Breast Health PowerPoint Presentation PDF

Breast Health N191 Adapted by Kasey Williamson, MSN, RN, RNC-OB Breast Self Exam Consistent BSE may facilitate breast self- awareness  Normal look and feel of breasts  Review technique regularly through return demonstration Copyright © 2017, El...

Breast Health N191 Adapted by Kasey Williamson, MSN, RN, RNC-OB Breast Self Exam Consistent BSE may facilitate breast self- awareness  Normal look and feel of breasts  Review technique regularly through return demonstration Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Self Exam Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer: Screening Guidelines Yearlymammograms for average-risk women ◦Starting at age 45 unless changes observed ◦Yearly ages 45-54 ◦Every 2 yr ≥ 55 ◦Continue screening mammograms as long as overall health is good Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer: Screening Guidelines Women at ↑ risk  Earlier mammography screening  Breast MRI  More frequent CBEs (clinical breast exams) Copyright © 2017, Elsevier Inc. All Rights Reserved.  Screening Mammogram Screening mammogram showing dense breast tissue and benign, scattered microcalcifications of a 57-year-old. A, Using conventional x-rays. B, Using digital x-rays. (From Adam A, Dixon AK, Grainger RG, et al: Grainger and Allison’s diagnostic radiology, ed 5,©St2017, Copyright Louis,Elsevier 2008, Churchill Inc. AllLivingstone.) Rights Reserved. Diagnostic Studies Radiologic studies ◦Mammography first ◦Ultrasonography most common / cost effective ◦MRI Copyright © 2017, Elsevier Inc. All Rights Reserved.  Diagnostic Studies Mammography ◦Comparison of images  Early tissue changes ◦About 10% to 15% of all breast cancers cannot be seen and need follow-up by palpation, ultrasonography, MRI, or biopsy Copyright © 2017, Elsevier Inc. All Rights Reserved. Benign Breast Disorders: Breast Infections ◦Mastitis  Inflammatory condition that occurs most frequently in lactating women  Localized S/S (red/hot/painful)  Fever is often present  Tx: prompt antibiotics Copyright © 2017, Elsevier Inc. All Rights Reserved. Benign Breast Disorders: Breast Infections ◦Lactational breast abscess  From persistent lactational mastitis  Localized S/S + fever  Possible I&D and wound care  C&S + antibiotics!!!!!  Breastfeeding can usually continue Copyright © 2017, Elsevier Inc. All Rights Reserved. Benign Breast Disorders: Fibrocystic Changes ◦ Benign condition with tissue changes  Development of excess fibrous tissue  Cyst formation  Palpable round, well-delineated, freely movable lumps ◦ Exaggerated response to hormones (sensitive to estrogen) Copyright © 2017, Elsevier Inc. All Rights Reserved. Benign Breast Disorders: Fibrocystic Changes ◦Not linked to ↑ breast cancer risk ◦Common in 35- to 50-year- old women  Women with premenstrual abnormalities, nulliparity, history of spontaneous abortion, no use of oral contraceptives, with early menarche and late menopause Copyright © 2017, Elsevier Inc. All Rights Reserved. Benign Breast Disorders: Fibrocystic Changes A, Normal breast tissue. B, Fibrocystic breast tissue. Benign Breast Disorders: Fibrocystic Changes Nursing/Interprofessional Mgmt ◦Excisional biopsy  Usually performed in an outpatient surgery unit  Teach:  Will come and go with menstruation  Reassure her that the cysts do not “turn into” cancer Benign Breast Disorders: Gynecomastia in Men Transient, noninflammatory (comes & goes) enlargement of 1 or both breasts ◦ Most common breast problem in men ◦ Usually a temporary, benign condition ◦ Not a risk factor for breast cancer  Can occur in puberty  May be a manifestation of other Copyright © 2017, Elsevier Inc. All problems Rights Reserved. Benign Breast Disorders: Senescent Gynecomastia Occurs in many older men ◦Probably caused by plasma estrogen elevation ◦Tender, firm, centrally located enlargement ◦Usually regresses in 6 to 12 months ◦Biopsy can rule out breast cancer Copyright © 2017, Elsevier Inc. All Rights Reserved. Gerontologic Considerations Pendulous breasts (decreased estrogen) ◦Loss of subcutaneous fat ◦Loss of structural support ◦Atrophy of mammary glands ↓ Glandular tissue density ↑ Incidence of breast cancer Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer Etiology and risk factors for women ◦ Cumulative and interacting  Family history!!!!!!!!!  Environmental factors  Genetics!!!!!!!!  Early menarche and late menopause  Age 60 or older ◦ Most women who develop breast cancer have no identifiable risk factors Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer Modifiable risk factors ◦ Excess weight gain during adulthood ◦ Sedentary life style ◦ Smoking ◦ Dietary fat intake ◦ Obesity ◦ Alcohol intake ◦ Environmental factors  Radiation exposure Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer Hormonal regulation r/t breast cancer development ◦Combined hormone therapy  ↑ Risk of breast cancer  ↑ Tumor size at diagnosis  ↑ Tumor stage at diagnosis ◦Estrogen alone may ↑ risk after 10 years Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer 5% to 10% are hereditary Genetic link stronger if involved family member ◦Has a history of ovarian cancer ◦Is premenopausal ◦Had bilateral breast cancer ◦Is a first-degree relative  Breast cancer risk is ↑ by 1.5 to 3 times Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer BRCA1 or BRCA2 mutations:* ◦Prophylactic oophorectomy + mastectomy  ↓ risk of breast and ovarian cancer Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer Risk factors for men ◦ Hyperestrogenism ◦ Family history of breast cancer ◦ Radiation exposure Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer Detected as lump, thickening, or mammography abnormality in breast ◦ Nipple retration ◦ Peau d’orange = orange peel like skin ◦ dimpling Rate of lesion growth varies ◦ Slow-growing = lower mortality rates Copyright © 2017, Elsevier Inc. All Right s Reserved. Breast Cancer: Where it Occurs Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Cancer Diagnostic Studies ◦Biopsy  Fine-needle aspiration (FNA)  Core needle biopsy  Vacuum-assisted biopsy  Excisional biopsy Copyright © 2017, Elsevier Inc. All Rights Reserved. Types of Breast Cancer Based on Invasiveness Ductal Carcinomas ◦Noninvasive (in situ) ◦Invasive (spreading to other locations)  Most Common Copyright © 2017, Elsevier Inc. All Rights Reserved. Inflammatory Breast Cancer Aggressive and fast growing High risk for metastasis Lymph channels in skin of breast become blocked by cancer cells ◦Breast looks red, feels warm ◦Breast skin has a thickened appearance, resembling an orange peel Copyright © 2017, Elsevier Inc. All Rights Reserved.  Diagnostic Studies Axillary lymph node analysis ◦The more lymph nodes involved, the greater the risk of recurrence Tumor size ◦Larger the tumor, poorer the prognosis Bigger chance of moving to other organs Copyright © 2017, Elsevier Inc. All Rights Reserved. Treatment Options Alloptions should be considered and discussed ◦ Surgical intervention (mastectomy) ◦ Radiation therapy (chemo/radiation) ◦ Drug therapy ( ◦ Hormone therapy ◦ Immunotherapy and targeted therapy Advanced age considerations Copyright © 2017, Elsevier Inc. All Rights Reserved.  Breast Cancer Surgery Breast cancer surgery. A, Preoperative. B, Lumpectomy. C, Simple mastectomy. D, Modified radical mastectomy. Copyright © 2017, Elsevier Inc. All Rights Reserved. Surgical Therapy Operable CA Surgery ◦Breast conservation surgery  Lumpectomy  Segmental mastectomy ◦Mastectomy  Removal of the breast  With or without reconstruction Copyright © 2017, Elsevier Inc. All Rights Reserved. Surgical Therapy Breast-Conserving Surgery Lumpectomy Radiation therapy after surgery Chemotherapy before radiation therapy Copyright © 2017, Elsevier Inc. All Rights Reserved. Surgical Therapy Mastectomy Breast reconstruction can be performed immediately after a mastectomy or it can be delayed Reconstruction is optional Two main types of procedures ◦Implant reconstruction ◦Tissue flap Copyright © 2017, Elsevier Inc. All Rights Reserved. Surgical Therapy Post-Mastectomy Pain Post-breast therapy pain syndrome (PBTPS) ◦Nerve injury during surgery ◦Pain, tingling, aching, burning, numbness, edema, itching ◦Tx: NSAIDS, low dose antidepressants, EMLA, antiseizure drugs Equivalent to phantom pain Copyright © 2017, Elsevier Inc. All Rights Reserved. Surgical Therapy Post -Mastectomy Pain Feeling pain in breast after a mastectomy ◦Brain continues to send signals to nerves in breast area that were cut during surgery Copyright © 2017, Elsevier Inc. All Rights Reserved. Surgical Therapy Axillary Node Dissection Lymphedema Accumulation of lymph in soft tissues. Possible after lymph node sampling or radiation therapy Radiation Therapy Adjuvant therapy ◦To prevent recurrence ◦Palliative: for pain caused by spread of cancer External radiation ◦ After surgery ◦ Based on probability of residual cancer cells  Will not prevent metastasis ◦ Side Effects: Fatigue, skin changes, breast edema Radiation Therapy MammoSite Copyright © 2017, Elsevier Inc. All Rights Reserved. Drug Therapy Systemic therapy including ◦Chemotherapy ◦Hormone therapy ◦Immunotherapy ◦Targeted therapy Patients at ↑ risk for recurrent or metastatic disease Copyright © 2017, Elsevier Inc. All Rights Reserved.  Nursing Assessment History of breast disorder assists in establishing a diagnosis ◦Presence of nipple discharge  Color, consistency, from one or both breasts ◦Pain ◦Rate of growth of lump ◦Breast asymmetry ◦Correlation with menstrual cycle Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Diagnoses Determined after medical diagnosis and before treatment plan is selected ◦Decisional conflict (how much pain & how much impact will it have on their life) ◦Fear and/or anxiety ◦Disturbed body image Copyright © 2017, Elsevier Inc. All Rights Reserved.  Planning Overall Goals ◦Participate in decision-making ◦Adhere to therapeutic plan ◦Communicate about and manage side effects of adjuvant therapy ◦Access and benefit from support ◦Comply with recommended follow-up Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Acute  Care Waiting for biopsy results and treatment recommendations is stressful ◦Clarify and expand on treatment options provided by HCP ◦Assess coping levels and strategies ◦Support decision-making Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Acute Care Provide sufficient information to ensure informed consent & signed Be sensitive to need for and preferred type of information  Pre- and postop pain control and care  Mobility restrictions/post-op exercises  Recovery period Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Acute Care Postop pain intensity varies ◦Regularly administer analgesics ◦Pre-medicate before exercises Teaching drain care may be needed Restoring arm function on affected side after breast cancer surgery is a key nursing goal Copyright © 2017, Elsevier Inc. All Rights Reserved. Postoperative Exercises Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Acute Care Use and teach patient to take measures to prevent or decrease lymphedema on affected side No BP readings, venipunctures, or injections* – causes lymphedema ◦ Arm should not remain in a dependent position for lengthy periods of time ◦ Prevent infection, burns, and compromised circulation Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Acute Care Psychosocial support ◦All aspects of care must include sensitivity to complex psychologic impact of diagnosis and implications of surgery  Provide a safe environment for expression of all feelings  Help identify sources of support and strength Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Acute Care Psychosocial support  Encourage patient to identify and learn coping strengths  Promote communication between patient and family/friends  Provide accurate and complete answers  Make counseling resources available  Offer information about community resources Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Ambulatory  Care Explain follow-up routine Emphasize importance of ongoing monitoring and self- care Teach what symptoms should be reported to HCP Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Ambulatory Care  Inform mastectomy patients ◦ Special garment choices ◦ Breast prosthesis  Address implications of cancer diagnosis and breast surgery on ◦ Sexual identity ◦ Body image ◦ Interpersonal relationships Copyright © 2017, Elsevier Inc. All Rights Reserved. Nursing Implementation Survivor Care H and P 1-4 times/year for 5 years, then annually BSE and self-chest wall examination  Report changes to HCP  Recurrence is usually at surgical site Annual mammogram Copyright © 2017, Elsevier Inc. All Rights Reserved. Evaluation Expected Outcomes ◦Identify activities to  Reduce postop edema  Improve mobility ◦Use pain control appropriately ◦Use effective coping to reduce anxiety ◦Discuss feelings ◦Identify resources Copyright © 2017, Elsevier Inc. All Rights Reserved. Breast Reconstruction Copyright © 2017, Elsevier Inc. All Rights Reserved.  Breast Implants & Tissue Expansion Implants: ◦ One Stage Surgery: Same time as mastectomy ◦ Two Stage Surgery: Expanders placed ◦ Silicone shell  Gel (Silicone or Cohesive)  Saline Tissue Expander Under the pectoralis muscle Does not work well in extensive radiation or surgical scar tissue. Copyright © 2017, Elsevier Inc. All Rights Reserved.  Tissue Flap Procedures Use of autologous tissue to recreate a breast mound ◦ Abdomen ◦ Back ◦ Thighs ◦ Buttocks TRAM Flap Copyright © 2017, Elsevier Inc. All Rights Reserved.