Surgical Therapy and Post-Mastectomy Pain

Surgical Therapy

• Breast-conserving surgery involves lumpectomy, radiation therapy after the surgery, and chemotherapy before radiation therapy.
• Mastectomy can be performed with immediate or delayed reconstruction.
• Breast reconstruction after mastectomy is optional, and there are two main types: implant reconstruction and tissue flap.

Post-Mastectomy Pain

• Post-breast therapy pain syndrome (PBTPS) can be caused by nerve injury during surgery.
• Common symptoms of PBTPS include pain, tingling, aching, burning, numbness, edema, and itching.
• Treatments for PBTPS include NSAIDs, low-dose antidepressants, EMLA, and antiseizure drugs.
• Phantom pain is equivalent to PBTPS.
• Feeling pain in the breast after a mastectomy occurs because the brain continues to send signals to the nerves in the breast area that were cut during surgery.

Axillary Node Dissection

• Axillary node dissection can lead to lymphedema, which is the accumulation of lymph in soft tissues.

Radiation Therapy

• Radiation therapy is used as an adjuvant therapy to prevent recurrence and as a palliative therapy for pain caused by cancer spread.
• External radiation is administered after surgery based on the probability of residual cancer cells.
• Side effects of radiation therapy include fatigue, skin changes, and breast edema.

MammoSite

• MammoSite is a type of radiation therapy.

Drug Therapy

• Systemic therapy includes chemotherapy, hormone therapy, immunotherapy, and targeted therapy.
• Systemic therapy is used for patients at an increased risk for recurrent or metastatic disease.

Nursing Assessment

• A history of breast disorders assists in establishing a diagnosis.
• Key aspects of a breast disorder history include:
  • Presence of nipple discharge, including color, consistency, and origin (one or both breasts).
  • Pain.
  • Rate of growth of a lump.
  • Breast asymmetry.
  • Correlation with the menstrual cycle.

Breast Cancer

• Breast cancer can be detected as a lump, thickening, or mammography abnormality in the breast.
• Other potential signs of breast cancer include nipple retraction, peau d’orange (orange peel-like skin), and dimpling.
• The rate of lesion growth varies, with slow-growing lesions having lower mortality rates.

Breast Cancer: Where it Occurs

• Breast cancer originates in the breast.

Diagnostic Studies

• Biopsy is a diagnostic study to confirm breast cancer diagnosis.
• Types of biopsies include:
  • Fine-needle aspiration (FNA).
  • Core needle biopsy.
  • Vacuum-assisted biopsy.
  • Excisional biopsy.

Types of Breast Cancer based on Invasiveness

• Ductal Carcinomas are the most common type of breast cancer.
  • Noninvasive (in situ) ductal carcinomas are localized, while invasive ductal carcinomas have spread to other locations.

Inflammatory Breast Cancer

• Inflammatory breast cancer is aggressive and fast-growing.
• It poses a high risk of metastasis.
• Cancer cells block the lymph channels in the skin of the breast, resulting in a red, warm, thickened breast.
• The thickened skin resembles an orange peel.

Diagnostic Studies

• Axillary lymph node analysis is conducted to determine the extent of cancer spread. More lymph nodes involved correlate with a higher risk of recurrence.
• Tumor size is a prognostic indicator. Larger tumors have a poorer prognosis and a greater chance of metastasis to other organs.

Treatment Options

• Treatment options should be discussed and considered for each patient individually.
• Options include surgical intervention, radiation therapy, drug therapy (including chemotherapy, hormone therapy, immunotherapy, and targeted therapy).

Treatment Options

• Advanced age considerations should be factored into treatment plan discussions.

Breast Cancer Surgery

• Operable CA Surgery includes:
  • Breast conservation surgery, which involves lumpectomy and segmental mastectomy.
  • Mastectomy, which involves removal of the breast, with or without reconstruction.

Nursing Diagnoses

• Nursing diagnoses are determined after a medical diagnosis and before a treatment plan is selected.
• Common nursing diagnoses in breast cancer include:
  • Decisional conflict (related to pain and life impact).
  • Fear and/or anxiety.
  • Disturbed body image.

Planning

• Overall goals for breast cancer care include:
  • Participation in decision-making.
  • Adherence to the therapeutic plan.
  • Communication and management of side effects of adjuvant therapy.
  • Access and benefit from support systems.
  • Compliance with recommended follow-up.

Nursing Implementation: Acute Care

• Waiting for biopsy results and treatment recommendations is stressful.
• Clarify and expand on treatment options provided by the healthcare provider.
• Assess coping levels and strategies.
• Support decision-making.
• Provide sufficient information to ensure informed consent and a signed consent form.
• Be sensitive to patient needs regarding information type and preferences.
• Educate about pre- and post-operative pain control and care, mobility restrictions/post-operative exercises, and recovery period.
• Regularly administer analgesics for post-operative pain.
• Pre-medicate patients before exercises.
• Teach drain care if necessary.
• Restoring arm function on the affected side after breast cancer surgery is a key nursing goal.
• Use and teach patients measures to prevent or decrease lymphedema on the affected side.
• Avoid BP readings, venipunctures, or injections on the affected arm, as they can cause lymphedema.
• Keep the affected arm elevated to prevent lymphedema.
• Prevent infection, burns, and compromised circulation on the affected arm.