breast disorders
Terms
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- Mammography
- can detect no palpable masses and help diagnosis palpable masses smaller then 1cm. 5-10% false negatives. Minimal radiation exposure. Use an accredited center. Recommendations
- Galatography
- inject 1 cc of radio-paque material through areola, followed by a mammogram, when discharge is found
- ultrasound (Ultrasonography)
- done with mammogram to distinguish fluid-filled cysts from other lesions. 95-99% accurate in diagnosing cysts but hot definitively rule out malignant.
- MRI
- best tool in diagnosing breast conditiojn with injeciton of dye
- Fine needle aspiration
- use a 21 or f22 needle to withdraw tissue or fluid. Then sent to cytologic for analysis. Not 100% accurate, can get false or negative
- sterotatic biopsy
- breast is positioned though an opening in the table and compressed for a mammogram. Local anesthetic is injected in breast and samples taken to lab. This technique allows accurate diagnosis and often allows the patient to avoid a surgical biopsy
- Surgical biopsy: two types
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1. excisional biopsy - remove the entire lesion, plus a margin of surroundihg tissue, is moved (ex; lumpectomy)
2. incisional biopsy - performed when tissue sampling alone is require (ex: advance cancer) - Mastitis
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inflammation or infecton of the breast tissue occus mostly - breastfeeding women.
Infection cause from microrganisms and bloodhound organisms.
Tx: heat and antibiotic for 7 to 10 days. Rest and hydration - Lactational abscesses
- develop as a consequence of acute mastitis. Breast tender and red, purulent drainage - culture often
- malilgnant tumor
- hard, poor defined, fixed to the skin or underlying tissue, usually nontender
- fibrocystic Breast
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benign condition
fibrocystic breast changes occur in women age 30 to 50yr. Cause Estrogen. The cysts may be painlessw or may become very tender premenstrual. - Danocrine
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fibrocystic breast med
side effects - flushing, vaginitis and androgenic changes.
nursign care - encourage to wear supportive bra and give notrin - fibroadenomas
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benign
late teens to 30- is usually cut out. - benign proliferative disease
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can cause cancer
1. atypical hyper;lasia
2. lobular carcinoma in situ - breast Cancer
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-will affect 1 in 8 women
-incidence rose by 54% in 40 years
-Mortality rate decreasing
-80% diagnosed after age 50 - breast cancer signs
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most tumor found in upper and outer quadrant
lesions no symptoms and non palpable lumps
detected on mammography - classic s/s in later stage
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-dippling or for a peau d' orange
-nipple retraction and lesions fixed to chest wall - BRAC-1
- gene has been linked to the development of breast and ovarian cancer
- BRAC-2
- identifies risk for brease cancer, but less so far ovarian cancer
- risk factors for breast cancer
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BRAC gene
age
familly hx
early menarche, late menopause
nulliparity
ETOH
radiation
occupational exposures
high-fat diet-increase the risk of breast cancer
oral contraceptives-increase the risk
smoking (lung cancer) - protective factors that decrease breast cancer
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excersie
pregnancy
breastfeeding - staging
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-guides treatment
-determines prognosis
-TNM (evaluates size, nodal involvement and metastasis)
-pathologic staging - TNM
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Ttmor
Node
Matastasis - Prognosis of breast cancer
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-tumor sixe: the smaller the better
-Metastasis: 5 year survival depends in large part on degree of spread
-estrogen/progesterone receptor + = good
-postive estrogen status - is a good thing - ductal carcinoma in situ
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-more common
-treatment = total or simple mastectomy (removal of the breast only) - lobular carcinoma in situ
- treatment - bilateral total mastectomy
- paget's disease
- s/s - a scaly lesion and burning or itching around the nipple-areola complex are frequent symptoms
- tests for paget's disease
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mammography - can detects the tumor
biopsy of lesion the only definitive test - pregnancy and breast cancer
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-2-5% occur during pregnancy
-ultrasound preferred diagnostic tool
-chemotherapy at 16 weeks
-early c-section is an option
-abortion
-can become pregnant after 2 years - medical management of breast cancer
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-1990 national institutes of health says: lumpectomy with radiation has a survival rate equal to that of modified radical mastectomy
-Tx. with chemo. r/t menopausal status and hormone receptors - breast conserving surgery
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-lumpectomy
-wide excision
-partial masstectomy
-segnental or quadrantectomy
-goal:remove the tumor with clear margins and good cosmetic result - totol mastectomy
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-removal of the breast tissue only
-appropriate for: carcinoma in situ typically ductal - modified radical mastectomy
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-removal of breast tissue and axillary nodes
-muscles remain intact (the pectoralis major and minor muscles)
-reconstruction inmmediate or late
-drainage tubbes post-op - radical mastectomy
- removal of breast tissue and pectoralis major and minor muscles and axillary node dissection
- sentinel node biopsy
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-60% of patients who have axillary's node dissecton are node negative
-lymphatic mapping and sentinel node biopsy provides the asme prognostic information
-success rate > 90% accuracy - If postive patient undergoes the standard axillary's dissection
- risk - lymphedema (chronic selling of the affected extremity)
- radiation therapy
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-follows tumor excision
-begins after surgical wound is healed, usually 6 weeks
-treatment are daily for 5-7 weeks
-IROT (intraoperative radiation therapy) - Chemotherapy
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-used to eradicate micrometastatic spreadof disease
-usually follows surgical intervention
-common agent include: cytoxan, methotrexate, fluorouracil, adriamycin, taxal --premenopausal women may experence temporaty or permanent amenorrhea leading to sterility - side effects of chemo
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-N/V
-taste chages
-alopecia
-mucositis
-dermatitis
-fatique
-wt. gain
-bone marrow suppression - Nursing consideration for chemo
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-wig consult
-patient education
-psychosocial isses - syndthetic growth
- stimulating factor injected subq daily for 10 days, which boosts the WBC count to prevent nadir fever infection
- ndir fever
- a fever that occurs and infection when the blood cell counts are at their lowest level
- Hormonal Therapy
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-based on estrogen and progesterone receptor assay taken during biopsy
-surgery to remove the endocrine glands
-tamoxife - is the primary hormonal agent used in breast cancer today - bone marrow trasplant
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-involves removing bone marrow prior to high dose chemotherapy. It is then re-infused later IV
-usually onlyu done at specialized transplant centers.
-use remains controversial ouside clinical trails
-side effects-fatigue and infection - Investigational therapy
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-stem cell transplant
-oncognes-tumor genes that contro cell growth
-growth factors- substances released by cancer cells to make the environment more conductive to growth
-monoclonal antibodies (Herceptin) - synthetic antibodies that fight cancer cells
-biologic response modifiers - substances that help increase the body's immune system response - Prosthetics
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-not all women are candidates for reconstructive surgery
-amercan cancer society-reach to recovery
-fitting 4-6 weeks after surgery
-provides a sense of psychological restoration and improves posture - reconstructive surgery
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-contraindications
-timing
-preoperative considerations
-postoperative care - post mastectomy exercises
- performed three times for 20 min at time until full ROM (usually 4 to 6 wks)
- tissue expanders
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-used with permanent implants
-creates a pocket inside the pectoralis muscle insers a prtially filled silastic expander and a grainage device
-is an outpatient surgery - tissue transfer procedures
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-another mentod of reconstruction
-transvers rectus abdominis mycocutaneous flap
-mipple-areola reconstruction - mipple-areola reconstruction
- using a skin graft from the inner thigh or labia because this skin has darken pigmentation then the skin on the reconstructed breast
- lymphedema; arm care
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-avoid B/P. injections or blood draws
-use sunscreen and insect repellent
-be carefull when cooking
-noninvasive manicures
-save underarms with electric razor
avoid lifting>10lbs
-avoid break in skin, call if s/s infection - recurrent breast cancer
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-the longer the disease -free perion the better the prognosis
-50% of recurrences occur locally Z(on the chest wall or in the conserved breast) or regilonally (lymph nodes) - reduction mammoplasty
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-used to treat breast hypertropy
-large breast often cause: back poin, tenderness, fatique, poor posture
-requires general anasthesia
-drains for 1-2 days - augmentation mammoplasty
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-produces larger fuller breast
-saline implants have replaced sillcone
-outpatient-local anesthesia
-complcation: infection, contracures - Gynecomastia
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-over developed breast tissue in men
-can be secondary to meds like - digitalis, ergotomine, kranitidine, dilantin
-mopre common in young boys
-overdeveloped mammary glands in the male - during breast examination
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-pt. sits in a comfortable position facing the examiner
-exa,omer omstricts tje [atoemt tp raose bptj ar,s pverjead. tp e;evate bptyj breasts eqia;;u
=-next, the patients is instructed to place her hands at her waist and push in
-these movement, cause contraction of the pectoral muscle - peau d' orange
- a classic sign of advance breast cancer -edema and pitting of the skin may result from a neoplasm
- physical assessment
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-palpation
-may use a circular, wedge or ventical pattern
-palpate auxiliary and clavicular areas while sitting
-supine position - shoulder is elevated - use circular motion elevate breast on pillow to banance the chest wall. Start clockwise directionk from outer limits of breast toward the nipple. Last, the areola is gently compressed to detect any discharge or secretion. - self breast exam
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-national cancer insitute
-only 25-30% of women perform BSE rgularly
-begin in late teens or early 20's
-perform after menses - Current American Cancer Society
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recommend 20 to 40 yr q3yr, then age 40yr once yearly
baseline mammogram agter age 35
high-risk seek the poinion of dr.
use an accrediatied center that produce erliable mammograms
high-risk age of diagnosis of about 10 yrs is seen. Mother diagnosed at 38, then daughter at 28.