Download Chapter 77

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
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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
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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
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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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Intraductal Papilloma
• 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
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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
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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
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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.
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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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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
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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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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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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
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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
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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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