208 Concept: Cellular regulation; breast assessment

Question 1

Define cellular regulation.

Answer 1

All function carried out within a cell to maintain homeostasis, including its responses to extracellular signals (e.g., hormones, cytokines, and neurotransmitters) and the way it produces an intracellular response.

Question 2

What is proliferation?

Answer 2

Proliferation refers to the production of new cells through cell growth and cell division.

Question 3

What is differentiation?

Answer 3

Differentiation refers to the acquisition of a specific cell function, a normal process by which a less specialized cell becomes a more specialized cell type.

Question 4

What is neoplasia?

Answer 4

An abnormal and progressive multiplication of cells, leading to the formation of a neoplasm (also known as a tumor).

Question 5

What are the two classifications of neoplasms?

Answer 5

Benign or malignant.

Question 6

What is the scope of cellular regulation?

Answer 6

Normal Cell Growth —— Dysplasia ——- Malignant Neoplasia

Question 7

What populations are at risk for cancer?

Answer 7

• certain racial and ethnic minorities appeared to be at higher risk
• it has been shown that these disparities in cancer burden largely reflect obstacles to receiving healthcare services related to cancer prevention, early detection, and high-quality treatment, with poverty as the overriding factor.
  In minority groups, communication barriers and provider assumptions can affect interactions between patients and physicians, which further contributes to miscommunication and the delivery of substandard care

Question 8

What are individual risk factors for cancer?

Answer 8

• Age (risk for developing an invasive cancer increases significantly as a person ages)
• Smoking/Tobacco (At least 30% of all cancer-related deaths and 80% of all lung cancer deaths can be attributed to smoking. In addition, smoking is a known risk factor for 18 different types of cancers
• Infectious Agents (Bacteria and viruses are known to cause cancer and examples include the Helicobacter pylori bacteria (gastric cancer), hepatitis B and hepatitis C viruses (liver cancer), and human papillomavirus (cervical, oropharyngeal, and anal cancer)
• Genetic Risk (Only approximately 5% of all cancers result from an inherited genetic alteration that is associated with an increased risk of developing certain types of cancer. In some cases, a specific gene mutation results in an extraordinarily high risk of cancer, such as women with a BRCA1 gene mutation that confers a 70% lifetime risk of developing either breast or ovarian cancer)
• Radiation ((ultraviolet and ionizing) exposure that are linked to an increased risk of developing certain types of cancer.)
• Carcinogens (Exposure to these carcinogens is often due to lifestyle choices (e.g., smoking), but other carcinogens are present as environmental pollutants in the air, water, soil, or food.)
• Nutrition and physical activity (Combined, more than 20% of all cancer cases are attributed to poor nutrition, a sedentary lifestyle, and excessive weight.)

Question 9

What are the assessment components associated with cancer and cellular regulation?

Answer 9

• history
• examination findings
• diagnostic tests
• classification: grading and staging

Question 10

What functions are associated with cellular regulation?

Answer 10

• hormonal control
• neurotransmission
• extracellular response
• intracellular responses (cellular replication and growth, proliferation and differentiation)

Question 11

True or false: breasts may be enlarged and visible in neonates.

Answer 11

True

Question 12

What is the white fluid that is secreted by neonates called?

Answer 12

“witch’s milk”

Question 13

When does adolescent breast development usually begin?

Answer 13

between 8 and 10 years of age

Question 14

What are the stages of breast development in girls?

Answer 14

Stage 1: preadolescent. Only a small elevated nipple is present.
Stage 2: breast bud stage. A small mound of breast and nipple develops; the areola widens
Stage 3: The breast and areola enlarge; the nipple is flush with the breast surface.
Stage 4: The areola and nipple form a secondary mount over the breast.
Stage 5: mature breast. Only the nipple protrudes; the areola is flush with the breast contour

Question 15

What is the breast composed of?

Answer 15

a) glandular tissue
b) fibrous tissue
c) adipose tissue

Question 16

Where does more than 75% of lymph drain into?

Answer 16

The ipsilateral (same side) axillary node.

Question 17

What are the four groups of axillary nodes?

Answer 17

• central axillary nodes
• pectoral
• subscapular
• lateral

Question 18

If you divided the breast into sections, what would the five sections be?

Answer 18

• upper inner quadrant
• upper outer quadrant
• lower inner quadrant
• lower outer quadrant
• axillary tail of spence

Question 19

What is a supernumerary nipple?

Answer 19

An extra nipple that can persist and is visible along the track of the mammary ridge.

Question 20

Normal or abnormal finding: during adolescents, one breast grows faster than the other.

Answer 20

Normal

Question 21

In the Tanner staging model of breast development, how long does it normally take for full development from stage 2 to 5?

Answer 21

3 years, though 1.5 to 6 years is the range.

Question 22

How long after the appearance of pubic hair does axillary hair appear?

Answer 22

2 years

Question 23

How long does breast development precede menarche?

Answer 23

About 2 years (average age of menarche is 12 years old)

Question 24

True or false: breasts change with menstrual cycle.

Answer 24

True

Question 25

What are common changes in breasts during pregnancy?

Answer 25

• early sign of pregnancy for most women
• expansion of the ductal system and supporting fatty tissues
• development of true secretory alveoli
• breasts enlarge and feel more nodular
• Nipples are larger, darker and more erect
• Areolae darken and become larger
• Tubercles become more prominent
• A venous pattern is prominent over the skin surface
• After the fourth month, colostrum may be expressed
• Milk production begins 1 - 3 days postpartum

Question 26

What changes occur in the breasts in older women?

Answer 26

• after menopause, breast glandular tissue decreases
• breast size decreases, as does elasticity, causing them to droop
• lumps may be more palpable

Question 27

What is gyneconastia?

Answer 27

Temporary enlargement of breast tissue in adolescent boys, Usually unilateral and temporary.

Question 28

At what age does the risk of breast cancer increase?

Answer 28

50 y/o +

Question 29

When does mammography start?

Answer 29

Sometimes 40, but every two years between 50 - 74 y/o

Question 30

Where do most breast tumours devep?

Answer 30

Tail of Spence and upper outer quadrant

Question 31

What health history topics are you covering for breast and regional lymphatic assessment?

Answer 31

Breast
1. Pain
2. Lump
3. Discharge
4. Rash
5. Swelling
6. Trauma
7. History of breast disease, and breast cancer risk factors.
8. Surgery
9. Self-care behaviours
Axilla
1. Tenderness, lump or swelling?
2. Rash?

Question 32

Are nodes usually palpable in the axillae?

Answer 32

Not usually, though you may feel a small, soft, non-tender node in the central group.

Question 33

What are the three patterns of breast palpation?

Answer 33

1. Vertical strip pattern
2. Spokes-on-a-wheel pattern
3. Concentric circles pattern

Question 34

If you feel a lump or mass, what characteristics should you note?

Answer 34

1. Location (use breast like a clock face, describe in distance cm from nipple)
2. Size (cm width x length x thickness)
3. Shape: oval, round, lobulated or indistinct
4. Consistency: soft, firm or hard
5. Movable: freely movable or fixed
6. Distinctness (solitary or multiple)
7. Nipple: displaced or retracted
8. Note the skin over the lump: erythmatous, dimpled or retracted
9. Tenderness (tender to palpation)
10. Lymphadenopathy: any regional lymph nodes palpable)