HA | Primer Breast and Lymphatic System

🩺 Breast Health & Cancer — High-Yield Study Guide (RN prep)

1) Classifications & Key Types

• DCIS: In-duct only, noninvasive.
• IDC: Most common (≈80–90%), past duct; firm ± fixed.
• ILC: ≈10%; often thickening vs discrete lump.
• IBC: Aggressive red-swollen breast, peau d’orange; urgent eval.
• Paget dz (nipple): Erythema, flaking, burning, discharge, pain (late); often linked to intraductal CA.
• Triple-Negative (ER-/PR-/HER2-): 10–20%; more in younger & Black pts; faster course.

2) Common Benign

• Fibrocystic changes: Cyclic tender “rubbery/granular” lumps ↑ pre-menses, ↓ after; hormonal.

3) Red Flags → Refer ⚠️

• New mass that’s hard, fixed, poorly defined.
• Spontaneous, unilateral, bloody/guaiac+ discharge.
• Skin changes: peau d’orange, new dimpling/retraction.
• New nipple inversion.
• Inflammatory signs (redness/warmth/rapid enlargement) → think IBC.

4) Bedside Approach (Nursing)

• HPI: COLDSPA for pain/lumps.
• Teach risk reduction: regular exercise, ≤1 drink/day, weight control; high-risk pts discuss enhanced screening.
• Med review (can cause pain/discharge): hormones/OCPs, antipsychotics (e.g., haloperidol/risperidone), antidepressants, sedatives, some antihypertensives; herbs: fennel/anise/fenugreek.

5) Screening (ACS-style talking points) 🎯

• Mammogram: annually from 40 (50–74 may go q2y).
• CBE: q2–3y in 20s–30s; yearly ≥40.
• BSE: optional—teach correct method; goal = body awareness.

6) Risk Factors (know these!) 🧬

• Non-modifiable: female, ↑age, BRCA1/2 (≈5–10%), prior LCIS/atypia, early menarche/late menopause, prior chest radiation, dense breasts.
• Reproductive: nulliparity or 1st birth >30.
• Lifestyle: obesity, post-meno HRT, alcohol (esp. ≥2/day), night-shift/2nd-hand smoke, high-fat diet.

7) Physical Exam (how to) 🧪

• Position: Inspect sitting (both breasts exposed); palpate supine.
• Inspect: symmetry, color/texture, venous pattern, areola/nipple, retraction/dimpling.
• Palpate: all 4 quadrants + Tail of Spence (🔺most tumors here); note location, size, shape, mobility, consistency, tenderness.
• Nodes: Axillary anterior (pectoral), posterior (subscap), lateral (brachial), central.