Breast & Prostate Cancer

• Modifiable risk factors for Breast Cancer

  • alcohol use
  • hormone use
  • heavy smoking
  • physical inactivity
  • weight gain/obesity
• Non-modifiable risk factors for Breast Cancer

  • 50 years old or older
  • family history
  • genetics
  • female
  • early menarche or late menopause
  • BRCA1 and BRCA2 (mutated suppressor genes)
  • prophylactic oophorectomy and mastectomy
• Breast Cancer: most common cancer in women in the US
• Non-invasive breast cancer:

  • Cancer within the ducts of the breast (intraductal) that has not invaded local tissue or spread to other organs
  • Includes ductal carcinoma in situ or pure Paget's disease
  • Typically treated with lumpectomy +/- radiation therapy, total mastectomy +/- SLNB, and/or hormone therapy
  • Can progress to an invasive cancer if left untreated
• Invasive Breast Cancer:

  • Invasive Ductal Carcinoma
  • Invasive Lobular Carcinoma
• Invasive Ductal Carcinoma:

  • Accounts for 80% of invasive breast cancer
  • Cancer begins in breast ducts and can invade surrounding tissue, sentinel or distant lymph nodes, and distant organs
  • Medullary carcinoma, tubular carcinoma, colloid carcinoma, papillary carcinoma and metaplastic carcinoma
• Invasive Lobular Carcinoma:

  • Starts in the lobules (glands) of the breast
• Clinical Manifestations of Breast Cancer:

  • Lump or thickening in the breast
  • Mammography screening can help detect early abnormalities
• Recurrence of Breast Cancer:

  • Local: skin or soft tissue near a mastectomy site
  • Regional: axillary or internal mammary lymph nodes
  • Distant: bone, lung, brain, liver, other
• Diagnostic Tests for Breast Cancer:

  • assess tumor size, lymph node involvement, hormone receptor status, cell-proliferation, genomic assay
• Breast Cancer Treatment:

  • Stage using the TNM staging system
  • Treatment is determined based on the cancer stage
  • Surgical intervention is the primary treatment in early stage cancer
  • Lumpectomy: removing the entire tumor along with a margin of normal surrounding tissue
  • Mastectomy +/- reconstruction: removal of the entire breast and can include removal of axillary lymph nodes
  • Radiation can be used in adjuvant or palliative setting
  • Chemotherapy, hormone therapy, or targeted therapy can be used in the adjuvant, metastatic (non-curative) or palliative setting
• Breast Cancer: Lymphedema

  • An accumulation of lymph in soft tissue as a result of defective lymph drainage and obstructive pressure on the local venous system
  • Can occur after lymph node removal or radiation to lymph nodes
  • Most often occurs in the upper extremity lateral to the site of lymph node removal
• Nursing Considerations: Lymphedema

  • Teaching patient not to leave the affected extremity in a dependent position for long periods of time
  • Encourage light exercise and active ROM with the affected extremity
  • NO BP readings, venipunctures, or injections on the affected extremity
  • Avoid any potential trauma to the extremity including lacerations, burns, constriction or blunt force
• Benign Prostatic Hyperplasia (BPH):

  • BPH is not prostate cancer
  • Condition when the prostate gland increases in size and disrupts the outflow of urine from the bladder through the urethra
  • Incidence increases with age: 70% of men between 60-69 has some degree of BPH
  • Thought to be caused by hormonal imbalances that naturally occur with older age
  • Symptoms and complications are related to urinary obstruction
• Modifiable risk factors for BPH:

  • Obesity
  • Inactivity
  • High amounts of dietary animal protein
  • Alcohol use
  • Smoke
• BPH Diagnostic Assessment:

  • History and physical exam
  • Digital rectal exam (DRE)
  • Urinalysis with culture/sensitivities
  • Prostate Specific Antigen (PSA)
  • Serum creatinine
  • Post-void residual
  • Transrectal ultrasound or pelvic MRI
• BPH Management Includes:

  • Active surveillance
  • Drug therapy
  • Minimally invasive therapy
  • Invasive (survey) therapy
  • Transurethral resection of the prostate
• Prostate Cancer: Most common cancer in men and second leading cause of cancer related deaths in men
• Modifiable Risk Factors: Prostate Cancer

  • Obesity
  • Diet high in red and processed meat
  • High fat diet
  • Chemical pesticide exposure
• Non-modifiable Risk Factors: Prostate Cancer

  • Age
  • Ethnicity
  • Family history
  • No known single gene factors however, hereditary prostate cancer occurs in 5-10% of cases
• Prostate Cancer is typically slow growing; androgen-dependent
• Prostate Cancer Spreads by 3 Routes:

  • Direct Extension
  • Lymphatic Spread
  • Bloodstream spread
• Direct Extension: prostate cancer spread

  • Invasion of cancer into the seminal vesicles, urethral mucosa, bladder wall, and external sphincter
• Lymphatic Spread: prostate cancer spread

  • Migration of cancer cells to regional lymph nodes
• Bloodstream Spread: prostate cancer spread

  • Cause for metastatic disease to the axial skeleton (pelvis, head of femur, and/or lower lumbar spine)
• Prostate Cancer: Clinical Manifestations 

  • In early stages, prostate cancer is relatively asymptomatic 
  • Initially, symptoms may mimic those of BPH 
  • In later stages, lumbosacral pain that radiates to the hips and legs is noted along with urinary obstructive symptoms/complications
  • Sacral and lumbar spine metastasis can cause severe pain and spinal cord compression (oncologic emergency)
• Prostate Cancer: Diagnostics

  • Screening for prostate cancer includes annual PSA testing and DRE 
  • When to start screening is dependent on age and other risk factors 
  • Biopsy of the prostate must be done to confirm prostate cancer and is usually conducted via transrectal ultrasound
• Prostate Cancer Active Surveillance

  • Patients are closely monitored with frequent PSA testing and DRE at least annually 
  • Any significant changes in the PSA or DRE or new/worsening symptoms may warrant further diagnostic testing and treatment
• Active Surveillance:

  • Low grade prostate cancer is relatively slow growing 
  • Patient can consider active surveillance or “watchful waiting” in these situations: 
  • Life expectancy of less than 10 years 
  • Low-grade / low stage tumor 
  • Serious coexisting medical conditions
• Prostate Cancer Treatment:

  • Staged using the TNM staging system, Gleason scale, Grade Group and PSA 
  • Treatment is based on cancer stage 
  • Early stage cancers may be cured with surgical resection however, surgery may also be offered to help relieve symptoms
  • Radiation therapy
  • Chemotherapy and hormone therapy can also be used to treat and palliate late stage cancer
• Prostate Cancer Treatment: Surgery

  • Radical prostatectomy (GOLD STANDARD) involves removal of the entire prostate gland, seminal vesicles, and part of the bladder neck as well as dissection of pelvic lymph nodes 
  • Adverse outcomes include erectile dysfunction (ED) and urinary incontinence
• Prostate Cancer Treatment: Radiation Therapy

  • External beam can be used to treat cancer confined to the prostate and/or surrounding tissues; comparable rates of cure with radial prostatectomy 
  • Brachytherapy involves placing radioactive seed implants into the prostate gland; helps spare surrounding tissue the adverse effects of radiation. It is best used for early stage cancer.