TERMINOLOGY
CLINICAL CLARIFICATION
• Cancer that develops in the cells of the breast 12
• Diagnosis requires a tissue biopsy for microscopic examination to determine pathology
CLASSIFICATION
• The TNM classification is used for clinical staging of breast tumors. The American Joint Committee on Cancer (AJCQ 7th edition stages breast cancer as follows: 12 o TX: primary tumor cannot be assessed o TO: no evidence of primary tumor o Tis: cancer in situ
- Tis (DCIS): ductal carcinoma in situ
- Tis (LCIS): lobular carcinoma in situ
- Tis (Paget): Paget disease of the nipple not associated with DCIS/LCIS o T1: 20 mm but " '50 mm in greatest dimension o T3: >50 mm in greatest dimension o T4: regional invasion o NX: regional nodes cannot be
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• Stages o Stage 0: TisNOMO o Stage lA: T1NOMO o Stage IB: (TO-T1)N1miMO o Stage IlA: (TO-T1)N1 MO, T2NOMO o Stage liB: T2N1MO, T3NOMO o Stage lilA: (TO-T2)N2MO, T3(N1-N2)MO o Stage 1118: T4(NO-N2)MO o Stage IIIC: any T, N3, MO o Stage IV: any T, any N, M1
DIAGNOSIS
CLINICAL PRESENTATION
• History o Breast mass may not be detectable and found incidentally on screening mammography 21 o Mass in breast detected by patient or by screening mammography 21 o Personal and/or significant family history (First- or second-degree relatives) of breast and/or ovarian cancer, or atypia noted on prior biopsies 21 o There may be bone pain due to metastasis in advanced disease o Shortness of breath may be present if spread to the lungs
• Physical examination o Palpable breast lumps are detectable in 90% of cancers and are the most common sign 8 o Eczematous ulcer of the nipple
- Paget 's disease may mimic these findings
o Skin edema/erythema o Breast lymphedema (peau d 'orange) o Skin nodules o In advanced disease, there may be signs of pleural effusion, and/or hepatomegaly, and/or bone metastases as regional and generalized spread of the cancer ensues 2 o Bloody nipple discharge:unilateral, spontaneous
- Nipple discharge generally relates to a benign condition and its most common cause is an intraductal papilloma, a benign condition treated by excision alone 8 o Skin and/or nipple retraction o Eczematous ulcer of the nipple
- Paget 's disease may mimic these findings
CAUSES AND
Situation: The client is a 50-year-old female teacher who was notified of an abnormal screening mammogram. Diagnosis of infiltrating ductal carcinoma was made following a stereotactic needle biopsy of a 1.5 x 1.5 cm lobulated mass at the 3:00 position in her left breast. The client had a modified radical mastectomy with lymph node dissection. The sentinel lymph node and 11 of 16 lymph nodes were positive for tumor. Estrogen receptors and progesterone receptors were both positive. Further staging work-up was negative for distant metastasis. Her final staging was stage IIB. Her prescribed chemotherapy regimen is 6 cycles of CAF after a single-lumen central line was placed.
Describe the three-pronged approach to early detection of breast masses: mammography, clinical breast exam, and self-awareness.
Extramammary Paget disease (EMPD) arises as a primary cutaneous adenocarcinoma in most cases. The epidermis becomes infiltrated with neoplastic cells showing glandular differentiation. Tumor cells may originate from apocrine gland ducts or from keratinocytic stem cells.
Mammograms are breast cancer screenings and are of great importance since they detect if indeed a malignant tumor is present and if so what stage it is in (Stephan, 2010). Cancers can be detected at stages I, II, or IIA (Haas et al., 2008).
TNM system is based on the size of the tumor (T), whether lymph nodes are involved (N) and whether the tumor has metastasized (M) and spread to another part of the body(Dighe et al., 2015). TNM system can classify the cancer into 5 stages ranging from Stage 0 (carcinoma in situ (DCIS) or (LCIS) up to Stage IV where cancer has already metastasized to other organs(Moussa and Yones 2015). Larger size, nodal spread and metastasis lead to larger stage number and worse prognosis(Dighe et al.,
New wheezing, shortness of breath, hoarseness, coughing up blood, swelling in the neck and face, difficulty swallowing, weight loss and no appetite, fatigue and weakness, clubbing of the fingers. (http://www.medicinenet.com/script/main/art.asp?articlekey=52889). Areas of tenderness or masses may be felt when palpating the chest wall. Increased vibrations felt on the chest wall indicates areas of the lung where air spaces are filled with a tumor or fluid. Lung areas with masses sound dull and flat rather than hollow on chest percussion. Breath sounds may change with a tumor in place. Wheezes will indicate obstruction of airflow, decreased or absent breath sounds will indicate complete obstruction of airway by a tumor or fluid. A pleural friction rub may be heard when inflammation also is present. Lung cancer may also effect other systems of the body like heart sounds could be muffled by a tumor or fluid around the heart. Bones will lose density with a tumor in
With all kinds of cancer, there are seven major warning signs. These seven signs found in one person would indicate that the person may be suffering from some type of cancer, and this person should see a doctor immediately. The seven warning signs are a significant change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lumps in breast, indigestion or difficulty swallowing, obvious changes in wart or mole, and a nagging cough or hoarseness.
Currently mammography and ultrasound are basic imaging techniques for detection and localization of breast tumor. Breast Ultrasound is a typically painless medical test that uses reflected sound waves for further evaluation of a breast abnormality or a specific area seen on mammography. Ultrasound can locate and measure abnormalities or changes to determine if a breast lump is solid or filled with fluid. A mammogram is an x-ray of the breast which may find tumors that are too small to feel. Women aged 40 to 74 years should have annual screening mammograms to lower chance of dying from breast cancer(2,15).Mammograms are less likely to find breast tumors in women younger than 50 years. This may
Three-quarters of all breast cancer patients are not in any of the groups considered at increased risk for breast cancer, indicating that not all risk factors are understood. As a result, doctors recommend that every woman should familiarize herself with the techniques for monthly breast self-examination. X-ray examination of the breasts, a technique called mammography, can detect tumors before they are large enough to be felt and increase the odds for successful treatment. The American Cancer Society recommends that women over age 40
“Cancer” is the name for a group of diseases that start in the body at the cellular level. Even though there are many different kinds of cancer, they all begin with abnormal cell growth with the potential to invade or spread to other parts of the body. These abnormal cells lump together to form a mass of tissue or “malignant tumor”. Malignant means that it can spread to other parts of the body or Metastasize . If the breast is the original location of the cancer growth or malignant tumor, the tumor is called breast cancer. (American Cancer Society, 2014, as cited in cbcf.org)
Mammograms are probably the most important tool doctors have in diagnosing breast cancer. Although they do not prevent one from acquiring breast cancer, it does help diagnosing as early as possible. “Mammography has a false-negative (missed cancer) rate of at least 10 percent (Wikipedia)”. Mammograms rarely miss cancerous cells. That of which they do miss is because of the density in the breast. A false negative is more common among younger women due to the fact that younger woman have more density in their breasts. There are four different categories found by mammograms: 1. easily treated cancers. 2. aggressive cancers that are detected too late. 3. slow-growing cancers that ultimately will not harm or kill a patient before natural causes do, and 4. a small number of cancers who treatment outcome is better because of early detection. Mammograms will help to find all kinds of cancers that are undetectable by self-examinations.
women normal breast tissue have a density of carcinoma. It very difficult to tell which is
There are four stages of breast cancer. The Stage 0 is noninvasive breast cancer, that is, carcinoma in situ with no affected lymph nodes or metastasis. Stage zero is the most favorable. Now Stage 1 breast cancer is less than two centimeters in greatest dimension and is only in the breasts. In Stage 2, the cancer is no larger than two centimeters but it has spread to the lymph nodes under the arm. The
The symptoms of breast cancer vary in different woman, and men sometimes to. A few symptoms of breast cancer is lumps, swollen lymph nodes under arm, leaking, changing color, and many other symptoms. Three main ones are lumps, lymph nodes swollen underarm, and last is change in color. A first symptom a person might encounter is a lump in his or her breast. According to American Cancer Society (2017) “The most common symptom of breast cancer is a new lump or mass.” A second symptom is lymph nodes swollen. According to American Cancer Society (2017) “Sometimes a breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in
It is also the leading cause of cancer death in women aged from 20 to 59 years old [1]. These alarming statistics arise from the fact that there are limitations in both current detection and treatment methods [2-5]. Advancements are, therefore, needed in early detection, to increase survival rates and improve clinical outcomes [6]. In addition, localized treatments are needed to overcome the side effects that are associated with current breast cancer therapies [7].