Elsevier items and derived items © 2006 by Elsevier Inc. Assessment and Management of Patients With...

Elsevier items and derived items © 2006 by Elsevier Inc.

Assessment and Management of Patients With Breast

Disorders


Benign Breast Disorders • Fibroadenoma, most common cause of breast

masses during adolescence; may occur in clients in their 30s

• Solid, slowly enlarging, benign mass; round, firm, easily movable, nontender, and clearly delineated from the surrounding tissue

• Usually located in the upper outer quadrant of the breast, enlargement in pregnancy

• US, needle aspiration, if solid - excision

• Fibroadenoma, most common cause of breast masses during adolescence; may occur in clients in their 30s

• Solid, slowly enlarging, benign mass; round, firm, easily movable, nontender, and clearly delineated from the surrounding tissue

• Usually located in the upper outer quadrant of the breast, enlargement in pregnancy

• US, needle aspiration, if solid - excision


Fibrocystic Breast Disease

• Physiologic nodularity of the breast, most common breast problem of women between 20 and 30 years of age

• Cause: ↑estrogen and ↓ progesteron

• Stage 1: late teens-early 20s, premenstrual fullness and tenderness in the outer upper quadrant, symptoms, resolve after menstruation

• Stage 2: late 20s-throught the 30s, multiple nodular areas in both breasts, mall marbles and occur with fullness and soreness

• Stage 3: between 35 and 55 years of age, microscopic or macroscopic cysts associated with pain, tenderness, or burning, three-dimensional, smooth, mobile, well delineated

• Mammography, fine needle aspiration, biopsy

• Physiologic nodularity of the breast, most common breast problem of women between 20 and 30 years of age

• Cause: ↑estrogen and ↓ progesteron

• Stage 1: late teens-early 20s, premenstrual fullness and tenderness in the outer upper quadrant, symptoms, resolve after menstruation

• Stage 2: late 20s-throught the 30s, multiple nodular areas in both breasts, mall marbles and occur with fullness and soreness

• Stage 3: between 35 and 55 years of age, microscopic or macroscopic cysts associated with pain, tenderness, or burning, three-dimensional, smooth, mobile, well delineated

• Mammography, fine needle aspiration, biopsy


Fibrocystic Breast Disease Collaborative Management

• Symptomatic management

• Hormonal manipulation (СOС, Danazol)

• Drug therapy: vitamins C, E, and B complex

• Diuretics

• Avoidance of caffeine

• Mild analgesics

• Limited salt intake before menses

• Well-padded supportive bra

• Local application of heat or ice for pain relief

• Symptomatic management

• Hormonal manipulation (СOС, Danazol)

• Drug therapy: vitamins C, E, and B complex

• Diuretics

• Avoidance of caffeine

• Mild analgesics

• Limited salt intake before menses

• Well-padded supportive bra

• Local application of heat or ice for pain relief


Ductal Ectasia

• Benign breast problem of women approaching menopause caused by dilation and thickening of the collecting ducts in the subareolar area

• Mass that is hard with irregular borders, tender

• Greenish brown nipple discharge, enlarged axillary nodes and edema over the site of the mass

• Benign breast problem of women approaching menopause caused by dilation and thickening of the collecting ducts in the subareolar area

• Mass that is hard with irregular borders, tender

• Greenish brown nipple discharge, enlarged axillary nodes and edema over the site of the mass


• Occurs most often in women 40 to 55

years of age, rarely palpable

• Benign process in the epithelial lining of the duct, forms a papilloma (pedunculated outgrowth of tissue)

• As papilloma growth, trauma and erosion within the duct result in a bloody or serous nipple discharge

• Microscopic examination of nipple discharge, rul out cancer

• Surgical excision

• Occurs most often in women 40 to 55

years of age, rarely palpable

• Benign process in the epithelial lining of the duct, forms a papilloma (pedunculated outgrowth of tissue)

• As papilloma growth, trauma and erosion within the duct result in a bloody or serous nipple discharge

• Microscopic examination of nipple discharge, rul out cancer

• Surgical excision

Intraductal Papilloma


Gynecomastia

• Benign condition of breast enlargement in men

• Can be a result of primary cancer such as lung cancer

• Causes include:

– Drugs

– Aging

– Obesity

• Benign condition of breast enlargement in men

• Can be a result of primary cancer such as lung cancer

• Causes include:

– Drugs

– Aging

– Obesity


Gynecomastia (Continued)

– Underlying disease causing estrogen excess

– Androgen deficiency

– Breast cancer

– Underlying disease causing estrogen excess

– Androgen deficiency

– Breast cancer


Breast Cancer

• Types of breast cancer

– Ductal carcinoma

– Lobular carcinoma

– Medullary carcinoma

– Colloid carcinoma

– Inflammatory carcinoma

• Complications include:

– Invasion of lymph channels causing skin edema

– Metastasis to lymph nodes

– Bone, lungs, brain, and liver—sites of metastatic disease from breast cancer

– Ulceration of overlying skin

• Types of breast cancer

– Ductal carcinoma

– Lobular carcinoma

– Medullary carcinoma

– Colloid carcinoma

– Inflammatory carcinoma

• Complications include:

– Invasion of lymph channels causing skin edema

– Metastasis to lymph nodes

– Bone, lungs, brain, and liver—sites of metastatic disease from breast cancer

– Ulceration of overlying skin


Breast Cancer in Men

• Of all breast cancers, only 1% occurs in men.

• Breast cancer in men usually presents as a hard, nonpainful subareolar mass.

• Breast cancer in men is often a widely spread disease because it is usually detected at a later stage than in women.

• Of all breast cancers, only 1% occurs in men.

• Breast cancer in men usually presents as a hard, nonpainful subareolar mass.

• Breast cancer in men is often a widely spread disease because it is usually detected at a later stage than in women.


Mammography

• Baseline screening mammography yearly at age 40 is recommended.

• Barriers to mammography compliance can involve factors such as fear.

• Increase compliance through education.

• Baseline screening mammography yearly at age 40 is recommended.

• Barriers to mammography compliance can involve factors such as fear.

• Increase compliance through education.


Breast Self-Examination

• The goal of screening for breast cancer is early detection because breast self-examination cannot prevent breast cancer.

• Early detection reduces mortality rate.

• Teach breast self-examination.

• The goal of screening for breast cancer is early detection because breast self-examination cannot prevent breast cancer.

• Early detection reduces mortality rate.

• Teach breast self-examination.


Breast Care

• Clinical breast examination

• Cancer surveillance

• Prophylactic mastectomy

• Chemoprevention

• Clinical breast examination

• Cancer surveillance

• Prophylactic mastectomy

• Chemoprevention


Pathologic Examination

• Key to diagnosis of breast cancer

• Presence or absence of estrogen receptors or progesterone receptors

• S-phase index, or growth rate

• DNA ploidy

• Histologic or nuclear grade

• HER2/neu gene expression

• Key to diagnosis of breast cancer

• Presence or absence of estrogen receptors or progesterone receptors

• S-phase index, or growth rate

• DNA ploidy

• Histologic or nuclear grade

• HER2/neu gene expression


Anxiety

• Interventions:

– Anxiety for the woman with breast cancer begins the moment the lump is discovered.

– Level of anxiety may be related to past experiences and personal associations with the disease.

– Allow the client to ventilate feelings.

– Flexibility is the key to nursing care.

• Interventions:

– Anxiety for the woman with breast cancer begins the moment the lump is discovered.

– Level of anxiety may be related to past experiences and personal associations with the disease.

– Allow the client to ventilate feelings.

– Flexibility is the key to nursing care.


Potential for Metastasis

• For clients with late-stage breast cancer, nonsurgical treatment may be the only alternative; tumor may be removed with local anesthetic, follow-up treatment with hormonal therapy, chemotherapy, and sometimes radiation.

(Continued)

• For clients with late-stage breast cancer, nonsurgical treatment may be the only alternative; tumor may be removed with local anesthetic, follow-up treatment with hormonal therapy, chemotherapy, and sometimes radiation.

(Continued)


Potential for Metastasis (Continued)

• For breast cancer at a stage for which surgery is the main treatment, follow-up with adjuvant radiation, chemotherapy, hormone therapy, or targeted therapy is commonly prescribed.

• For breast cancer at a stage for which surgery is the main treatment, follow-up with adjuvant radiation, chemotherapy, hormone therapy, or targeted therapy is commonly prescribed.


Surgical Management

• Mass should be removed to reduce risk for local recurrence; but controversy exists concerning the best treatment.

• Axillary lymph nodes (dissection or removal)

• Sentinel lymph node biopsy

• Preoperative care

• Operative procedure

• Mass should be removed to reduce risk for local recurrence; but controversy exists concerning the best treatment.

• Axillary lymph nodes (dissection or removal)

• Sentinel lymph node biopsy

• Preoperative care

• Operative procedure


Postoperative Care

• Avoidance of using the affected arm for blood pressure measurement, giving injections, or drawing blood

• Monitoring of vital signs

• Care of drainage tubes

• Comfort measures

• Mobility and diet

• Breast reconstruction

• Avoidance of using the affected arm for blood pressure measurement, giving injections, or drawing blood

• Monitoring of vital signs

• Care of drainage tubes

• Comfort measures

• Mobility and diet

• Breast reconstruction


Adjuvanat Therapy

• To decrease the risk of recurrence, adjuvant therapy consists of:

– Radiation therapy

– Chemotherapy

– Hormonal therapy

– Stem cell transplantation

– Targeted therapy

• To decrease the risk of recurrence, adjuvant therapy consists of:

– Radiation therapy

– Chemotherapy

– Hormonal therapy

– Stem cell transplantation

– Targeted therapy

Elsevier items and derived items © 2006 by Elsevier Inc. Assessment and Management of Patients With...

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