1. Assessment and Management of Patients With Breast Disorders

2. 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
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3. Fibrocystic Breast Disease
Physiologic nodularity of the breast, most common breast problem of women between 20 and 30 years of age
Stage 1: premenstrual fullness and tenderness, symptoms occur on menstrual cycle
Stage 2: multiple nodular areas in both breasts
(Continued)
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4. Fibrocystic Breast Disease (Continued)
Stage 3: microscopic or macroscopic cysts associated with pain, tenderness, or burning occurring in women between 35 and 55 years of age
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5. Collaborative Management
Symptomatic management
Hormonal manipulation (СOС, Danazol)
Drug therapy: vitamins C, E, and B complex
Diuretics
Avoidance of caffeine
Mild analgesics
(Continued)
S&P
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6. Collaborative Management (Continued)
Limited salt intake before menses
Well-padded supportive bra
Local application of heat or ice for pain relief
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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
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8. Intraductal Papilloma
Occurs most often in women 40 to 55 years of age
Benign process in the epithelial lining of the duct, forming an outgrowth of tissue
S&P
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9. Intraductal Papilloma (Continued)
Trauma and erosion within the duct, resulting in bloody or serous nipple discharge
Diagnosis aimed first at ruling out breast cancer
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Gynecomastia
Benign condition of breast enlargement in men
Can be a result of primary cancer such as lung cancer
Causes include:
Drugs
Aging
Obesity
(Continued)
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11. Gynecomastia (Continued)
Underlying disease causing estrogen excess
Androgen deficiency
Breast cancer
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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
S&P
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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.
S&P
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Mammography
Baseline screening mammography yearly at age 40 is recommended.
Barriers to mammography compliance can involve factors such as fear.
Increase compliance through education.
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16. 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.
S&P
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Breast Care
Clinical breast examination
Cancer surveillance
Prophylactic mastectomy
Chemoprevention
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19. 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
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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.
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21. 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)
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22. 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.
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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
S&P
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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
S&P
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Adjuvanat Therapy
To decrease the risk of recurrence, adjuvant therapy consists of:
Radiation therapy
Chemotherapy
Hormonal therapy
Stem cell transplantation
Targeted therapy
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