NR 325 - FINAL EXAM STUDY GUIDE
BREAST CANCER SCREENING GUIDELINES - regular screening mammography
starting at age 45 years.
Women aged 45 to 54 years should be screened annually.
Women 55 years and older should transition to biennial screening or have the
opportunity to continue screening annually.
continue screening mammography as long as overall health is good and life expectancy
is 10 years or longer
THE BREAST SELF-EXAMINATION - lie down and place one arm behind the head
use finger pads of three middle fingers of the other hand to feel for lumps
use overlapping dime-sized circular motions to feel the breast tissue
use three different levels of pressure
up-and-down vertical pattern is recommended
stand in a front a mirror; examine breasts for:
- shape
- size
- redness/scaliness
- dimpling (skin/nipple)
MASTITIS - inflammation of the breast
occurs in up to 10% of postpartum lactating mothers 2-4 weeks after birth
MASTITIS - CLINICAL MANIFESTATIONS - warm to touch
indurated/painful
often unilateral
most commonly caused by staphylococcus aureus
BEST TIME TO PERFORM SELF BREAST EXAM (BSE) - Perform BSE at the end of
the menstrual period
breast tenderness is less likely to occur
,RISK FACTORS FOR BREAST CANCER - early menarche
late menopause
Age - at or older than 50 yrs
hormone use
Family history/Genetics
History of cancer (breast, colon, endometrial, ovarian)
First full term pregnancy after age 30
nulliparity (never given birth)
benign breast disease (atypical epithelial hyperplasia)
weight gain/obesity after menopause
exposure to ionizing radiation
alcohol consumption
ADVANTAGE OF FINE-NEEDLE ASPIRATION (FNA) BIOPSY - FNA is performed in
outpatient settings
results are available within 24-48 hours
no incision required
BREAST LUMPS - ASSESSMENT - *painless* and *fixed* lumps suggest breast
cancer/malignancy
HORMONE THERAPY (HT) - *HT has been linked to increased risk for breast cancer*;
patient and HCP must determine whether or not HT therapy is appropriate
*Breast cancer incidence is increased in women using HT*, independent of other risk
factors
HT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers
CLASSIFICATION OF BREAST CANCER - based on tissue type
based on invasiveness
,based on hormone receptor and genetic status
CLASSIFICATION OF BREAST CANCER - BASED ON ON TISSUE TYPE - Ductal
carcinoma (milk ducts)
- Medullary
- Tubular
- Colloid (mucinous)
Lobular carcinoma (milk-producing glands)
Other
- Inflammatory
- Paget's disease
- Phyllodes tumor
CLASSIFICATION OF BREAST CANCER - BASED ON INVASIVENESS - Noninvasive
(In situ)
- ductal carcinoma in situ (DCIS)
- lobular carcinoma in situ (LCIS)
Invasive (spreads)
- invasive ductal carcinoma
- invasive lobular carinoma
CLASSIFICATION OF BREAST CANCER - BASEDON HORMONE RECEPTOR
STATUS/GENETIC STATUS - *Estrogen and Progesterone Receptor Status*
- Estrogen receptor positive
- Estrogen receptor negative
- Progesterone receptor positive
- Progesterone receptor negative
*HER-2 Genetic Status*
- HER-2 positive
- HER-2 negative
TRASTUZUMAB (HERCEPTIN) - THERAPEUTIC USE - this Rx is for the treatment of
of tumors that have the HER-2 receptor
TRASTUZUMAB (HERCEPTIN) - ADVERSE EFFECT - this Rx can lead to ventricular
dysfunction
patient is taught to self-monitor for symptoms of heart failure
TAMOXIFEN (NOLVADEX - THERAPEUTIC USE - this Rx is for the treatment of
estogen-dependent breast tumors in premenopausal women
, ESTRADIOL - CAUTION - this Rx will increase the growth of estrogen-dependent
tumors
RALOXIFENE - THERAPEUTIC USE - this Rx is used to prevent breast cancer
this Rx *IS NOT USED* postmastectomy
RADICAL MASTECTOMY - POST OP NURSING CARE - patients are at increased risk
for lymphedema and infection
therefore, *NO BLOOD PRESSURES OR VENIPUNCTURES* in the affected arm
signage should be posted at the bedside to help remind staff
RADICAL MASTECTOMY - PATIENT TEACHING - patients should avoid any activity
that might injure the affected arm
analgesics can be used
exercises should be continued in order restore strength/ROM
affected arm should be elevate at or above the heart to improve ROM/function
SITES OF BREAST CANCER RECURRENCE/METASTASIS - *LOCAL
RECURRENCE*
skin
chest wall
*REGIONAL RECURRENCE*
lymph nodes
*DISTAL METASTASIS*
skeletal
spinal cord
brain
pulmonary
liver
bone marrow
TNM SYSTEM OF STAGING & PROGNOSIS - T = tumor size
N = nodal involvement
M = metastasis
BREAST CANCER SCREENING GUIDELINES - regular screening mammography
starting at age 45 years.
Women aged 45 to 54 years should be screened annually.
Women 55 years and older should transition to biennial screening or have the
opportunity to continue screening annually.
continue screening mammography as long as overall health is good and life expectancy
is 10 years or longer
THE BREAST SELF-EXAMINATION - lie down and place one arm behind the head
use finger pads of three middle fingers of the other hand to feel for lumps
use overlapping dime-sized circular motions to feel the breast tissue
use three different levels of pressure
up-and-down vertical pattern is recommended
stand in a front a mirror; examine breasts for:
- shape
- size
- redness/scaliness
- dimpling (skin/nipple)
MASTITIS - inflammation of the breast
occurs in up to 10% of postpartum lactating mothers 2-4 weeks after birth
MASTITIS - CLINICAL MANIFESTATIONS - warm to touch
indurated/painful
often unilateral
most commonly caused by staphylococcus aureus
BEST TIME TO PERFORM SELF BREAST EXAM (BSE) - Perform BSE at the end of
the menstrual period
breast tenderness is less likely to occur
,RISK FACTORS FOR BREAST CANCER - early menarche
late menopause
Age - at or older than 50 yrs
hormone use
Family history/Genetics
History of cancer (breast, colon, endometrial, ovarian)
First full term pregnancy after age 30
nulliparity (never given birth)
benign breast disease (atypical epithelial hyperplasia)
weight gain/obesity after menopause
exposure to ionizing radiation
alcohol consumption
ADVANTAGE OF FINE-NEEDLE ASPIRATION (FNA) BIOPSY - FNA is performed in
outpatient settings
results are available within 24-48 hours
no incision required
BREAST LUMPS - ASSESSMENT - *painless* and *fixed* lumps suggest breast
cancer/malignancy
HORMONE THERAPY (HT) - *HT has been linked to increased risk for breast cancer*;
patient and HCP must determine whether or not HT therapy is appropriate
*Breast cancer incidence is increased in women using HT*, independent of other risk
factors
HT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers
CLASSIFICATION OF BREAST CANCER - based on tissue type
based on invasiveness
,based on hormone receptor and genetic status
CLASSIFICATION OF BREAST CANCER - BASED ON ON TISSUE TYPE - Ductal
carcinoma (milk ducts)
- Medullary
- Tubular
- Colloid (mucinous)
Lobular carcinoma (milk-producing glands)
Other
- Inflammatory
- Paget's disease
- Phyllodes tumor
CLASSIFICATION OF BREAST CANCER - BASED ON INVASIVENESS - Noninvasive
(In situ)
- ductal carcinoma in situ (DCIS)
- lobular carcinoma in situ (LCIS)
Invasive (spreads)
- invasive ductal carcinoma
- invasive lobular carinoma
CLASSIFICATION OF BREAST CANCER - BASEDON HORMONE RECEPTOR
STATUS/GENETIC STATUS - *Estrogen and Progesterone Receptor Status*
- Estrogen receptor positive
- Estrogen receptor negative
- Progesterone receptor positive
- Progesterone receptor negative
*HER-2 Genetic Status*
- HER-2 positive
- HER-2 negative
TRASTUZUMAB (HERCEPTIN) - THERAPEUTIC USE - this Rx is for the treatment of
of tumors that have the HER-2 receptor
TRASTUZUMAB (HERCEPTIN) - ADVERSE EFFECT - this Rx can lead to ventricular
dysfunction
patient is taught to self-monitor for symptoms of heart failure
TAMOXIFEN (NOLVADEX - THERAPEUTIC USE - this Rx is for the treatment of
estogen-dependent breast tumors in premenopausal women
, ESTRADIOL - CAUTION - this Rx will increase the growth of estrogen-dependent
tumors
RALOXIFENE - THERAPEUTIC USE - this Rx is used to prevent breast cancer
this Rx *IS NOT USED* postmastectomy
RADICAL MASTECTOMY - POST OP NURSING CARE - patients are at increased risk
for lymphedema and infection
therefore, *NO BLOOD PRESSURES OR VENIPUNCTURES* in the affected arm
signage should be posted at the bedside to help remind staff
RADICAL MASTECTOMY - PATIENT TEACHING - patients should avoid any activity
that might injure the affected arm
analgesics can be used
exercises should be continued in order restore strength/ROM
affected arm should be elevate at or above the heart to improve ROM/function
SITES OF BREAST CANCER RECURRENCE/METASTASIS - *LOCAL
RECURRENCE*
skin
chest wall
*REGIONAL RECURRENCE*
lymph nodes
*DISTAL METASTASIS*
skeletal
spinal cord
brain
pulmonary
liver
bone marrow
TNM SYSTEM OF STAGING & PROGNOSIS - T = tumor size
N = nodal involvement
M = metastasis
