NCLEX Review Guide: Breast Cancer

Understanding Breast Cancer Development

• Breast cancer occurs when cells in breast tissue grow uncontrollably, most commonly originating in the ducts (ductal carcinoma) or lobules (lobular carcinoma).
• Invasive ductal carcinoma (IDC) accounts for 80% of all breast cancers and spreads beyond the milk ducts into surrounding breast tissue.
• Major risk factors include age over 50, family history of BRCA1/BRCA2 mutations, personal history of breast/ovarian cancer, and prolonged estrogen exposure.

Clinical Manifestations

• Early signs include painless, hard, immobile breast lump with irregular borders, often discovered during self-examination or routine screening.
• Advanced symptoms may include breast skin changes (peau d'orange appearance), nipple retraction, bloody nipple discharge, and lymph node enlargement.
• Inflammatory breast cancer presents with rapid onset of breast swelling, redness, warmth, and skin thickening without a palpable mass.

Diagnostic Procedures

1. Mammography: Primary screening tool for women 40+ years; can detect microcalcifications and masses
2. Ultrasound: Differentiates solid masses from cysts; guides biopsy procedures
3. MRI: Used for high-risk patients or to evaluate extent of disease
4. Biopsy: Definitive diagnosis through core needle biopsy or surgical biopsy

Surgical Interventions

• Lumpectomy (breast-conserving surgery) removes the tumor and small margin of healthy tissue, preserving most of the breast.
• Mastectomy involves removal of entire breast; types include simple, modified radical, and radical mastectomy based on extent of tissue removal.
• Sentinel lymph node biopsy identifies the first lymph node(s) cancer would spread to, minimizing surgical complications.

Adjuvant Therapies

• Chemotherapy uses cytotoxic drugs to destroy cancer cells; common regimens include AC-T (Adriamycin, Cyclophosphamide, Taxol).
• Radiation therapy targets remaining cancer cells after surgery; typically given 5 days/week for 5-7 weeks.
• Hormone therapy blocks estrogen in hormone receptor-positive cancers using medications like tamoxifen or aromatase inhibitors.
• Targeted therapy includes HER2-targeted drugs like trastuzumab (Herceptin) for HER2-positive tumors.

Post-Operative Care

1. Positioning: Elevate affected arm on pillows to promote lymphatic drainage and reduce swelling
2. Drain Management: Monitor Jackson-Pratt drains for output, color, and patency; empty when half-full
3. Wound Care: Assess incision for signs of infection, bleeding, or dehiscence
4. Pain Management: Administer prescribed analgesics and assess pain using 0-10 scale

Chemotherapy Nursing Care

• Monitor for myelosuppression by checking CBC before each cycle; hold treatment if ANC <1000 or platelets <100,000.
• Assess for cardiotoxicity with doxorubicin (Adriamycin) by monitoring ECHO or MUGA scans and watching for signs of heart failure.
• Manage peripheral neuropathy from taxanes by assessing sensation, gait, and fine motor skills at each visit.

Self-Assessment Questions:

• ☐ Can you list 5 risk factors for breast cancer?
• ☐ Do you know the difference between ductal and lobular carcinoma?
• ☐ Can you explain proper post-mastectomy arm positioning?
• ☐ Do you understand lymphedema prevention measures?
• ☐ Can you differentiate between tamoxifen and aromatase inhibitors?