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63 Cards in this Set
- Front
- Back
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What is the key to effective treatment and survival for breast cancer?
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Early detection (since prevention is currently not a viable option)
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What is the most common type of breast cancer?
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Infiltrating ductal carcinoma (80%)
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What is the 5-year survival rate for breast cancer?
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1. 97% for localized breast cancer
2. 79% when the breast cancer has spread to the regional lymph nodes 3. Survival drops to only 23% when the breast cancer is metastatic |
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When is breast cancer classified as invasive?
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When it penetrates the tissue surrounding the duct
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What is fibrosis?
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Replacement of normal cells with connective tissue and collagen around the cancer
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What is the complication of fibrosis?
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Causes shortening of Cooper's ligaments and the resulting typical skin dimpling that is seen with more advanced disease
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What are the complications of tumors invading the lymphatic channels?
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1. Blocks skin drainage and causes skin edema and an "orange peel" appearance of the skin (peau d'orange)
2. Ulceration of the overlying skin over time since the cancer replaces the skin itself |
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What causes metastasis?
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Seeding of the cancer cells into the blood and lymph systems, which permits spread of these cells to distant sites
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What are the most common sites of metastasis of breast cancer?
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1. Bone
2. Lungs 3. Brain 4. Liver |
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What is the prevalence of breast cancer in men?
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About 1% of all cases
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What is the age of onset of breast cancer in men?
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At or after age 60 years
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What causes breast cancer in men?
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A genetic mutation in either the BRCA1 or the BRCA2 gene
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What are the clinical manifestations of men with breast cancer?
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Usually present with a hard, nonpainful, and subareolar mass
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What is the genetic risk factor of breast cancer?
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1. Women with a family history of breast cancer, particularly a history of a first-degree relative (mother, sister, or daughter) with premenopausal breast cancer, have a THREEFOLD risk increase
2. This risk is further increased if the relative either had breast cancer in both breasts or was diagnosed before 40 years of age 3. Family history includes multiple relatives with breast cancer, early age at diagnosis, and in some families, ovarian cancer |
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What are the risk factors of breast cancer?
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1. Female gender
2. Exposure to high-dose ionizing radiation to the thorax (especially before 20 years of age) 3. Early menarche (before 12 years of age) 4. Late menopause (after 50 years of age) 5. A history of previous breast cancer 6. Nulliparity (no pregnancies) 7. First birth after 30 years 8. Diet high in animal fats 9. Alcohol consumption 10. Long-term estrogen replacement therapy 11. Obesity may be a factor associated with the development of breast cancer in postmenopausal women |
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What are the approaches for early detection of breast cancer?
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1. Mammography
2. Breast self-exam (BSE) 3. Clinical breast exam (CBE) |
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What is the recommended screening activity for women ages 20-39 years?
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1. Monthly breast self-exam (BSE)
2. Clinical breast exam q 3 years |
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What is the recommended screening activity for women 40 yrs and older?
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1. Monthly BSE
2. Annual CBE 3. Annual screening mammography (2 views of each breast) |
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What are the barriers to mammography compliance?
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1. Fear of radiation
2. Fear of results 3. Concern about pain 4. Lack of education |
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What is the benefit of BSE?
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Detection of breast cancer before axillary node invasion increases the chance of survival
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What is the proper timing of BSE for premenopausal women?
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1 week after the menstrual period. At this time, hormonal influence on breast tissue is minimal, so that fluid retention and tenderness are reduced.
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What is the proper timing of BSE for menopausal women or women not influenced by hormonal fluctutations (i.e. after TAH)?
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Pick a random day each month to do BSE, such as the first day of the month, and do it consistently every month
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What is the proper technique of BSE?
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1. Palpate in a vertical pattern, in a horizontal pattern, or in concentric circles, covering every inch of the breast tissue, including the tail of Spence, which extends from the upper outer quadrant of the breast into the axilla
2. The supraclavicular lymph nodes are palpated for the presence of enlarged nodes by hooking the fingers over the clavicle 3. Finally, the nipple is gently compressed to detect the presence of a discharge. If a discharge is produced, note the "area of the clock" where the breast was compressed when the discharge was released. If there is a history of discharge, the client may be able to express the discharge more successfully than the examiner can and should be asked to do so. |
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What is cancer surveillance?
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A prevention option preferred by most high-risk women
(also known as "secondary prevention") |
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What are the recommendations of cancer surveillance?
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1. Monthly BSE beginning by 20 years of age
2. CBE every 6 to 12 months beginning at 25 to 35 years of age 3. Annual mammography beginning at 25 to 35 years of age |
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What is a prophylactic mastectomy?
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Preventive (and controversial) surgical breast removal that is another option for reducing the risk of breast cance
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Does a prophylactic mastectomy eliminate all risks of breast cancer development?
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No, because no mastectomy reliably removes all mammary tissue
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What is chemoprevention?
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Another management option for women at high risk for breast cancer by using combinations of drug therapy
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What drugs are used in chemoprevention?
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1. Selective estrogen receptor modifiers (SERMs), such as tamoxifen citrate (Nolvadex, Tamofen, Tamone)
2. Raloxifene (Evista) 3. Toremifene (Fareston) 4. Droloxifene 5. Idoxifene |
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What are the clinical manifestations of breast cancer?
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1. Any skin change, such as peau d'orange (dimpling, orange peel appearance)
2. Increased vascularity 3. Nipple retraction 4. Ulceration 5. Enlarged lymph nodes 6. Pain or soreness in the affected breast |
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What are the major psychosocial issues of breast cancer?
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1. Fear of cancer
2. Threats to body image, sexuality, intimate relationships, and survival 3. Decisional conflict related to treatment options |
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What is the best practice for assessing a breast mass?
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1. Identify the location of the mass by using the "face of the clock" method
2. Describe the shape, size, and consistency of the mass 3. Assess whether the mass is fixed or movable 4. Note any skin changes around the mass, such as dimpling (peau d'orange), increased vascularity, nipple retraction, and ulceration 5. Assess the adjacent lymph nodes, both axillary and supraclavicular nodes 6. Ask the client if she experiences pain or soreness in the area around the mass |
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What lab assessment indicates possible liver metastasis of breast cancer?
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Elevated liver enzyme levels
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What lab assessment indicates possible bone metastasis of breast cancer?
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Increased serum calcium and alkaline phosphatase levels
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What is the purpose of a mammography?
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Revealing lesions
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What is the purpose of ultrasonography?
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Differentiating lesions as fluid-filled cysts or solid masses
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What are the other prognostic factors of breast cancer?
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1. Presence or absence of estrogen receptors (ER) or progesterone receptors (PR)
2. S-phase index, or growth rate (done by flow cytometry to determine the S-phase fraction, also known as mitotic index) 3. DNA ploidy (the amount of DNA in a tumor cell compared with the amount in a normal cell to determine whether the number of chromosomes in the cancer cells is normal (euploid) or abnormal (aneuploid) 4. Histologic or nuclear grade 5. HER2/neu gene expression |
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What is the significance of the presence or absence of estrogen or progesterone receptors?
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Cancer cells that contain estrogen receptors (ER positive) or progesterone receptors (PR positive) have a better prognosis and usually respond to hormonal therapy
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What is the significance of the Her2/neu gene expression?
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This receptor is related to the growth potential of the cancer cell. When breast cancer cells have excessive numbers of the HER2/neu gene, they grow more rapidly and are relatively resistant to standard therapies. However, there is a targeted therapy, trastuzumab (Herceptin), that blocks these receptors and slows or stops the breast cancer cell growth.
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What is the significance of DNA ploidy?
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Tumors with a high growth rate index and altered DNA content have worse prognoses
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What is the common nursing diagnosis for breast cancer?
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Anxiety related to the diagnosis of cancer
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What is the common collaborative problem of breast cancer?
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Potential for Metastasis
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What is Stage I breast cancer?
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1. Tumor is smaller than 2cm
2. No lymph nodes are positive for cancer 3. No metastases evident |
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What is Stage II breast cancer?
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1. Tumor is 2-5cm
2. 0-1 lymph nodes are positive for cancer 3. No metastases evident |
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What is Stage IIIa breast cancer?
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1. Tumor greater than 5 cm
2. No lymph nodes are positive for cancer cells 3. No metastases evident |
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What is Stage IIIb breast cancer?
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1. Tumor is less than 2cm
2. Axillary lymph nodes are positive for cancer cells 3. No metastases evident |
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What is Stage IIIc breast cancer?
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1. Tumor is 2-5 cm
2. Axillary lymph nodes are positive for cancer cells 3. No metastases evident |
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What is Stage IV breast cancer?
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1. Tumor size varies
2. Lymph nodes may or may not be positive for cancer cells 3. Distant metastases present (brain, lungs, bone, liver, other breast) |
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What are the other nursing diagnoses of breast cancer?
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1. Anticipatory Grieving related to loss and possible or impending death
2. Acute Pain related to tumor compression on nerve endings 3. Disturbed Sleep Pattern related to pain and anxiety 4. Disturbed Body Image related to illness treatment, surgery, or loss of a body part 5. Sexual Dysfunction related to surgery, disease process, or altered body structure |
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What are the intervention activities a nurse can do?
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1. Listen attentively
2. Use a calm, reassuring approach 3. Provide factual information concerning diagnosis, treatment, and prognosis 4. Encourage verbalization of feelings, perceptions, and fears 5. Identify when level of anxiety changes 6. Support the use of appropriate defense mechanisms 7. Determine client's decision-making ability |
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What are the surgical options for Stage I and Stage II breast cancer?
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Breast-conserving surgery (i.e. lumpectomy or partial mastectomy) in which the breast is not removed, just the cancer-affected areas
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What are some postmastectomy exercises?
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1. Hand wall climbing
2. Pulley exercise 3. Rope turning |
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What is the best practice for postoperative care of clients with breast reconstruction?
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1. Assess the incision and flap for signs of infection (excessive redness, drainage, odor) during dressing changes
2. Assess the incision and flap for signs of poor tissue perfusion (duskiness, decreased capillary refill) during dressing changes 3. Avoid pressure on the flap and suture lines by positioning the client on her nonoperative side and avoiding tight clothing 4. Monitor and measure drainage in collection devices, such as Jackson-Pratt drains 5. Teach the client to return to her usual activity level gradually and to avoid heavy lifting 6. Remind the client to avoid sleeping in the prone position 7. Teach the client to avoid participation in contact sports or other activities that could cause trauma to the chest 8. Teach the client to minimize pressure on the breast during sexual activity 9. Remind the client to refrain from driving until advised by the physician 10. Remind the client to ask at the 6-week postoperative visit when full activity can be resumed 11. Reassure the client that optimal appearance may not occur for 3 to 6 months postoperatively 12. If implants have been inserted, teach the proper method of breast massage to enhance expansion and prevent capsule formation (consult with the physician) 13. Review the breast self-examination procedure and the need to continue this practice monthly 14. Remind the client that mammograms should be scheduled at least yearly for the rest of her life |
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What does adjuvant therapy depend on?
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1. The stage of the disease
2. The client's age and menopausal status 3. Client preferences 4. Pathologic examination 5. Hormone receptor status 6. Presence of a known genetic predisposition |
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What is the purpose of adjuvant therapy?
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To decrease the risk of recurrence for the client who has no evidence of but is at risk for metastasis or to prolong survival after metastasis occur
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What is the adjuvant therapy for stage I and stage II breast cancer?
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Breast-conserving surgery with radiotherapy after surgery or of modified radical mastectomy
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What is the purpose of adjuvant radiation therapy?
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To kill breast cancer cells that may remain near the site of the original tumor
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What is the purpose of adjuvant chemotherapy?
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To kill breast cancer cells that may have left the original tumor and moved to more distant sites
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What are the common side effects of chemotherapy?
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1. Nausea and vomiting
2. Hair loss (alopecia) 3. Increased risk for infection because of bone marrow suppression |
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What is the response rate of hormonal therapy?
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50-60%
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What is the primary targeted therapy?
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Trastuzumab (Herceptin) for Her2/neu +
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What are the common side effects of Herceptin?
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1. Headaches
2. Skin rashes 3. Diarrhea 4. Flu-like symptoms of fever, chills, and muscle aches |
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What is the home teaching plan for the client after surgery?
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1. Measures to optimize a positive body image
2. Information to enhance interpersonal relationships and roles 3. Exercises to regain full range of motion 4. Measures to prevent infection of the incision 5. Measures to avoid injury, infection, and swelling of the affected arm 6. Care of the incision and drainage device |
