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Breast cancer N430

QuestionAnswer
Pathophysiology Arises from epithelial lining of ducts (ductal carcinoma) or from epithelium of lobules (lobular carcinoma)
Affects prognosis size, axillary node involvement, tumor differentiation, DNA content, estrogen/progesterone receptor status
Paget's disease breast malignancy characterized by persistent lesion of nipple and areola w/without palpable mass
Breast self-exam (BSE): monthly by all women beginning at age 20
Clinical breast exam (CBE): every 3 years for women 20-39 and annually beginning age 40
Mammography: every year beginning age 40
Women with BRCA-1 or BRCA-2 begin annual or semiannual CBE and annual mammography age 25-35
Symptoms Mass (hard, irregular, nontender) or thickening in breast or axillae Spontaneous persistent unilateral nipple discharge Nipple retraction or inversion(asymmetry)Dimpling or puckering of skinRedness, ulceration, edema, dilated veins
Sx local or regional spread Enlarged lymph nodes: supraclavicular cervical areaAbnormal CXR with or without pleural effusion, alkaline phosphatase/Ca++, positive bone scan, bone painAbnormal liver function tests
Diagnosis Fine-needle aspiration bx (cannot determine invasiveness)Core needle bxIncisional bxStereotactic fine-needle or core needle bxUltrasound-guided bx
Immediate post-op Infection preventionJP drain careLimited ROM (flex fingers, squeeze ball, brush hair/teeth, move wrist/elbow)-active ROM 2nd or 3rd day
Management of lymphadema Elevation hand/arm, No lab, BP etcCompressive sleeve or stocking Single-cell pump or sequential gradient pumpComplex decongestive physiotherapy (CDP) or manual lymph drainage (MLD)
Radiation therapy primarily reserved for patients who have high risk for local recurrence. Also used in conjuction with breast-conserving surgery, or those usable to undergo surgical procedure, palliation
Adjuvant Chemotherapy Cyclophosphamide (C), methotrexate (M), doxorubicin (A), 5FU (F)Herceptin: for those with her2/neu overexpressionAdriamycin most effective single agent for metastatic breast disease
Endocrine therapies Selective estrogen receptor modulators (SERMS), Aromatase inhibitors (AIs), Estrogen receptor downregulators
Created by: leigh_86us
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