Breast Cancer

Breast cancer

Breast cancer

type of cancer that starts in breast

usually from a tumor that can often be seen on an x-ray or felt as a lump

common in women but men can also get it too

breast cancer

Risk factors for Breast Cancer (GAHRA ONNUB)

Gender
Age
Hereditary
Race and Ethnicity
Alcohol intake
Obesity
Not being physically active
Nulliparous women
Using birth control/contraceptives
Breast implants

Gender

main risk factor for breast cancer

Age

as they grow older, risk of breast cancer goes up

most breast cancers are found in women age ____

55 and older

__________of breast cancer are thought to be hereditary

5% to 10%

Race and Ethnicity

African American women are more likely to develop breast cancer

Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer

Alcohol Intake

Women who have 1 alcoholic drink a day have a small (about 7% to 10%) increase in risk compared with non-drinkers

Women who have 2 to 3 drinks a day have about 20% higher risk than non-drinkers

Obesity

can increase the risk of the breast cancer coming back (recurrence) in women who have had the disease

Fat tissue (adipose tissue) produces excess amounts of _________; high levels have been associated with increased risks of breast, endometrial, ovarian and some other cancers

estrogen

______________ is responsible for 3.2% of breast cancer cases, and is associated with a higher risk of developing breast cancer

Physical inactivity

Nulliparous Women

Never given birth to a live baby

Also to a woman who has had a pregnancy loss or elective abortion

Using birth control/contraceptives

risk decreases over time after stopping the pill

Birth control pills contain synthetic versions of estrogen and progesterone, which can stimulate the growth of some cancers

Breast implants

not at a higher risk of developing breast cancer but rather in the tissue around the breast implant

called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) *around the breast implant

Breast cancer stage

refers to how far the cancer cells spread beyond the original tumor

Ductal Carcinoma in SITU (DCIS)

very common

noninvasive

located in the milk ductus

Invasive Lobular Carcinoma (ILC)

10% of breast cancers

tumor starts in the milk-producing lobules and spread

Invasive Ductal Carcinoma (IDC)

80% of breast cancers

started in a milk duct and has spread

Triple Negative Breast Cancer

Uncommon cancer

Tested negative for three hormone receptors; fuel most breast cancers

Tends to spread easily and to recur

SITU

in the original place

Most common symptoms (NTSR)

new lump or mass

tender, soft

round

Signs and Symptoms

• swelling of all or part of the breast

• skin irritation or dimpling

• breast pain

• nipple pain or the nipple turning inward

• redness, scaliness, or thickening of the nipple or breast skin

• a nipple discharge other than breast milk

• a lump in the underarm area

50% located in the

upper outer quadrant of the breast

Assessment

• firm lump or thickness in breast

• painless

• 50% located in the upper outer quadrant of the breast

• Spontaneous nipple discharge; may be bloody, clear or serous

• Asymmetry of the breast may be noted as the woman changes positions

  • Compare one breast with the other

• Nipple retraction or scaliness (esp. Paget’s disease)

• Enlargement of auxiliary or supraclavicular lymph nodes may indicate metastasis (spread of cancer cells from the original tumor to other parts of the body)

Screening test (mammograms)

yearly

given routinely to people who appear to be healthy and not suspecting of having breast cancer

most accurate method of detecting non-palpable lesions

Ultrasonography

may be used to distinguish cysts from solid masses

Biopsy

confirms diagnosis and determines the type of breast cancer

given to people who are suspected of having breast cancer; symptoms may be experienced or a screening test result

monitoring tests

monitor how well therapies are working

used to check for any signs or recurrence

Estrogen or progesterone receptor assays, proliferation or S phase study (tumor aggressive), and other test of tumor cells

determine appropriate treatment and prognosis

blood testing

detects metastasis

includes liver function tests to detect liver metastasis

calcium and alkaline phosphatase levels to detect bony metastasis

X-ray and CT Scan

detect metastasis

Stage 0

LCIS or DCIS

abnormal cancer cells are present either in the lining of breast lobule or duct; have not spread to the surrounding fatty tissue

Stage I

invasive

infiltrating cancer

has spread from lobules and ducts to nearby tissue in the breast

has 2 cm or less in diameter tumor

not spread to lymph nodes

Stage II

tumor can range from about 2 cm to less than 5 cm in diameter

lymph nodes sometimes not involve

Stage IIIA

tumor is 5 cm or greater in diameter

have grown extensively into axillary (underarm) lymph nodes

Stages IIIB/IIIC

locally advanced cancer

tumor may be of any size

has spread into the skin of breast, tissues of chest wall, lymph nodes near collarbone

Stage IV

metastatic

cancer has spread from the breast to other parts o the body; bone, liver, lung, or brain

Local treatments

treat tumor without affecting the rest of the body

Breast Conserving surgery

aka. lumpectomy, quadrantectomy, partial mastectomy or segmental mastectomy

Surgery in which only part of the breast containing the cancer is removed

Mastectomy

entire breast is removed

Systemic treatments

can be given by mouth or into bloodstream

Chemotherapy

Hormone therapy

Immunotherapy

Chemo may be given directly into ______ which surrounds brain and spinal cord

spinal fluid

The more the breast cancer has spread, ______________

the more treatment you will likely need

Treatment of TRIPLE-NEGATIVE breast cancer

chemotherapy is the main systemic option

it responds well to chemo but tends to come back more frequently

Monitor for adverse effects of radiation therapy (FSDNA)

• Fatigue

• Sore throat

• Dry Cough

• Nausea

• Anorexia

Adverse effects of Chemotherapy (BNAW FSA)

• bone marrow suppression

• nausea and vomiting

• alopecia

• weight gain or loss

• fatigue

• stomatitis (cold sores in lips)

• anxiety and depression

What should be administered for patients receiving chemotherapy

antiemetics

IV fluids

hyperalimentation (parenteral nutrition TPN)

Discharge Guidelines

Patient will be discharged with dressings and wound stains

• empty the drainage receptacle twice a day

• record the amount on a flow sheet, and take this information along when keeping a doctor’s appointment;

• report symptoms of infection or excess drainage on the dressing or the drainage device

• sponge bathe until the sutures and drains are removed

• continue with daily lower arm ROM exercises until the surgeon orders more strenuous exercises

• avoid caffeinated foods and drinks, nicotine, and secondary smoke for 3 weeks postoperatively.

• Review pain medication instructions for frequency and precautions

• Request no blood pressure or blood samples from affected arm

• Do not carry packages, handbags, or luggage with the affected arm; avoid elastic cuffs

• Protect the hand and arm from burns, sticks, and cuts by wearing gloves to do gardening and housework

  • using a thimble to sew

  • applying sunscreen and insect repellent when out-of-doors

  • Report swelling, pain, or heat in the affected arm immediately

  • Put the arm above the head and pump the fist frequently throughout the day