chapter 6 OB: Disorders of breasts

Benign breast disorders

• fibrocystic breast

• fibroadenomas

• mastitis

Fibrocystic breast

• overgrowth of fibrous tissue in connect tissue in breast

• can be accompanied by cysts

• lumpy feeling move freely; oatmela/rice krispy

• noncancerous lesions are fixed and painless

• pain is cyclic and dissipates after onset of menses

  • response of breast tissue to monthly estrogen and progesterone levels

• most common breast disorder affecting women between 20-50

• rare in postmenopasual women

• therpp management: self-care; meds for severe cases

FIBROCYSTIC BREAST

• assessment

  • lumpy tender breast bilaterally primarily during week before menses

  • dull aching fullness

  • possible clear to yellow nipple discharge

  • fibrosis or thickening early on; cyst formation in later stages, cysts usually mobile and tender without skin retraction

  • mammography (yearly after age 35) and ultrasound

• Management

  • education about condition

  • self care tips (OTC, supportive bra, limit caffeine)

  • monthly breast self exam after menses for changes

Fibroadenomas

• proliferative lesions without cell abnormalities

• benign SOLID breast tumor

• made of both fibrous and glandular tissue

  • between women ages 15-25

• feels round, oval, rubbery, smooth and are MOBILE

• also known as hyperplastic lesions

Fibroadenomas assess and manage

Assessment

• firm, rubbery, well circumscribed feely mobile nodules w/ or w/o tenderness (from hormone surge or not)

Management

• reevaluation in 6 months, monthly breast self exam, and annual clinical breast examination

Treatment:

• watchful waiting, surgery, cryoablation (freezing)

mastitis

• Infection/inflammation of the connective tissue in the breast primarily in lactating or engorged women

• 2 Types

  • Lactational

    • Caused by Staph Aureus or Hemophili Influenza (bacteria from baby biting)

  • Non-lactational

    • Secondary to trauma, RA, steroid treatment, DM(high sugar feeds infection)

    • Usually seen as a periareolar abscess

• Treatment

  • PCN resistant antibiotics

  • Cephalosporin

Matitis A&M

assess

• risk factors, flu-like symptoms; warm, red, tender, swollen breast, crack or abraded nipple

manage

• continue breastfeeding/emptying breast; medications; proper infant positioning at nipple; warm compress; handwashing, supportive bra

Treat

• antibiotic

MALIGNANT BREAST DISORDERS

• Breast CA is most common cancer in women

• Second leading cause of CA deaths

• 1 in 3 cancers diagnosed

• Complex interaction between environment, genetics, and hormonal factors

• Progressive rather than systemic disease unless it metastasizes

• 2 Types

• Non-invasive

• Invasive - traveled to other areas

Staging breast cancer incorporates

• grade (0-4)

• estrogen receptor status

• progesterone receptor status

• HER 2 (blood test testing genetic markers)

• tumor size

• lymph node involvement

• evidence of metastasis

Breast cancer characteristics

• O: in situ; early type of breat cancer

• I: localized tumor <1 in in diameter; survival rate: 80-90%

• II: Tumor 1-2 in in diameter; spread to axillary lymph nodes; survival rate: 50%

• III: Tumor 2 in or larger; spread to other lymph nodes and tissues

• IV: cancer has metastasized to other body organs

breast cancer risk factors

modifiable

• not having children

• children past age 30

• use of postmenopausal; hormone therapy

• not breastfeeding

• alcohol consumption

• smoking obesity

• sedentary lifestyle

breast cancer risk factors

non-modifiable

• Gender

• Aging

• Genetic mutations (BRCA 1 & 2)

• Hx of ovarian or colon CA

• Increased breast density

• Family Hx of breast CA

• Previous abnormalities to breast biopsy

• Exposure to chest radiation

• Early menarche

• Late onset menopause

breast cancer diagnosis

• Mammography

• MRM: magnetic resonance mammography

• fine needle biopsy - identifies solid tumor, cyst, fluid

• Stereotactic needle biopsy

• Sentinel lymph node biopsy - check if spread to lymph nodes and checks fluid

• Hormone receptor status

Breast cancer therapeutic management

surgical options

• breast conserving surgery

  • least invasive

  • used for early stages of localized tumors (0-1)

  • may receive radiation 2-4 weeks after surgery

• mastectomy

  • simple

    • removes all breast tissue, nipple, areola

  • radical

    • removes breast tissue and positive axillary nodes

beast augmentation

• common surgical procedure involving implants

  • saline filled

  • location typically is subglandular (over the pectoral muscle) or subpectoral (under muscle)

  • implants not lifetime devices, but most are guaranteed for approximately 10 years

• Risks

  • capsular contracture, rippling, implant rupture, infection, or hematoma

breast cancer adjunct therapy

• Radiation

  • High energy rays to destroy cancer cells that may have been left behind

• Chemo

  • Toxic to all cells, interferes with cells ability to reproduce

• Hormonal therapy

• Works in 1 of 3 ways: blocks estrogen, prevents body from producing estrogen, eliminates hormone receptors cells

• Immunotherapy

• Represents bodies natural defenses to recognize and attack cancer cells

• Targets HER 2 pathway

late signs of bc

continued and persistent changes in breast

hump or thickeing in one breast

persistent nipple irritation

unusual swelling and assymetry

lump or swelling in axilla

changes in skin color or texture

nipple retraction

BC assessment

• often asymptomatic; possible changes in appearance or contour

• clinical breast exam

• characteristics of mass

BC diagnosis. and interventions

NANDA

• disturbed body image

• fear

• deficient knowledge

Interventions

• emotional support

• education

• post operative care

  • immediate post op care

  • pain management

  • affected arm care

  • wound care

  • mobility care

  • respiratory care

  • education

Promotion and prevention of breast cancer

• Breast Cancer Screening

• Breast self exam (BSE)

• Clinical breast exam (CBE)

• Mammo

• Nutrition and Lifestyle

• Decrease alcohol consumption

• Increase fruits and vegetables

• Increase physical activity

• Smoking cessation

• Limit fatty foods especially of animal origin