Breast Cancer Terms – Flashcards
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tamoifen (Novalex) and raloxifene ( Evista )
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Common breast cancer treatment drug also used for prevention. Is a Hormonal/Endocrine therapy drug. Increases the risk for endometrial cancer.
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Hormonal/ Endocrine Therapy Medications. (Selected Estrogen Modulator Receptors)
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Bind to estrogen receptors so the cancer cells cannot attach to the cell.
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Aromataste Inhibitors (Arimidex ,Arranon, Aromaset)
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Work to suppress enzyme aromataste which is necessary to create estrogen so prevents it from forming thus the cancer cells cannot attach to the estrogen
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Receptor Antagonist (Faslodex)
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Binds to and destroys estrogen receptors.
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Braca 1 and Braca 2 gene mutation
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Braca's not functioning properly and do not stop suppress cell division. 85% risk of breast and ovarian cancer
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P53 Gene
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"guardian angel gene" protects against cancer unless it is mutated
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Propholactic Masectomy
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done when tests show Braca 1 and 2 mutation
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Idoxifene
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A selective estrogen receptor modulator-SERM in clinical trials for treating advanced breast CA and preventing osteoporosis
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raloxifene (Evista)
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an osteoporosis med found to help prevent invasive breast cancer with less side effects than Tamoxifen
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Gender and Age (female/ 60+)
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Most significant risk factors for breast cancer
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Estrogen
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promotes growth of breast tumors in 2/3 of all patients
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Breast Cancer Risk Factors
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Personal Hx, Family HX, Genetic, Early Menarche, late menopause, Nullparity, childbirth after 30, benign breast disease, obesity, high fat diet,
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lowers risk factor
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birth of a child and breast fed for more than one year
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Exercise
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lowers risk factor and lowers risk of recurrance
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Fat Tissues
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produce estrogen so increase estrogen level
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Atypical Ductal Hyperplasia
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a medical condition in which the cells which line the milk ducts of the breasts experience abnormal growth. This condition is not cancerous, but can indicate an increased cancer risk for a woman.
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Lobular carcinoma in situ (LCIS)
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not really cancer, but rather a noninvasive condition that increases the risk of developing cancer in the future
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85% of breast cancers
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sporatic occurance of breast cancer (no risk factors involved)
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Cervical dysplasia
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term indicates that abnormal cells were found on the surface of the cervix, a breast cancer risk factor
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painless lump or mass
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typical clinical manifestation 70% of all breast cancers
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thinkening of breast tissue, nipple discharge, skin lesions
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less common clinical manifestation
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Peau d" Orange Breast cancer
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rare, caused by interference with lymph drainage, skin pores enlarge around areola, skin thick, hard, discolored
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Enlarged Lymph Nodes
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typical finding in regional spread of breast cancer
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evidence of matastisis
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enlarged lymph nodes in superclavicular and cervical area
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Abnormal liver function test
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shows matastisis to liver
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eleveated calcium level
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shows matastisis to bone
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bone, liver, lung, brain
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common sites of matastisis
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Abnormal chest xray
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shows plueral effusion when matastisis to lung
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Pet Scans
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used to diagnose where matastisis has occurred and to stage the cancer
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Early detection
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most important means of control and survival is related to stage of disease
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Clinical Breast Exam
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recommended every 3 years between 20-30, after 40 annually
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digital mammogram
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more accurate than conventional mammograms done on suspicious mass
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high risk women
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Hx of breast cancer, radiation hx, family hx, should consult breast cancer specialist
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routine mamograms
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shows lumps been there for two years
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Breast ultrasound
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can differentiate mass or fluid or a cyst
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MRI of breast
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recommended for high risk, braca gene, mass seen on mammogram
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Ductagram
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examines nipple discharge
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Biopsy
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tissue diagnosis of palpable masses
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Fine needle or Aspiration Biopsy
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small needle aspirates mass and fluid is examined
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Core Needle Biopsy
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large needle used to aspirate large amount of tissue
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Sterotactic biopsy
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done on deeper lesions that are not palpable but seen on mammogram a three dimensional picture is used to locate tumor to aspirate tissue
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Braca 1 and 2 mutation
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screening done starting at 25
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Strong family hx risk
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screening started 10 yrs. prior to onset of family members cancer
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Patient teaching about breast cancer
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pros and cons of self exam, what is significant or not, inflammatory breast cancer
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Excisional Surgical Biopsy lumpectomy
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done with early stage breast cancer to remove entire mass and surrounding tissue to leave clean boarder
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Incisional surgical biopsy
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tumor too large to be removed so a piece of the tissue taken to diagnose
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wire needle localization
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a mammogram machine is used to locate and surround perimeter of mass to remove and diagnose
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TNM Staging System
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Tumor sized, nobes counted, matastisis or not but not how anapalastic (virulent) it is
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Central Needle Biopsy
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surgery removes nodes tumor drains into first. dye injected and followed to where it drains. goal to remove as little nodes as possible
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Grading of tumor 1- 4
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diagnoses how anapalastic or virulent, how inmature the cells are and how undifferenciated. graded
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CA - 15- 3
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non specific tumor marker
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CEA Carcinoma embryonic antigen
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tumor marker levels are checked during treatment to tract progress
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cell kill theory
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one cell left behind during cancer surgery can grow and kill patient
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Surgery
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primary treatment used for breast cancer depending on tumor size and grade. All surgeries must have clear margin around cancerous tumors
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primary goal of breast surgery treatment
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to erradicate presence and control cancer from local and regional areas
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Adguvent Chemotherapy
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done after surgery when cancer has spread beyond tumor site
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Neoadguvent radiation treatment
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done before surgery to shrink tumor so it is less invasive
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Neoadguvent Chemotherapy
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done before surgery when it has already matastised
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quandrantectomy
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a type of partial mastectomy in which a quadrant of tissue may be removed with axillary node
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axillary mode dissection
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removal of some fat enmeshed axillary nodes for biopsy
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modified radical mastectomy
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removal of all breast tissue and axillary node dissection but no muscle
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radical mastectomy
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removal of entire breast along with ancillary lymph nodes and breast muscle rarely done today
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total mastectomy
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removal of entire breast tissue, but no lymph nodes. Done after sentenal node biopsy shows lymph nodes are not involved
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wide excision
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done on larger tumors. removes malignant tissue, surrounding tissue and axillary nodes are disconnected
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sentinel node biopsy
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dye inserted and route is followed to which nodes the tumor drains into to determine which nodes to remove.
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Contraindication to breast conserving surgeries
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pts. who have had radiation to the chest wall or those who cannot have radiation therapy (scleraderma, lupus, vascular disease, pregnant woman)
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Prophylactic Mastectomies
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for peace of mind for those high risk (braca genes, ductal hyperplasia and L-globular InSitual markers) removal of non vital tissue or organs
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Patient teaching Pre-Op
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change of body image, reconstruction if and when, results of biopsy turnaround, clarify misconceptions, pros and cons for procedures
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Post Op care
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ABC's, check for bleeding, hematomas, redness, warmth
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Surgi- Bra
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holds dressings in place with jackson prax drain
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Pt. teach post op
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how to care for drain because they can remain in place for several weeks
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Nx care post op
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drains must be emptied, assess color, amount odor. HOB up 30%, elevate arm, stocking on legs and arm, cough, turn, deep breathing,
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Assess Pain
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Quantify on pain scale, recheck 30 min. after pain med given
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exercise/ ROM
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on surgical side, dr. order, resolves constriction, and to create colateral lymphatic channels
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Reach to Recovery
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cancer surviver's organization help pts cope
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drains
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remain in until amount is less than 30cc per day
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ROM
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hand and forearm day 1 post op, 4x day, increase daily
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reconstructive breast surgery
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addressed Pre Op, self image issues, what are expectaions
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timing of reconstructive surgery
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pro: done immediately then one less procedure, con: interferes with diagnosing recurrances
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goal of reconstructive surgery
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to construct a breast mound, achieve symetry, and build nipple area
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Prosthetic Implants
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done at time of mastectomy-tissue expander inserted under skin and muscle, injected once a week to gradually stretch tissue and muscle. when full of saline or silicone, replaced with breast implant
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Autogolous Reconstruction
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tissue is used from other part of body
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TRAM Flap Transverse Rectus Abdominus Myocutaneous
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a tunnel is made from belly and tissue, blood vessels and muscle is transferred to the area where the breast will be, done in stages.
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hematoma
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after surgery complication: apply ice packs, monitor for infection (swelling redness, drainage)
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post op infection
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should not occur if patient had no infection prior to surgery
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Phantom Breast Syndrome
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pt. feels sensations from missing breast
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TRAM flap necrosis
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is a risk and is caused by blood supply not functioning properly
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lymphodema
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abnormal collection of protein rich fluid accompanied by chronic inflammation. occurs after ancillary node dissection
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cause of lymphodema
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removal of lymph nodes changes the flow of lymph fluid
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symptoms of lymphodema
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chronic collection of fluid in the hand, arm or trunk of surgical side. from removal of lymph channels
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Nx care lymphodema
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protect limb from trauma, no BP, bloods draws, elevate to promote venous backflow, ROM, mechanical compression sleeve
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Pt. teach lymphodema
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report redness, swelling, don't lift , cut salt, avoid sun and heat (heat is a vasodilater) wear gloves to avoid infection. can happen at any time after surgery for lifetime.
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ovarian oblation
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removal of ovaries and adrenolectomy to rid estrogen sources
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Luprone and Zolodex
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negative feedback meds. look like estrogen so hypothalmus does not produce and inhibits further production
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Faslodex (fulvestrant)
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receptor antagonist. binds to and destroys estrogen sources
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radiation therapy
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done after lumpectomy to destroy micro matastisis cells and reduce recurrence rate, also reduces bone cancer pain
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Teletherapy or External Beam Radiation Therapy
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precisely targets tumor, done before surgery to reduce mass.
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internal radiotherapy (brachytherapy),
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the radiation source is placed inside the body, external beam radiotherapy directs the radiation at the tumor from outside the body
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a balloon catheter device
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The goal of treatment is to radiate breast tissue in and around the tumor cavity in order to destroy any remaining cancer cells, while limiting irradiation to healthy tissues in your lungs, heart, skin, and fat
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intentionally isolating radiation
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uses less radiation by directly targeting tumor
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Brachytherapy (from the Greek word brachys, meaning "short-distance")
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also known as internal radiotherapy, sealed source radiotherapy,
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gynomastia
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enlarged breast tissue in men
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s/s breast cancer in men
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enlarged non painful sub areolla mass, nipple discharge, retraction, erosion, ulceration
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Stem Cell Transplantation
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can be autogolous bone marrow and allows for more aggressive chemo and radiation
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Rescue Therapy
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bone marrow stem cells removed before tx and grown then reinserted after chemo or radiation treatment
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Her 2 Receptor
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gene in woman with breast cancer that overgrow. the extra copies sit on tumor cells and trigger rampant growth.
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Avastan (vascular edothelial growth factor)
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antigen that stops or suppresses the growth of blood capillaries (angiogenisis)
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Gleevec
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targets specific cancer proteins, to treat chronic myeloid leukemia and gi tumors. Side effects: heart failure
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Heart Failure Symptoms
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peripheral edema, weight gain, SOB,
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First abnormal cells
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begin in the lobules that produce milk and ducts that channel it to the nipples
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Hyperplasia
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Overgrowth of normal cells which may begin to block the duct. Cells appear abnormal
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Stage 0
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"In situ carcinmoma" confined to the duct, rarely causes a noticeable lump, may be detected by mammogram
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Stage 1
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Lumps (less than 2cm) develope when abnormal cells escape the ducts or lobules and invade the adjoining tissue. Tumor less than 3/4in. no lymph nodes involved.
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Stage 2
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Tumor 1-2in. (5cm) cancer may be spreading to lymph nodes around breast and shoulder
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Stage 3
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Tumor larger than 2in.(>5cm) may have invaded chest wall or skin. Has spread to lymph nodes.
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Stage 4
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Cancer has spread to distant sites, such as lungs, bone or liver (metastasis)
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Paget's disease
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Malignancy of Mammary ducts. Erythema of nipple and areola, thickening, scaling and erosion of the nipple and areola
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Herceptin
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a monoclonal antibody, recognizes and blocks Her-2 receptors on cancer cells
