Breast and axilla Flashcards
What do you always check for in breast cancer screens?
Axillary lymph nodes
What is tanner stage 1?
Elevation of only the papilla
What is tanner stage 2?
Breast bud stage
Elevation of breast and papilla as a small mound
Enlargement of areola
What is tanner stage 3?
Further enlargement of breast and areaola WITHOUT separation
What is tanner stage 4?
Areola projected aboive level of breast as a secondary mound
What is tanner stage 5?
Mature stage
Recession of areola mound to the general contour of the breast
Pojection of papilla only
How long does it take to develop breasts?
4 years
What are the 5 characterisitcs to look for during the breast examination?
Size Symmetry Shape Skin color Skin texture
What is the best position for the patient to be in when palpating the breast?
Supine, with pillow beneath scapula
What is the best method for palpating the breast?
vertical method
Where do most malignancies in the breast occur?
Upper, outer quadrant
What is the inframmary ridge?
Normal finding: reidge of compressed tissue along the lower edge of the breast
When do you compress the nipple?
Only if there is discharge
What are the five D’s for breast exam?
Discharge Depression or inversion Discoloration Dermatologic changes Deviation (compare opposite side)
True or false: an “innie” nipple is always bad
False–only bad if changed
What is the areola?
Pigment surrounding nipple
What is colostrum?
a clear or milky fluid that is expressed from teh breast before milk production
What is galactorrhea?
Lactation no associated with child bearing
What is gynecomastia?
Abnormal large mammary glands in the male (sometimes may excrete milk)
What is mastisits?
Inflammation of the breast
What is mastodynia?
Pain in the breast
When does breast development occur relative to the pubic hair development?
1 year prior to pubic hair
2 years prior to menarche
What are the non-modifiable factors for breast CA?
Gender Age Genetic FHx PHx Race (whites more likely to have, blacks more likely to die) Dense breast tissue Previous chest radiation DES exposure Early menarche/menopause
What are the modifiable factors for breast CA?
Postmenopausal obesity Exercise EtOH Hormone replacement Recent oral contraception breast feeding lowers risk
What are the three risk assessment tools?
Gail model
Claus model
BTCAPRO model
When are mammograms recommended?
above age 40, yearly
75+ should have discussion
When should women 20-39 have clinical breast exams?
1-3 years
When should women 40+ have clinical breast exams?
Yearly
When should women begin self-breast exam?
over 20 years
How often should high risk women have mammograms (or MRIs)?
yearly
When are venous changes normal?
Bilateral in obese or pregnant women
When are venous changes abnormal?
Unilateral
When you should not examine braests?
during menses (wait 5-7 days after)
What are the three biggest symptoms of breast disease?
Mass
pain
nipple discharge (color dependent bloody=CA)
What are the characteristics of breast carcinoma discharge (4)?
- spontaneous
- bloody
- associated with mass
- localized to a single duct in one breast
What are the characteristics of non-malignant breast discharge?
- Discharge only with compression
- multiple duct involvement
- Frequently bilateral
nipple discharge that is clear, yellow, white, or dark green is characteristic of what type of breast issue (carcinoma or non-malignent)?
Either
What muscles form the floor of the breast (6)?
Pectoralis major &minor Serratus anterior Lats Subscapularis External oblique Rectus abdominus
Where are the four places lymph can drain
Central axillary
Pectors
Subscapular
Lateral (along upper humerus)
Where do the pectoral lymph nodes receive drainage from?
Chest wall, breast
Where do the subscapular lymph nodes receive drainage from?
posterior chest wall, lateral border of the scap
Where do the lateral lymph nodes receive drainage from?
Upper arm
When is the best time (of the month) to perform a breast exam?
5-7 days after onset of menses
Where in the breast do most malignancies occur?
Upper, outer quadrant
What is the best method to use to palpate the breast: vertical (lawnmower), circular, or spoke?
Vertically
When should you compress the nipple?
Only if it has discharge
What is the common breast lesion for women ages 15-25?
Fibroadenomas
What is the common breast lesion for women ages 25-50?
Cysts
Fibrocystic changes
CA
What is the common breast lesion for women ages 50+?
CA until proven otherwise
What is the common breast lesion for women who are pregnant?
Lactating ademonma
What are the characterisitics of fibroadenomas? Are they mobile? Are they TTP?
Usually smooth, rubbery, round, mobile, no TTP
What are the characteristics of cysts?
usually soft, round, mobile
What are the characterisitcs of CA? Are they mobile?
Irregular, firm, may be mobile or fixed
What are the characteristics of fibrocystic changes?
nodular, ropelike
How many times more likely are women likely to get breast cancer than men?
100x more likely
What percent of breast cancers are heriditary?
5-10%
What is the most common genetic cause of breast CA?
BRCA1/2
What percent of invasive breast cancers were in women aged 55 or older?
2/3
One, first degree relative with breast CA increased your risk how much? How about for two primary relatives?
doubles risk, 5x for two
What is the racial disparity between white and african american women in terms of developing breast CA?
White more likely to develop
Black more likely to die
Are women with dense breast tissue more or less likely to develop breast CA?
MOre
What is DES? How does it relate to breast CA?
Used in the 40’s-70s to decrease miscarriage, but carinogenic to both mother and daughters
Women who have menopause (insert word here) or had menarche (here too) are more likely to develop breast CA.
Had menarche early, menopause later
Does breast feeding increase or decrease the risk for breast cancer?
Decreases
Does using hormone replacement therapies increase or decrease the risk for breast CA?
Increases
Define: areola
pigmented area surrounding the nipple
Define: colostrum
clear or mily fluid that is expressed from the breast before milk production
Define: duct ectasia
a benign condition of the subareolar ducts that can cause a nipple discharge
Define: fibroadenoma
a benign tumor of the breast
Define: fibrocystic disease
a benign condition that presents with fluid-filled cyst due to ductal enlargement that
is usually bilateral and multiple.
what is Galactorrhea
lactation not associated with childbearing
define Gynecomastia
abnormally large mammary glands in the male; sometimes may excrete milk
What are Intraductal papillomas?
benign tumors of the subareolar ducts that produce a nipple discharge
What is pain in the breast called?
Mastodynia:
what are tiny sebaceous glands that may appear on the areola called?
Montgomery follicles
What is Paget’s disease
skin manifestations that are indicative of ductal carcinoma
What are skin changes of the breast due to edema caused by blockage of the lymph drainage
associated with inflammatory breast cancer called?
Peau d’orange
What is the tail of spence?
area where most malignancies of the breast tissue occurs.
What is the beginning of female pubertal breast development called?
Thelarche
Are fibrocystic changes of the breast usually unilateral or bilateral?
bilateral
What is the only type of mass that causes retraction of the breast?
CA
Which of the breast masses discussed varies with menses?
Fibrocystic breast changes
Is cancer usually unilaterally found, or bilaterally?
unilaterally
What type of shape are breast CAs?
Irregular or stellate
Does breast CA have well defined borders or poorly define borders? Are they fixed or mobile? Are they firm or soft
Poorly defined borders, fixed, hard
When are venous pattern changes in breasts concerning?
When they are unilateral
What happens to breasts at pregnancy (4)?
- Fuller and more firm
- areola darkens
- nipple enlarges
- Colostrum produced in the third trimester
You are seeing a new female patient that is concerned for breast CA. She is 23 years old, and presents with multiple, round masses in her right breast. The masses are firm, well delineated, mobile, and are non-tender. Retraction signs are absent. Based on lecture what is your diagnosis?
Fibroadenoma
You are seeing a new female patient with a concern for breast CA. She is a 37 yo female, who presents with, round, soft, and well delineated masses in her breasts bilaterally. The masses are mobile, and TTP. Retraction signs are absent. Based on lecture what is your diagnosis?
Cysts
You are seeing a well established 58 y.o. female patient who has a concern for breast CA. She presents with a single, poorly delineated, and irregular mass in her left breast that is firm to palpation. The mass is not moble, and retraction is present. Based on lecture what is your diagnosis?
May be CA
Infiltrating ductal presents as what (3 features)? What age group is most commonly affected?
Single, fixed, irregular mass
30-80 yo it is the most common
Are inflamatory tumors of the breast malignant or benign?
Malignant with poor prognosis