Breast Cancer

Risk Factors
1. Female
2. Age > 50 years
3. Family History
4. Early Menarch (<12 years old)
5. Late Menopause (> 50 years old)
6. First full-term pregnancy after age 30…the longer the period of time a women has her cycle increases her risk
7. Nulliparity…no children
8. Obesity after menopause…adipose tissue stores estrogen and estrogen is a risk factor for breast cancer

Genetic Link
BRCA-1: tumor-suppressor gene
Discovered on Chromosome 17
When genes are mutated they have a 50-85% chance of acquiring breast cancer
BRCA-2: tumor-suppressor gene
Located on chromosome 11
Increase risk of breast cancer
BRCA-1 & BRCA-2 mutations increase the risk of ovarian cancer as well as breast cancer
Associated with early onset of breast cancer…at a younger age
DNA testing
Prophylactic bilateral oophorectomy and bilateral mastectomy

Types of Breast Cancer

Non-invasive
Ductal…A
Lobular…B
Most often progresses to invasive breast cancer if left untreated.

Invasive
Paget’s Disease
Lesion of the nipple and areola area
Itching, burning, bloody nipple discharge with superficial erosion

Inflammatory
Most malignant: aggressive and fast-growing
Rare
Skin of breast red, warm, “peau d’ orange”…orange peal in French
- look like hives
- the inflammatory changes make it look like that (orange peel) is caused by the cancer cell that are blocking
the lymph ducts
- it spreads very early and frequently and it is aggressive
- but it is the most rare

Clinical Manifestations
Single lump occurring most often in the upper outer quadrant of the breast, it doesn’t matter if it is right or left

Clinical Manifestations of Malignant

a) Hard
b) Irregularly shaped
c) Poorly delineated
d) Non-mobile
e) Non-tender
f) Asymmetry of breasts…tumor cause breast to look bigger than other

Diagnostic Studies
a) Mammography…base line screening
b) Ultrasound

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 c) Biopsy…definitively diagnosis

Prognostic Indicators
Sentinel lymph node dissection (SLND)…the first lymph node the tumor drains into
- They inject dye into the area where the tumor was
- If tumor cells in sentinel node then they remove the lymph node
- If no tumor they can keep lymph nodes

HER-2 / neu genetic marker

–Associated with aggressive tumor growth
–25-35% of tumors produce excessive HER-2
–Overexpression of this receptor=increased chance of recurrence and poorer prognosis (more genes than normal)
–Treated with Herceptin
Estrogen / Progesterone receptor status
– (+) Well differentiated, lower recurrence, responsive to hormone therapy
– (-) Poorly differentiated, frequently recur, usually unresponsive to hormone therapy
– Treated with Tamoxifen
Treatment: Surgery
Axillary lymph node dissection…done with (SLND), if positive for tumor cell they will remove the rest of the
lymph nodes
Lumpectomy…breast conservation surgery…taking out the lump and conservating the breast…radiation
performed after that (for small tumor)
Modified radical mastectomy…breast is remove alone with lymph node…but the (pectoris) major muscle is
kept intact (done for large tumor)
Post-op Care
–Preserve full ROM
–Prevent / reduce lymphedema
–Exercises they can do
o Comb or brush hair…that want infected arm to start working
o Tie a rope or string to a door handle and have them make big circles
o Wall walking….stand in front of wall and wall all the way up with both hands
o Maintain full ROM

Lymphedema: Accumulation of lymphatic fluid that causes swelling in the arms = NO BP, draw blood or inject meds,
start IV in affected area.
Increased ability of cellulitis because of stagnation of accumulated fluid
Compression pumps are being used to treat lymphedema. This system consists of a pump and an appliance (sleeve)
which fits over the extremity. Air pressure is applied to the appliance which in turn, applies pressure to the extremity.
The basic pump applies a uniform pressure over the extremity. The better devices consist of a pump and appliance with
three or more segment which sequentially apply pressure along the extremity, distally to proximally.
proximally.
If untreated, this stagnant protein rich fluid not only causes the tissue channels to increase in size and number, but
also reduces oxygen through the transport system, interferes with wound healing, and provides a culture mediaum for
bacteria that can results in various infections
Compare CMS (circulation movement and sensation) in affected limb to unaffected limb
- Circulation…pulse, color, capillary refill, temperature

Treatment: Radiation
Primary = removed breast tumor
Adjunct to surgery
High-dose brachytherapy…put a catheter into the tumor site, high dose of radiation to where the tumor is
Palliative = patient’s tumor is not resected

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Treatment: Systemic
Chemotherapy
Hormonal therapy : Tamoxifen pill: Side effect - Nausea/vomiting, increase risk of blood clot, hot flashes
Biologic therapy : Herceptin (for overexpression neu gene) help to prevent tumor growth from the
overexpression gene

Home Care
Annual mammography
BSE
Sexuality
Fear
Uncertainty
Self-Esteem
Body image
Reach to Recovery – to meet
physical needs, physiological,
emotional needs, peer information or
support
Y-Me