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Breast cancer N430
| Question | Answer |
|---|---|
| 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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