Breast Cancer

Invasive lobular carcinoma

Cancer that exists in the lobes, milk-producing glands, of the breast. This cancer is likely to exist in both breasts.

Invasive ductal carcinoma

Cancer that exists in the milk ducts of the breast. Most common form of breast cancer.

Paget’s breast cancer

Cancer that effects the nipple of the breast.

Angiosarcoma

Cancer that lines the blood vessels and lymph vessels.

Mammography

X-ray of the breast while its squished between two plates to view the tissue. Gold standard to find cancerous growths.

When should women start mammograms (no family history of cancer)?

At the age of 40

When should women start mammograms (history of breast cancer present)?

10 years prior to the diagnosis of the cancer patient (mom having cancer at 45, mammograms for daughter would start at 35).

How often should a mammogram be performed?

Every 3 years until the age of 40, but every year after the age of 40.

When should women be taught to do self breast exams?

When they hit puberty.

What factors increase the risk of breast cancer?

Genetics, hormonal factors, environment, obesity, BRCA mutation, alcohol use, smoking, sedentary lifestyle, and night shift work.

What are the protective factors of breast cancer?

Breastfeeding for over a year, regular to moderate physical activity, and maintaining a healthy body weight.

What are the S/S of benign breast masses?

Frequently painful, firm but rubbery mass, bilateral masses, induced nipple discharge, regular margins of tumor, no skin dimpling, no nipple retraction, mobile and not affixed to the chest wall, and no bloody discharge.

What are the S/S of malignant breast masses?

Hard mass, painless, irregularly shaped mass, immobile/affixed to chest wall, skin dimpling, nipple retraction, unilateral mass, bloody and/or serous nipple drainage, spontaneous nipple discharge.

Stage 0 breast cancer/ in situ

An early form of cancer that is non-invasive. Starts in the milk duct.

Stage 1 breast cancer

Localized tumor that is under 1 inch in diameter

Stage 2 breast cancer

Tumor that is 1-2 inches in diameter, spreads to axillary lymph nodes.

Stage 3 breast cancer

Tumor is 2 inches or larger, spreads to other lymph nodes and tissues.

Stage 4 breast cancer

Cancer has metastasized to other body organs.

Inflammatory breast cancer

Invasive ductal cancer that differs in S/S and treatment options. It is harder to diagnose and accounts for 1-5% of all breast cancers. It often does not cause a lump, and the symptoms are caused by a blockage of lymph vessels. This cancer is not typically found until stage 3 or 4.

What are the S/S of inflammatory breast cancer?

Edema and redness, pitting or thickening of skin, inverted or retracted nipple, size differences in breast, tender, painful, and itchy breast, swelling of the axillary and/or supraclavicular lymph nodes.

How is inflammatory breast cancer treated?

Tumor removal followed by chemotherapy, then followed by radiation therapy.

Triple negative breast cancer (TNBC)

A form of breast cancer that is estrogen, progesterone, and HER2 negative. It grows and spreads quickly, has the worst prognosis, and has few treatment options. It accounts for 10-15% of all breast cancers.

In what populations is triple negative breast cancer more common in?

Women under the age of 40, black, and BRCA 1 mutation.

What are the treatment options for triple negative breast cancer?

Surgery and chemotherapy are the only existing options.

What are the treatments for breast cancer as a whole?

Local (radiation, surgery) and systemic (chemo, hormone, targeted, immunotherapy).

What are the two forms of radiation therapy?

External beam (most common, whole breast or chest wall), and brachy therapy (internal device, dependent on tumor size and location).

What treatments can occur during radiation? What treatments must be performed before or after?

Hormone and targeted therapy can go along with radiation. Radiation cannot be done until a surgical site is healed, cannot be done during chemo.

What are the short-term side effects of radiation?

Swelling in the breast, skin changes, anorexia, and fatigue.

What are the long-term effects of radiation?

Breast shrinking, skin changes, unable to breastfeed from effected breast, less reconstructive options for breast, weakened ribs, and brachial plexopathy (numbness and/or weakness of arm).

What are the side effects of brachytherapy?

Redness or bruising of injection site, fluid collection in the breast, pain, infection, damage to fatty tissues in breast, weakness, and rib fractures.

Breast conserving surgery

Removes the tumor and some surrounding tissue.

Mastectomy

Removal of the entire breast.

Sentinel lymph node biopsy

a surgical procedure to identify and remove the first lymph node(s) to which cancer is likely to spread, helping determine if cancer has spread beyond the primary tumor. Surgeon injects blue dye that cancerous lymph nodes absorb, those nodes are removed.

Axillary lymph node dissection

a surgical procedure to remove lymph nodes from the armpit to check for cancer. It is typically performed to determine if cancer has spread to the axillary lymph nodes.

When does breast reconstruction take place?

It can happen after the breast is fully healed or directly after tumor removal, plastic surgeon and general surgeon are present in the OR.

Chemotherapy

Drugs that kill systemic cancers. It targets the malignant cells, but also innocent cells of the skin, hair follicles, mouth, GI tract, and bone marrow. It typically lasts for 3-6 months and can be given before surgery (neoadjuvant) or after surgery (adjuvant).

What drugs fall under the umbrella term of chemotherapy?

Anthracyclines (doxorubicin, epirubicin), taxanes (paclitaxel, docetaxel), 5-FU, cyclophosphamide, and carboplatin.

What are the typical chemotherapy side effects?

Nausea and vomiting, diarrhea or constipation, hair loss, weight loss, stomatitis, fatigue, and immunosuppression.

Hormone therapy

Used as an adjuvant therapy. Reduces the risk of cancer returning and typically taken for up to 5 years.

What are the four classes of hormone therapies?

Selective estrogen receptor modulators (SERMs), selective estrogen receptor degraders (SERDs), aromatase inhibitors, and ovarian suppressors.

Selective estrogen receptor modulators (SERMs)

Blocks estrogen receptors so the cancer cannot feed off of estrogen. Taken PO.

Ex. Tamoxifen

Selective Estrogen Receptor Degraders (SERDs)

Blocks estrogen receptors. Most often given post-menopause but can be given pre-menopause with LHRH agonists (causes medical menopause). Given day 1, 15, 29, then monthly.

Ex. Faslodex

Aromatase inhibitors

Stops most estrogen production. Taken PO.

Ex. Letrozole and Anastrozole

Ovarian Suppressors

Used for pre-menopausal women to cause medical menopause. Recommended if there is a high risk of cancer recurrence.

Ex. Oophorectomy (removal of ovaries), LHRH agonists, chemotherapy

How long can a woman be on LHRH agonists until they require a break?

6 months to a year

What are the side effects of hormone therapy?

Menopausal symptoms.

Hot flashes, bone pain and thinning, insomnia, weight gain, depression, fatigue, mood swings, constipation, nausea, cough, dyspnea, and headache.

Targeted therapy

These drugs are directed at the proteins on the cancer cells. Goal is to destroy the cell or at least inhibit growth. The drug is specific to the cancer being treated and can be used alongside other treatments.

Immunotherapy

Boosts the immune system. Uses checkpoints to assess and start immune response so that we aren’t attacking normal cells.

Ex. PD-1 inhibitor → Pembrolizumab (Keytruda) IV q3-6wks.

What forms of breast cancer can men get?

DCIS, LCIS, invasive, and inflammatory. Invasive ductal carcinoma is the most common form in men.

Gynecomastia

Most common male breast disorder, increased amount of breast tissue aka a mass behind the breast.

How can a nurse care for a breast cancer patient?

Provide education, emotional support, and treatment-related care.