Assessment of Breast and Axillary Lymph Nodes Flashcards
Identify the Component of the Breast being Described
- has fibrous bands
- provide structural support
- attached to the chest wall masculature
Coopers Ligament (Fibrous Tissue)
Identify the Component of the Breast being Described
- containing alveoli that produce milk
Lobes
Identify the Component of the Breast being Described
- trasnport milk to the nipple
Lactiferous Ducts
Most common route for the spread of breast cancer cells
Lymphatic System
Health History: Breast Cancer_Signs and Symptoms
- Lump, thickening or swelling of breast
- unusual change in the size or shape of the breast
- one breast is unusually lower than the other
- puckering/dimpling of the skin of the breast
- retraction of the nipple
- a sore in the nipple
Health History: Breast Cancer_Risk Factors
- Family History
- Unhealthy diet
- obesity
- woman’s age above 30
- during first pregnancy or those who never had children
- smoking and drinking
When should premenopausal women be examined?
examination should occur 5 to 7 days after the menstrual cycle ends, or 3 to 5 days before
When should postmenopausal women do BSE or Breast Self Examination
should be performed on the same day each month
Methods on examining the patient’s Breasts
- Sitting, arms to the side
- Sitting, Arms over the head
- Sitting, hands on the hips
- Sitting, Leaning Forward
- Supine, with pillow under the shoulder of the breast being examined
- Sitting, pushing hands together
Inspection of the breasts
- Inspect the skin
should be smooth, undimpled, and the same color as the rest of the skin
Inspection of the breasts
- Check for edema
- lymphatic obstruction
- may signal cancer
Inspection of the breasts
- Note breast size and symmetry
Asymmetry may occur normally in some adult women,with the left breast usually larger than the right
Inspection of the breasts
- Inspect for the presence of dimpling or retraction
sign of a serious form of cancer
Inspection of the breasts
- Inspect for nipple
(+) inverted, dimpled, or creased →ask when she first noticed the abnormality.
How to palpate the breast
✓ lie in a supine position
✓ place a small pillow under her shoulder on the side you’re examining
✓ put her hand behind her head
* This spreads the breast evenly across the chest and makes finding nodules easier.
* If her breasts are small,she can leave her arm at her side.
✓ Use your three middle fingers to palpate the breast systematically.
✓ Rotating your fingers gently against the chest wall, move in concentric circles applying light, medium, and deeper pressure at each examining point.
* Make sure you include the tail of Spence and the subareolar area in your examination
3 Breast Palpation Methods
- Circular
- Wedged
- Vertical Strip Pattern (best pattern so far)
Examining the nipple
- (+) lump noted, examine the
nipple for discharge. - Gently squeeze the nipple
between your thumb and index
finger. - Note the color, amount, and
consistency of any discharge
Acronym for what to look out for when assessing the nipple D.I.S.C
Discharge
Inversion
Skin Changes
Compare with the other side
Documenting a breast lump characteristics
- size in cm
- shape: round, discoid, regular, or irregular
- consistency: soft, firm, or hard
- mobility
- degree of tenderness
- location using the quadrant or clock method
4 quadrants of the breast
- upper inner
- upper outer
- lower inner
- lower outer
EXAMINING THE AXILLARY NODES
❑ Techniques: inspection and palpation
❑ With the patient sitting or standing, inspect the skin of the axillae for rashes, infections, or unusual pigmentation.
❑ Before palpating, ask the patient to relax her arm at her side. Support her elbow with one of your hands.
❑ Cup the fingers of your other hand, and reach high into the apex of the axilla.
❑ Place your fingers directly behind the pectoral muscles, pointing toward the midclavicle
EXAMINING THE AXILLARY NODES
❑ Palpate the central nodes by pressing your fingers downward and in toward the chest wall.
❑ Palpate one or more of the nodes:
❑ NORMAL: soft, small, and nontender.
❑ ABNORMAL: hard, large, or tender lesion →palpate the other groups of lymph nodes for comparison
Palpating the axilla
- palpate central nodes by pressing fingers downward and toward the chest wall
- palpate pectoral and anterior nodes by grasping the anterior axillary fold between your thumb and fingers and palpating inside the borders of the pectoral muscles
- palpate lateral nodes by pressing your fingers along the upper inner arm. try to compress this nodes against the humerus
- stand behind the patient to feel the inside of the muscle of the posterior axillary fold to feel the posterior nodes
ASSESSING THE CLAVICULAR NODES
❑ If the axillary nodes are abnormal, assess the nodes in the clavicular area
❑ flexing patient’s head slightly forward
❑ Stand in front or back of her and hook your fingers over the clavicle beside the sternocleidomastoid muscle.
❑ Rotate your fingers deeply into this area to feel the supraclavicular nodesand other nodes
2 methods of self breast examination
Supine and Standing
Standing self breast examination
- Stand in front of mirror with hands pressing firmly down on your hips
- look for any changes in size, shape, contour, or dimpling, or redness or scaliness
- Examine each underarm while sitting up or standing with your arm slightly raised so you can easily feel the area
Abnormal findings during breast examination
- irregularly shaped mass with poorly defined edges
- mass is fixed, feels firm to hard, and usually not tender
- evidence of skin retraction may be present
Breast Cancer Mass
Abnormal findings during breast examination
- breast cancer in the earliest stage of development in the ducts of the breast
Ductal Carcinoma in Situ
Abnormal findings during breast examination
- Cancer begins within the duct and spreads to the breast’s parynchymal tissue
Infiltrating (Invasive) Ductal Carcinoma
Abnormal findings during breast examination
- puckering or retraction of skin on the breast
- results from abnormal attachment of skin to underlying tissue
- suggests inflammatory or malignant mass
- usually represents late sign of breast cancer
Dimpling
Abnormal findings during breast examination
- edematous thickening and pitting of breast skin
- occurs with breast or axillary lymph node infection or Grave’s Disease
- has striking orange peel from lymphatic edema around deepened hair follicles
Peau d’orange
Abnormal findings during breast examination
- round, elastic, mobile masses that are commonly tender on palpation especially around menstruation
- multiple cysts may be present
- no evidence of skin retraction
Fibrocystic Changes
Abnormal findings during breast examination
- benign, round, lobular, well demacrated mobile mass that feels slippery and firm to soft on palpation
- usually nontender and causes no visible skin retraction
Fibroadenoma
Abnormal findings during breast examination
- inward displacement of nipple below the level surrounding breast tissue
- may indicate an inflammatory breast lesion or cancer
- results from scar tissue formation within a lesion or large mammary duct
- as scar tissue shortens, it pulls adjacent tissue inward causing nipple deviation, flattening, and finally retraction
Nipple Retraction
Abnormal findings during breast examination
- rare form of breast cancer
- usually starts as red, granular or crusted, scaly lesion on the nipple or areola
- may ulcerate and cause erosion of nipple
Paget’s Disease
Abnormal findings during breast examination
- affects lactating females
- when pathogen in the breastfeeding infant’s nose or pharynx invades breast tissue through fissured or cracked nipple
- disrupts normal lactation
- causes breast to be tender, hard, swollen, and warm
Mastitis
Abnormal findings during breast examination
- results from venous and lymphatic stasis and alveolar milk accumulation
- causes painful breasts that feel heavy and may feel warm
Breast Engorgement
Abnormal findings during breast examination (Men)
- barely palpable and is usually bilateral
- can be caused by cirrhosis, leukemia, thyrotoxixosis, hormones, illicit drug use, or alcohol consumption
Gynecomastia
