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University of Calgary
NURS 287
Rick Nilson

BREAST CANCER  Breast cancer is the most common malignancy in American women except for skin cancer.  Although the etiology of breast cancer is not completely understood, a number of factors are thought to relate to breast cancer including a family history, environmental factors, genetics, early menarche and late menopause, and age 60 or over. However, most women who develop breast cancer have no identifiable risk factors.  Noninvasive breast cancers include ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). o DCIS tends to be unilateral and most likely would progress to invasive breast cancer if left untreated. o LCIS is a risk factor for developing breast cancer, but it is not known to be a premalignant lesion. No treatment is necessary for LCIS. Tamoxifen may be given as a chemoprevention.  Paget’s disease: o Paget’s disease is a rare breast malignancy characterized by a persistent lesion of the nipple and areola with or without a palpable mass. o Treatment is a simple or modified radical mastectomy.  Inflammatory breast cancer: o Inflammatory breast cancer is the most malignant form of all breast cancers. o The skin of the breast looks red, feels warm, with a thickened appearance described as resembling an orange peel (peau d’orange). o Metastases occur early and widely. Radiation, chemotherapy, and hormone therapy are more likely to be used for treatment than surgery.  Breast cancer is detected as a lump or mammographic abnormality in the breast. It occurs most often in upper, outer quadrant of breast.  If palpable, breast cancer is usually hard, and may be irregularly shaped, poorly delineated, nonmobile, and nontender. Nipple discharge may also be present.  In addition to earlier listed tests, other tests useful in predicting risk of recurrence or metastatic breast disease include axillary lymph node status, tumor size, estrogen and progesterone receptor status, and cell proliferative indices.  Patients with breast cancer should discuss all treatment options with their health care provider, including local excision, mastectomy with breast reconstruction, breast- conserving treatment (lumpectomy), radiation therapy, and/or tamoxifen.  Common options for resectable breast cancer include breast conservation surgery with radiation therapy and modified radical mastectomy with or without reconstruction.  Breast conservatio
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