Breast Cancer Student PPT-1 PDF

Unit 5 Benign Breast Disorders + Breast Cancer NUR 211 Unit 5 Cortney Maffett, MSN, FNP-BC Breast Anatomy Benign Breast Disorders Atypical Hyperplasia Proliferative breast disorder with growth of abnormal cells Not cancer, but increases risk An...

Unit 5 Benign Breast Disorders + Breast Cancer NUR 211 Unit 5 Cortney Maffett, MSN, FNP-BC Breast Anatomy Benign Breast Disorders Atypical Hyperplasia Proliferative breast disorder with growth of abnormal cells Not cancer, but increases risk Annual mammogram and bi-annual breast exams after diagnosis Cannot take oral contraceptives or Hormone Replacement Therapy (HRT) Fibroadenoma Mass of connective tissue that is unattached to the surrounding tissue ○ Most common benign tumor during reproductive years ○ Can occur post-menopause ○ Usually found during self-breast exam or mammogram ○ Oval, freely mobile, rubbery feel ○ Size varies from 1-15 cm ○ Can be anywhere in the breasts ○ Ultrasound or needle aspiration Fibrocystic Breast Condition (FBC) Pathophysiology: ○ Changes in the lobules, ducts, and stromal tissues of the breast. ○ 2 main features of the condition are fibrosis and cysts. ○ Most often occurs in premenopausal women between ages 20-50. ○ Etiology thought to be related to imbalance of estrogen and progesterone. ○ Tenderness increases before menstrual period  FBC - S&S ○ Breast pain ○ Rope-like lump ○ Nipple discharge ○ Pain, fullness, swelling (associated with menstruation) ○ Described as dull, heavy pain with a sense of fullness and tenderness that increases premenstrual Intraductal Papilloma Most common in women 40-55 Growth of mass in the duct Causes trauma as it grows Causes serous discharge Mass rarely palpable R/o breast cancer Surgical removal Breast Cancer Link to ACS Cancer Statistics  Breast Cancer Most common cancer diagnosed in women 1 in every 8 women in the U.S, will develop breast ca by age 70 5 year survival rate: ○ Localized: 98% ○ Mets to lymph nodes: 84%  Breast Cancer Etiology and RFs Female Radiation exposure Age Nulliparity Overweight or obese First child born after age Sedentary lifestyle 30 Increased ETOH intake Use of hormone therapy Familial history (esp. combination pill) Inherited genetic Early menarche (before mutations age 12) ○ BRCA 1 and BRCA 2 Late menopause (after age 50)  Screening Guidelines Mammograms Women between 40 and 44: have the option to start screening yearly. Women 45 to 54: every year. Women 55 and older: every other year; they can opt for yearly Clinical Breast Exam (CBE) Breast Self-Exam (BSE)  Breast Cancer – S/S New lump or mass o Painless, hard, and irregular edges o Usually fixed to tissue, but might be movable o Can be soft, tender, and round Skin irritation or dimpling Swelling Breast or nipple pain Nipple retraction (turning inward) Peau d’orange Redness, scaliness, or thickening of the nipple or breast skin Peau d’orange (commonly associated w/ IBC) Breast Cancer - Assessment History: Focus on 3 issues: Risk factors Characteristics of Breast Mass Health Maintenance practices Psychosocial assessment Fear of cancer Threats to body image, sexuality, and intimacy Decisional conflict regarding treatment options Uncertainty about treatment outcomes/survival Breast Cancer: Diagnostics/Labs Digital mammography Breast tomosynthesis Ultrasonography MRI or CT Breast biopsy done so tissue can be examined for diagnosis of cancer Immunohistochemistry (IHC) test Labs once diagnosed: Elevated liver enzymes (liver mets) Increased calcium and alkaline phosphatase (bone mets) Chest x-ray  Hormone Receptors Proteins on breast cells, catch hormones that promote cell growth Immunohistochemistry (IHC) test ER-positive: present estrogen receptors PR-positive: present progesterone receptors HER2-positive: present HER2; more aggressive and higher risk for recurrence  Hormone Receptors Cont. Hormone receptor- positive: has one or both receptors Hormone receptor- negative: does not have the estrogen or the progesterone receptor Triple-negative: No  Breast Cancer: Types Noninvasive (in situ) ○ Remains within the mammary duct ○ Ductal carcinoma in situ (DCIS) ○ Lobular carcinoma in situ (LCIS) Invasive ○ Spreads into surrounding breast tissue ○ Infiltrating ductal carcinoma (IDC) ○ Inflammatory Breast Cancer (IBC) ○ Triple Negative Breast Cancer Mets ○ Bone, Lungs, Brain, Liver Noninvasive Breast Cancer Ductal Carcinoma in Situ Early noninvasive form Cells are in the duct Precursor to invasive cancer Early diagnosis Treatment: Surgery, Radiation, Tamoxifen  Lobular Carcinoma in Situ Rare, NOT considered cancer or pre- cancer Does not spread, but can increase risk for breast cancer developing elsewhere Abnormal cell growth in lobules (milk producing glands) Usually not visible on MMG, seen with breast biopsy Women 40-50 yo pre-menopause Can be treated with observation Invasive Breast Cancer Infiltrating Ductal Carcinoma Most common form Starts in cells lining milk ducts Lump = irregular, poorly defined Fibrosis may develop dimpling (in advanced disease) Peau d-orange (in advanced disease)  Inflammatory Breast Cancer Rare, but aggressive 1-5% of breast cancers Younger women (