma
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prognosis is excellent, metastases is uncommon
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Describe inflammatory carcinoma
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-malignant cells blocking the lymph channels in the skin
-rare, aggressive, diffused edema, brawny erythema, peau d'orange, |
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Describe Paget Disease
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-ductal carcinoma in situ of nipple with potental invasive component
scaly, erythematous, pruritic lesion of the nipple |
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What are the risk factors of breast cancer?
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female gender, increasing age, personal hx of brest cancer, family hx, genetic mutations, early menarch, late menopause, nulliparity, first child after 30, hormone therapy, exposure to radiation as a child, hx of benign proliferative breast disease, obesity, high fat diet, alcohol intake, smoking
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What are prevention strategies for high risk patients?
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long-term surveillance, chemoprevention, prophylactic mastectomy
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What are the s/s of breast cancer?
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early signs- nontender, fixed, hard, irregular lesion, usually in upper outer quadrant
Later signs- skin dimpling, nipple retraction, skin ulceration |
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What are the stages?
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Stage 0- paget disease, DCIS, LCIS no invasion
Stage 1- tumors <2cm with no involvement of axillary lymph nodes Stage 2- A,B Stage 3- A,B,C Stage 4- tumor with distant metastasis |
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What is the prognosis?
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based on tumor size and location, most common route of regional spread is axillary lymph nodes
common sites of metastasis are: bone, lung, liver, pleura, adrenals, skin, brain |
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What are favorable factors assoc with breast cancer?
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noninvasive tumors, tumors <1cm, negative axillary lymph nodes, estrogen receptor and progesteron receptor proteins, well-differentiated tumors, low expression of HER-2, no vascular or lymphatic invasion, diploid tumors with low S-phase fraction
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What is a modified radical mastectomy?
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removal of entire breast tissue, plus axillary lymph nodes, used for invasive cancer
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What is a total mastectomy?
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removal of breast and nipple-areola complex, used for non-invasive cancer
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What are other surgery treatments for breast cancer?
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lumpectomy, wide excision, partial/segmental mastectomy, quadrectomy, sentinel lymph node biopsy
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What are side effects of removal of axillary lymph nodes?
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lymphedema, cellulitis, decreased arm mobility, sensory changes, hematoma, infection
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How does lymphedema occur and what are the risk factors?
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-once axillary lymph nodes are removed collateral circulation must assume the role, if it does not edema occurs
-incr age, obesity, presence of axillary disease, radiation, injury or infection |
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What preventive things can be done for lymphedema and is it chronic?
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-exercises, arm over heart several times per day, gentle muscle pumping, injury or trauma prevention
-can be chronic |
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Describe patient education for lymph node dissection?
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avoid BP, injections, blood draws in extremety, use sunscreen, apply insect repellent, wear gloves when gardening, use cooking mitts, avoid cutting cuticles, use electric razor, avoid lifting, if trauma or break in skin occurs wash immed apply antibacterial ointment and watch
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Describe hematoma and seroma complications
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-hematoma- collection of blood inside the cavity, swelling, tightness, pain, bruising, may return to OR or allowed to reabsorbed
-seroma- collection of serious fluid, swelling, heaviness, discomfort, sloshing of fluid, usually go away on their own |
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When are drains usually removed?
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when output in <30mL in a 24 hour period
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Describe radiation therapy for breast cancer
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delivers high=energy photons from linear accelerator, usually given after lumpectomy, if contraindicated radical mastectomy is done instead
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What are 3 types of radiation therapy?
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external beam radiation, brachytherapy (partial breast rad at lumpectomy site), intraoperative radiation therapy (in surgery during lumpectomy)
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What are the side effects of radiation therapy?
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fatigue, skin breakdown, erythema, edema, pneumonitis, rib fracture, breast fibrosis
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What are contraindications for radiation therapy?
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pregnancy, multicentric breast disease, prior radiation, collagen vascular disease, large tumor to breast ration, tumor beneath nipple
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What nurse management is taught for radiation therapy?
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maintanence of skin integrity:
-mild soap, minimal rubbing -avoid perfumed soaps or deodorants -use antipruritic soap -avoid tight clothing -sunscreen |
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Whom gets chemotherapy and what is it dependent on?
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-those with positive lymph nodes or invasive tumors >1cm
-usually after surgery but before radiation (3-6 months in length) -based on tumor characteristics, pt's age, physical status, comordidities |
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What is dose-dense chemotherapy?
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admin of chemo agents at standard doses with shorter time intervals between
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What are the side effects of chemo?
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N/V, bone marrow suppression, taste changes, alopecia (hair loss), mucositis, skin changes, fatigue, weight gain, peripheral neuropathy, arthralgias, myalgias, neutropenia, anemia
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What is adjuvant hormonal therapy?
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use of hormonal therapy to compete with estrogen (used for estrogen causing tumors)
-tamoxifen-estrogen antagonistic (prevent binding of estrogen to receptor site -aromatase inhibitors- block enzyme that allows circulation of estrogen |
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What are the side effects of hormonal therapy?
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hot flashes, vaginal dryness, irreg mensus, N/V, mood disturbances, inc risk for endometrial cancer, DVT, osteoporosis, fatigue
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What are common reconstruction surgeries after mastectomy?
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tissue expander followed by permanent implant, transverse rectus abdominis mycutaneous, TRAM flap, nipple-areola reconstruction
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What 2 genes can be tested for using a blood test?
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BRCA-1, BRCA-2
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What are the effects of breast cancer and pregnancy?
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can occur from increased levels of hormones following preg and lactation, radiation maybe done in trimester, chem in second and third, many chemo agents can lead to infertility
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Define gynecomastia?
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overdeveloped breast tissue commonly found in males
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What can cause gynecomastia and how is it treated?
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medication, testicular tumors, testes infections, liver disease, parasitic infection
-usually resolves on its own, surgical removal or liposuction can also be performed |
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What are the risk factors for men and breast cancer?
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BRCA-2 gene, history of mumps orchitis, radiation exposure, Klinefelter's syndrome, liver disease (inc estrogen), parasitic infection
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What are the s/s and treatment for men with breast cancer?
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-painless lump beneath areola, nipple retraction, bloody nipple discharge, skin ulceration
-total/radical mastectomy, chemo, radiation, estrogen receptor tamoxifen |
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What is the Breast Imaging Reporting and Data System (BIRADS) score?
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This indicates the radiologist's opinion of the absence or likelihood of breast cancer
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Describe the BIRAD levels?
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0- incomplete, not enough info to diagnosis, repeat mamo
1- negative 2- benign, routine mamos 3- probably benign, follow up in 6 months 4- suspicious, biospy recommended 5- highly suspicious, take approp action 6- known malignancy, treat |
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What is herceptin?
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monoclonial antibody used to treat breast cancer
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