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Breast Cancer for NP

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Breast Cancer for the Nurse Practitioner Licensing Exam
Definition and Classification
  • Definition
    • Breast cancer is a malignancy arising from the breast tissue, commonly from the ducts (ductal carcinoma) or lobules (lobular carcinoma).
  • Classification by Receptor Status
    • Hormone Receptor-Positive (ER+ and/or PR+): Most common type, responsive to hormone therapy.
    • HER2-Positive: Overexpresses HER2 protein, more aggressive but responds to HER2-targeted therapies.
    • Triple-Negative Breast Cancer (TNBC): Lacks ER, PR, and HER2; typically aggressive and treated with chemotherapy.
Epidemiology and Risk Factors
  • Epidemiology
    • Most common cancer in women, with incidence increasing with age.
  • Risk Factors
    • Non-Modifiable: Female gender, older age, family history, BRCA1/2 mutations.
    • Modifiable: Obesity, alcohol intake, hormone replacement therapy, and lack of physical activity.
Clinical Manifestations
  • Palpable Mass
    • Firm, typically painless mass with irregular borders, often the first symptom.
  • Skin and Nipple Changes
    • Skin dimpling, nipple retraction, or discharge; inflammatory breast cancer presents with erythema and peau d’orange.
  • Axillary Lymphadenopathy
    • Enlarged axillary lymph nodes may suggest spread to regional lymph nodes.
breast cancer breast changes
Diagnosis
  • Imaging
    • Mammography: Primary screening tool for women over 40 or at increased risk.
    • Ultrasound: Assesses mass characteristics, differentiates cystic from solid masses, and evaluates lymph nodes.
  • Biopsy
    • Core Needle Biopsy: Preferred method, allows histologic diagnosis and receptor testing.
Treatment
  • Surgery
    • Lumpectomy: Breast-conserving, often followed by radiation.
    • Mastectomy: Complete removal of the breast, recommended for large or multicentric tumors.
  • Radiation Therapy
    • Reduces recurrence risk, especially after lumpectomy.
  • Systemic Therapy
    • Hormonal Therapy: For ER/PR-positive tumors, includes tamoxifen (premenopausal) or aromatase inhibitors (postmenopausal).
    • Chemotherapy: Used for high-risk cases or TNBC.
    • HER2-Targeted Therapy: Trastuzumab and related agents for HER2-positive tumors.
Key Points
  • Breast Cancer is classified by receptor status (ER, PR, HER2), which directs treatment.
  • Risk Factors include both modifiable (e.g., obesity, alcohol) and non-modifiable factors (e.g., age, family history).
  • Diagnosis: Mammography, ultrasound, and core needle biopsy confirm diagnosis and receptor status.
  • Treatment includes surgery, radiation, and systemic therapies based on tumor characteristics.

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