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

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. Gynecomastia (Continued) –Underlying disease causing estrogen excess –Androgen deficiency –Breast cancer –Underlying disease causing estrogen excess –Androgen deficiency –Breast cancer

Elsevier items and derived items © 2006 by Elsevier Inc. 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

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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.

Elsevier items and derived items © 2006 by Elsevier Inc. 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.

Elsevier items and derived items © 2006 by Elsevier Inc. 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.

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Breast Care Clinical breast examination Cancer surveillance Prophylactic mastectomy Chemoprevention Clinical breast examination Cancer surveillance Prophylactic mastectomy Chemoprevention

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. 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.

Elsevier items and derived items © 2006 by Elsevier Inc. 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)

Elsevier items and derived items © 2006 by Elsevier Inc. 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.

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. 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

Elsevier items and derived items © 2006 by Elsevier Inc. 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