Women's Health And Breast Disorders

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fibroadenoma

Back 1

common benign breast tumor
seen in teens- early 30's
freely movable, solid tumor
well defined
excision with needle aspiration of mass

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fibrocystic breast

Back 2

fluid filled lesions
most frequent benign breast condition
most prevalent in ages 20-50
rare in women not taking HRT
NOT at risk for cancer

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cause of fibrocystic breast

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hormonal imbalance

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HRT

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Hormonal Replacement Therapy

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Symptoms of fibrocystic breast

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cyclic pain- worse in luteal phase
family history
nodular cysts, mobile and tender
no skin retraction

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Diagnosis of fibrocystic breast

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mammogram
sonogram
palpation
fine needle aspiration

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treatment of fibrocystic breast

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sodium restriction
mild diuretic before menses- decrease fluid retention in breast
vitamin E and Thiamine
evening primrose
decrease caffeine

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Gynecomastia

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hypertrophy of male breasts
one or both
is a symptom, not a disease

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cause of gynecomastia

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have increased estrogen- possibly from fat cells
liver disease
hyperthyroidism
chronic renal failure
exacerbated by some drugs
evaluate for cancer

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treatment of gynecomastia

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weight loss
anti-estrogen
reductive surgery

Front 11

breast cancer

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a group of malignant deseased that usually occur in the female breast and infrequently in the male breast

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incidence of breast cancer

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1/8 women
most common Cancer in women
2nd leading cause of mortality

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prognosis of breast cancer

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depends on stage at diagnosis
localized and no regional spread- 75-90%
small tumor and no lymph nodes involved- 90% 5 year survival rate
axillary lymph node involvement- 40-50% survival rate

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Infiltration Ductal carcinoma (IDC)

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80% of cases of breast cancer
non invasive if tumor is confined to duct
invasive if tumor penetrates surrounding tissue
originates in epithelial tissue lining of mammary ducts
poorest prognosis of ductal carcinomas

Front 15

medullary carcinoma

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found in 5-7% of breast cancer
better prognosis

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Mucinous (colloid) carcinoma

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3% of breast cancer
often occurs with other breast cancer
prognosis is good if breast cancer is predominately mucinous

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tubular carcinoma

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often occurs with other breast cancers

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infiltrating lobular carcinoma

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5-10% of breast cancers
ill defined area of ticking rather than lump

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paget's disease

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1-4% of breast cancer
long history of crusting and scaling skin changes in nipple with burning, itching, or bleeding

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inflammatory breast cancer

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rapidly growing
first manifestations are breast skin edema and redness
looks like orange peel

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complications of breast cancer

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edema from blocked lymph channels
orange peel skin
ulceration of overlying skin
matastisis to other organs- bone (c/o bone pain), lungs, brain, and liver

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etiology of BC

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unknown

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Risks for BC

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advancing age
family member with BC
high dose radiation
early menarche with late menopause- prolonged exposure to estrogen
history of previous BC
Nulliparity
first birth after age 30

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reproductive asessment of BC

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mammogram
US- differentiates fluid lesions from solid lesions

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Mammogram recomendations

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every year over 40 unless family history indications
clinical breast exam should be done close to the scheduled mammogram

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diagnostic tools for BC

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thermography-measures metabolic activity in tissue
biopsy- excising tumor or part of it for study

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breast self-exam

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early detection is goal
5 days after period
monthly on women over 20

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manifestations of BC

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unilateral mass often in upper outer quadrant
usually painless, nontender, hard, irregular and nonmobile

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psychosocial assessment of BC

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fear of cancer
threats to body image, sexuality, intimate relationships, and survival
decisional conflict r/t treatment

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BC diagnostics

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tumor markers
biopsy
exam of lymph tissues
liver enzymes- check for mets
calcium and alkaline phosphatase- check bone mets
mammogram and US studies
estrogen and progesterone receptors

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Nursing diagnosis and BC

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anxiety
anticipatory grieving
pain
sleep pattern disturbance
body image distrubance
sexual dysfunction

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non surgical management of BC

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usually with late stage BC
due to physical condition
chemo, radiation, or both

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surgical managment of BC

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axillary lymph node dissection-staging
lumpectomy- removal of cancer and magin of normal tissue
partial mastectomy- removes part of the breast in which the cancer is located

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Modified radical mastectomy

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removal of breast, axillary lymph nodes and overlying skin

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Total (simple) mastectomy

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resection of breast tissue and some skin from clavicle to costal margin- axillary nodes not removed

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standard radical mastectomy

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removal of breast, overlying skin, pectoral muscles and axillary nodes

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surgical hormonal manipulation

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removal of ovaries, hypophysectomy, bilateral adrenalectomy

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adjuvant therapy for BC

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after surgery, radiation and/ or chemo and/or hormonal therapy used

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purpose of adjuvant therapy for BC

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to decrese risk of recurrence

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BC post op care

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no procedures in affected arm
monitor drains and I&O
observe for infection
ambulation and regular diet next day
support arm on affected side
teach exercises after DC
avoid injury of that arm for lifetime
support groups