In-Depth Notes on Breast Cancer

Overview of Breast Cancer

• Two main categories:
• Invasive Breast Cancer: Cancer that invades surrounding breast tissue.
• Non-Invasive Breast Cancer: Cancer that remains in the ducts, not spreading.

Common Sites of Metastasis

• Most common locations include:
• Brain
• Bone
• Liver
• Lung

Types of Breast Cancer

• Non-invasive:
• Ductal Carcinoma In Situ (DCIS):
  • Early form of breast cancer, detected via screening, generally curable.
• Invasive:
• Invasive Ductal Carcinoma (IDC):
  • The most common type of breast cancer, characterized by irregular lumps.
• Inflammatory Breast Cancer (IBC):
  • Less common but aggressive form of invasive breast cancer.

Symptoms of Invasive Breast Cancer

• Irregular, poorly defined lumps.
• Breast dimpling, resembling skin texture of an orange.
• Nipple pitting (a late sign, indicating possible advanced disease).
• Skin changes, including hyperpigmentation and thickening.

Genetic Factors

• Significant genetic components:
• BRCA mutations (BRCA1 and BRCA2): Major risk factors.
• Other mutations: ATM, and others.
• Family history increases risk.
• Statistics:
• 1 in 8 women will develop breast cancer in their lifetime.

Risk Factors

• Increased age.
• Early menarche and late menopause.
• Obesity and physical inactivity.
• Hormone Replacement Therapy (HRT) post-menopause.
• Alcohol consumption.
• Mortality rates are higher in Black women compared to White women (40% increase).

Screening and Early Detection

• Importance of screenings for both men and women, especially those with genetic predispositions.
• Self Breast Exams (SBE):
• Should be done monthly, ideally on the same day.
• Clinical Breast Exams (CBE):
• Conducted by a qualified healthcare provider.
• Mammography:
• Typically starts at age 40, with annual screenings at 45 for average risk.
• High-risk individuals may start earlier and may require additional imaging like MRI.

Pathologic Studies and Diagnosis

• The only definitive diagnosis of breast cancer requires a biopsy.
• Assessment of lymph nodes to check for metastasis.

Chemotherapy Management

• Administration methods: oral and IV.
• Precautions include wearing chemotherapy gloves and being aware of extravasation risks.
• Care during treatment includes avoiding procedures (blood pressure checks, IVs) on the affected side post-mastectomy to prevent lymphedema.

Treatment Options

• Surgical Treatments:
• Options include lumpectomy, mastectomy (single or double), focusing on complete removal of cancerous tissue.
• Radiation Therapy:
• Types include teletherapy (external) and brachytherapy (internal).
• Brachytherapy requires precautions due to radioactivity.
• Complementary Therapies:
• Techniques may include meditation, acupuncture, and other supportive therapies.

Psychosocial Considerations

• High levels of anxiety and panic attacks upon diagnosis are common; emotional support is crucial.
• Importance of counseling and community resources.

Care Coordination and Ongoing Management

• Home care needs assessed, particularly post-surgery with potential drains.
• Patients monitored for lymphedema, ensuring precautions in handling the affected side.

Outcome Goals

• Aim for no recurrence or metastasis.
• Supportive care through palliative and hospice services if metastasis occurs.

Conclusion

• Continuous education and awareness about breast cancer are key in reducing risks and improving outcomes.
• Engage patients in discussions about feelings and impact on life, including body image concerns post-treatment.