PAIN AFTER BREAST CANCER SURGERY：乳腺癌手术后疼痛.pptVIP

TREATING PAIN AFTER SURGERY Andrea V. Barrio, MD, FACS Attending Breast Surgeon Associate Program Director, Breast Fellowship Program The Bryn Mawr Hospital INTRODUCTION Breast cancer most common cancer among women ACS estimates 232,340 new cases in 20131 Second most common cause death 39,620 deaths in 20131 SCOPE OF THE PROBLEM Estimated 2.9 million breast cancer survivors 2012 Persistent postsurgical pain demonstrated in 25 -50% of patients undergoing breast cancer surgery1 OVERVIEW Anatomy Presentation of breast cancer Common surgical procedures for breast cancer Causes of acute post-surgical pain Causes of post-surgical sensory disturbances Lymphedema Treatment BREAST ANATOMY Female breast Lobules (milk-producing glands) Ducts (tubes carry milk from lobules to nipple) Stroma (fatty tissue and connective tissue surrounding ducts and lobules) THE LYMPHATIC SYSTEM Part of body’s defense system Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes) Some connect to lymph nodes inside the chest (internal mammary nodes) and some to those above the collar bone (supraclavicular nodes) BREAST CANCER PRESENTATION Imaging abnormality Mass Calcifications Architectural distortion Palpable lump Skin changes Changes in nipple Rash Nipple discharge BREAST CANCER PRESENTATION Imaging abnormality Mass Calcifications Architectural distortion Palpable lump Skin changes Changes in nipple Rash Nipple discharge BREAST CANCER PRESENTATION Imaging abnormality Mass Calcifications Architectural distortion Palpable lump Skin changes Changes in nipple Rash Nipple discharge IMAGE-GUIDED BREAST BIOPSY Minimally invasive biopsy standard of care for initial diagnosis of imaging abnormalities Hematoma after biopsy can often cause significant discomfort/pain CAN I DECREASE MY CHANCES OF HAVING A POST-BIOPSY HEMATOMA? Often unavoidable Avoid blood thinners Coumadin Anti-platelets Aspirin? Vitamin E Fish oil LUMPECTOMY Incision is made on the breast Removes t