Role of the Community Specialist Breast Care Nurse

Role of the Community Specialist Breast Care Nurse

Role of the Breast Care Nurse • • Free service - public or private health system A central contact point throughout your cancer experience Provide up-to-date information Provide practical and emotional support Act as a ‘sounding board’ to discuss options Referral to other services as required Act as a link with support groups and other support networks

How to Refer to Breast Care Nurse • Self • General Practitioner • Surgeon • Medical/ Radiation Oncologist • Nurses • Hospital • Breast Screen NSW • MDT

What happens next? • Phone client to arrange possible meeting. • Face to face meeting at place of client choosing. • In-patient contact • Post discharge • Pre adjuvant treatment • Post completion of active treatment • Ongoing support as required

Multidisciplinary Team Meetings • Local Medical Officers • Pathologist • Surgeons • Specialist Breast Care Nurses • Radiologists • Genetic Counsellor • Radiation Oncologist • Physiotherapist • Medical Oncologist • Social Worker

Support Services v Prosthesis -Medicare Funded up to $400, every 2 years v Breast Cancer Network- My Journey Kit & My Care Kit v Social Workers- case conference, financial and legal concerns, counselling v The Cancer Council NSW v Genetic Counselling v Breast cancer support groups in Ballina, Byron Bay, Casino, Kyogle, Lismore and Murwillumbah. v Look Good Feel Better Workshops v Wig Library - NNSWCI

Encore- gentle exercise program after breast cancer Lymphoedema Therapists (public and private). Located in Lismore, Ballina, Casino and Byron Bay Patient Assisted Travel (IPTAAS). For patients who need to access specialist services 70 km or more from home or >200 km in a week. Volunteer (community) transport Rainbow Dragons Abreast – Lennox & Mount Warning groups Can. TEEN- support to 12 to 24 year olds Knockers, bags, pillows, beanies……. . 7

Anatomy Of the breast • • A - Ducts B – Lobule C – Lactiferous Duct (holds milk) D – Nipple E – Fat F – Pectoralis major muscle G – Chest wall / rib cage • A – Normal Duct • B – Basement membrane • C – Lumen (Breast. Cancer. org, 2012)

Triple Test • Clinical examination & history • Mammogram • Ultrasound +/- stereotactic core biopsy • 9 out of 10 lumps are benign in Pre-Menopausal women • 3 out of 4 lumps are benign in Post- Menopausal women

Types of breast cancer • An abnormal cell growth that begins & remains within or insitu (noninvasive) is called: • Duct = DCIS or Ductal Carcinoma Insitu • Lobule = LCIS or Lobular Carcinoma Insitu (AIHW & Cancer Australia, 2012)

Types of breast cancer continued • An abnormal cell growth that NO longer remains within the duct/lobe is called invasive or infiltrating; • IDC = Infiltrating Ductal Carcinoma (most common breast cancer) • ILC = Infiltrating Lobular Carcinoma (AIHW & Cancer Australia, 2012)

Less common breast cancers • Inflammatory breast cancer • A rare form of invasive breast cancer which affects the lymphatic vessels in the skin of the breast making the skin become red & inflamed. • often thought to be cellulitis/mastitis (Yarbro, Wujcik & Gobel, 2011)

Paget’s Disease – affects the nipple and the areola & often associated with invasive cancer elsewhere in the breast.

Surgical Options for Breast Cancer Wide Local Excision (WLE) - the removal of the breast lump with good clear tissue margins while conserving the breast Simple Mastectomy - the removal of the breast

Lymph Node status • Is necessary for diagnostic, prognostic and therapeutic purposes in order to; • Classify the extent of disease • Planning adjuvant treatment such as chemotherapy, radiotherapy, endocrine treatment

Breast area lymph nodes A- Pectoralis major muscle B- Axillary lymph nodes Level l C – Axillary lymph nodes level ll D – Axillary lymph nodes level lll E – Supraclavicular lymph nodes F internal mammary lymph nodes (Breast. Cancer. org, 2012)

Sentinel lymph node biopsy

Axillary lymph node dissection Standard surgical practice when: • Lymph nodes are clinically palpable • Depending on level of clearance, approximately 10 - 50 lymph nodes may be removed

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