30 Questions
What is the primary goal for breast reconstruction?
To match the opposite breast in size, shape, and contour
Where can breast implants be placed during reconstruction?
Under the pectoralis major muscle
What is a musculocutaneous flap procedure used for in breast reconstruction?
To extract tissue from elsewhere in the body to reconstruct the breast
When is nipple reconstruction typically performed during the breast reconstruction process?
As a separate procedure after the initial breast reconstruction
What is the 5-year survival rate for localized breast cancer?
Close to 100%
How does breast cancer typically metastasize?
Through the lymphatic system and bloodstream
What is the age range in which fibrocystic breast condition commonly occurs?
30-50 years
What is a common characteristic of cystic lesions in the breast related to fibrocystic breast condition?
Bilateral and multiple
What is a common medical management approach for recurrent cysts in fibrocystic breast condition?
Surgical excision
What diagnostic test can be used to confirm fibrocystic breast condition?
Mammography or ultrasound
When should a patient be instructed to perform breast self-examination to recognize the presence of cysts?
1 week after menses
What is a common cause of acute mastitis in women?
Bacterial infection
What is the primary treatment modality for a Stage 0 (carcinoma in situ) breast cancer?
Lumpectomy
Which stage of breast cancer indicates the tumor is greater than 5 cm and has spread to 3-10 lymph nodes, but no distant metastasis?
Stage IIIA
What surgical procedure involves removal of the entire breast, overlying skin, nipple, pectoralis minor muscle, axillary lymph nodes, and fascia, while preserving the pectoralis major muscle?
Modified radical mastectomy
Which of the following is a potential side effect of external beam radiation therapy for breast cancer?
All of the above
What is the purpose of chemotherapy in the treatment of breast cancer?
All of the above
What is the mechanism of action for most chemotherapeutic agents used in breast cancer treatment?
Interfering with cell replication
Which of the following is a common risk factor for chronic mastitis?
Having cracked or inverted nipples
What is the most common cause of breast cancer?
An adenocarcinoma arising from the epithelium
Which of the following is NOT a risk factor for breast cancer?
Having given birth and breastfed a child
What is the purpose of sentinel lymph node mapping in breast cancer diagnosis?
To identify the first lymph node most likely to drain cancerous cells
Which of the following diagnostic tests is used to determine if a tumor is hormone receptor-positive or negative?
Estrogen and progesterone receptor status test
What is the TNM system used for in breast cancer staging?
To categorize the disease by tumor size, lymph node involvement, and metastasis
Which type of cells are most affected by rapid multiplication?
Hematopoietic, hair follicle, and GI system cells
What is the purpose of hormonal therapy in breast cancer treatment?
To remove or block the source of estrogen, thus promoting tumor regression
What is the first step in determining if a patient can receive hormonal therapy?
Determining the patient's receptor status
Which of the following is NOT a common adverse effect of cancer treatment?
Increased blood pressure
What is the purpose of using bisphosphonates in breast cancer treatment?
To reduce the occurrence of skeletal problems in those with advanced breast cancer
What is the primary purpose of breast reconstruction surgery?
To avoid the need for an external prosthesis, have greater clothing choices, and feel less self-conscious
Study Notes
Breast Conditions
- Mastitis: an acute bacterial infection of the breast tissue
- Causes: S. aureus or streptococci, often in late pregnancy and lactation, due to clogged milk duct, inadequate cleanliness, nipple fissure, or infection in the breastfeeding infant
- Treatment: antibiotics, application of warm packs, support of the area with a well-fitting brassiere, continued nursing to promote emptying of the inflamed ducts and reduce milk stasis
Chronic Mastitis
- Bacterial infection of the breast, commonly in obese women, with a history of difficulty nursing, inverted or cracked nipples, and traumatic blow to the chest and breasts
- Effects: increased fibrosis of tissue, cyst formation, palpable, tender, and painful
- Treatment: same as for acute mastitis
Fibrocystic Breast Condition
- Benign tumors and cysts of the breast, related to ovarian activity and hormones
- Occurs in women 30-50 years of age
- Cysts: characterized by numerous cellular changes, with an abnormal amount of epithelial hyperplasia and cystic formation within the mammary ducts
- Rarely become malignant, but risk of breast cancer rises for those with this condition
- Clinical manifestations: cystic lesions are bilateral and multiple, soft, well-differentiated, tender, and freely moveable
- Diagnostic tests: mammography or ultrasound, confirmed by biopsy
- Medical management: surgical excision for recurrent cysts, conservative treatment usual, eliminate methylxanthines to reduce symptoms, danazol to decrease estrogen production may be prescribed
Breast Cancer
- Etiology and pathophysiology: adenocarcinoma, arising from epithelium and developing in the lactiferous ducts, infiltrating the parenchyma
- Risk factors:
- Female, over 50 years of age, postmenopausal
- Personal history of breast cancer, atypical hyperplasia, or carcinoma in situ
- Early menarche, first pregnancy after age 30, natural menopause after age 55
- Genetics: two or more first-degree relatives with breast cancer, first-degree relative with bilateral premenopausal breast cancer, one or more breast cancer genes (BRCA1 & BRCA2)
- Clinical manifestations:
- Tumors are usually small, solitary, irregularly shaped, firm, non-tender, and non-mobile (minimal size detectable by palpation is 1cm)
- May be change in skin color, tenderness, puckering or dimpling of tissue, peau d'orange (orange-peel like skin texture), nipple discharge, retraction of the nipple, axillary tenderness
- Diagnostic tests:
- Regular performance of Breast Self-Examination
- Physical exam and clinical breast exam every 3 years for age 20-40, every year for age 40+
- Screening mammography beginning between age 40-44
- MRI screening with mammograms for those with a significant family history or genetic tendencies
- Biopsy (fine needle aspiration, core cutting, excisional, incisional) – all breast masses, even if unpalpable
- Ultrasound – to differentiate a benign cyst from malignant mass
- MRI and PET scan – to differentiate between malignant and benign disease in some patients
- Sentinel lymph node mapping – identifies the first lymph node most likely to drain the cancerous cell
- TNM system: categorizes the disease by tumor size and spread, lymph node involvement, and metastasis
- Staging: box 52.5, p. 1789, box 57.2, p. 1988-1989
- Medical management: depends on tumor stage, age, health, hormonal status, and presence of estrogen receptors
- Radiation, chemotherapy, and surgery often used in combination
Nursing Interventions and Patient Teaching
- Instruct the patient to perform breast self-examination 1 week after menses to recognize the presence of cysts and report any changes
- Encourage the patient to verbalize concerns and recognize feelings about surgery and treatment
- Provide emotional support and prepare for anticipatory grieving for the loss of a body part
- Assess and identify members of the patient's support system
- Refer the patient to support groups (ex. Reach for Recovery)
- Establish a therapeutic relationship with the patient and family and support group; openly discuss the patient's fears
- Provide interventions for body image acceptance
- Assist the patient in finding helpful coping mechanisms
- Enable breast prosthesis if authorized by the HCP
Learn about fibrocystic breast condition, a benign condition characterized by tumors and cysts in the breasts, related to ovarian activity and hormones. Understand its etiology, pathophysiology, clinical manifestations, and the rare risk of developing into breast cancer.
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