Breast and Axillae - Lecture Flashcards
What muscles form the floor of the breast (7)?
pectoralis major pectoralis minor serratus anterior latissimus dorsi subscapularis external oblique rectus abdominus
extends from connective tissue layer through the breast and attaches to the underlying muscle fascia, providing support for the breast
fibrous tissue: Coopers ligament or suspensory ligaments
lie along the chest wall; high in the axilla, midway between the anterior and posterior axillary folds
central nodes
anterior, lower border of pectoralis major; drains chest wall and much of the breast
pectoral nodes
posterior, lateral border of the scapula; drain posterior chest wall and a portion of the arm
subscapular nodes
along the upper humerus; drain most of the arm
lateral nodes
Briefly describe the path of lymph drainage in the breast
lymph drains from central axillary nodes to infraclavicular and supraclavicular nodes which then drains into axilla lymph nodes
When does onset of breast development occur?
approximately 1 year prior to onset of pubic hair development
2 years prior to menarche
How long does the process of breast development take?
usually 4 years
ridge of vestigial epithelium running from axilla to inguinal region which may house rudiments of breast tissue
milk line
What does modifiable risk mean?
factors that patient can change
What does non-modifiable risk mean?
factors that patient cannot change, such as genetics
What are some non-modifiable risks for breast cancer?
1) gender
2) age
3) genetic
4) family history
5) personal history
6) race
7) dense breast tissue
8) previous chest radiation
9) DES (diethylstilbestrol) exposure
10) menstrual periods
11) certain benign breast conditions
Which of the non-modifiable risks is the most important?
age
2 of 3 invasive breast cancer of women 55 or older
How much more likely are women to get breast cancer compared to male?
100 times more common in women
What percentage of breast cancer is hereditary?
5-10%
BRCA1 & BRCA2 are the most common (risk is as high as 80% to occur in younger women and affecting both breasts)
How is family history a non-modifiable risk?
first degree relative doubles risk, two first degree increases risk 5-fold
How is personal history a non-modifiable risk?
increase risk in getting new cancer in the other or same breast
Which race is more likely to develop breast cancer?
Whites are more likely to develop
African-Americans are more likely to die
What is DES (diethylstilbestrol)?
it was a drug used to treat miscarriages (1940s-1970s)
may increase risk of breast cancer in both the mothers and their daughters
What do menstrual periods be a risk factor for breast cancer?
menarch prior to age 12
menopause after age 55
these women are at higher risks
What benign breast condition can be a risk factor for breast cancer?
lobular carcinoma in situ
What are some modifiable risk factors for breast cancer?
1) postmenopausal obesity
2) exercise
3) alcohol
4) hormone replacement
5) recent oral contraceptive use
6) childbirth
What are some uncertain, controversial, or unproven risk factors for breast cancer?
1) diet and vitamin intake
2) antiperspirants
3) bras
4) induced abortion
5) breast implants
6) chemicals in environment
7) tobacco smoke
8) night work
What are some risk assessment tools used for breast cancer?
1) Gail model
2) Claus model
3) BTCAPRO model
Which breast cancer risk assessment tool assesses risk of BRCA1 and BRCA2?
BTCAPRO model
Which breast cancer risk assessment tool incorporates family history of both female and male relatives?
Claus model
Which breast cancer risk assessment tool gives 5 year and lifetime estimates for invasive breast cancer?
Gail model
What age group is fibroadenomas most likely occur in?
15-25, usually puberty and young adulthood, but up to 55
What shape are fibroadenomas?
round, disc-like, or lobular
What kind of consistency do fibroadenomas have?
usually firm, rubbery
What is the mobility of fibroadenomas?
very mobile
Would patient experience tenderness with fibroadenomas?
usually nontender
Will there be retraction signs for fibroadenomas?
no, it is absent
What numbers could fibroadenomas occur in?
usually single but could be multiple
What age group do fibrocystic changes occur in?
25-50
What numbers could fibrocystic changes occur in?
single or multiple
What shape to fibrocystic changes have?
round
What is the consistency of fibrocystic changes?
soft to firm, usually elastic
What is the mobility of fibrocystic changes?
mobile
Are there retractions for fibrocystic changes?
no
Will patient experience tenderness with fibrocystic changes?
yes, often tender
What kind of delineation do fibrocystic changes have?
well delineated
What age group do breast cancer usually occur in?
30-90, most common over age 50
What numbers are cancer tissues present?
usually single, but my coexist with other nodules
What shape do cancerous tissues have?
irregular or stellate
What consistency do cancerous tissues have?
firm or hard
What kind of delineation do cancerous tissues have?
not clearly delineated from surrounding tissues
What is the mobility of cancerous tissues?
may be fixed to skin or underlying tissues
Will patient experience tenderness with cancerous tissues?
no, usually nontender
Will there be retraction signs present in cancerous tissues?
may be present
A 23 year old female presents with bilateral palpable masses. Upon examination, the masses are found to be round, somewhat soft and mobile. There are no signs of retraction and. Patient indicate they are tender and varies with menses. What is the likely diagnosis?
fibrocystic changes
A 16 year old female presents with multiple palpable masses, bilateral. Upon examination, both masses are round, firm, and very mobile. There are no signs of retraction and patient indicate they are not tender. Patient denies variation with menses. What is the likely diagnosis?
fibroadenomas
A 52 year old postmenopausal female presents with a single palpable mass, located in the upper outer quadrant at two o’clock in the left breast. Upon examination, the mass is found to be irregular in shape, hard, and seems to be fixated. There are no signs of retraction and patient indicates is is nontender. The mass does not have defined borders. What is likely diagnosis?
cancer
Are Montgomery tubercles normal findings?
yes, usually associated with pregnancy
crusting and flaking could be a sign of…
Paget’s disease
A patient has one breast with everted nipple while the other has inverted nipple, is this finding alarming?
yes
What is the most common type of cancer? And which age group is this most prevalent in? What are other characteristics of this cancer?
infiltrating ductal 30-80 years old single mass irregular or stellate, hard, stone-like fixed
What type of breast cancer is frequently involved with lymphatics and has poor prognosis?
inflammatory
What type of breast cancer usually presents with eczematous patches on nipple, a rare form of breast cancer, can be associated with nipple redness and burning, and it is diagnosed by skin biopsy?
Paget’s disease
When a patient presents with unilateral dilation in venous patterns, what could it be indicative of?
malignancy, however, bilateral can be seen in pregnancy or in obese women
Is it normal for one breast to be larger than the other?
Yes, often the right is larger than the left
How do you differentiate between Paget’s disease from contact dermatitis?
tissue biopsy
Cystosarcoma phyllodes, fibroadenoma, and intraductal papilloma are all examples of…
benign tumors
most common tumor under 25 years of age, small, movable and firm, no variation in size with menses or pregnancy
fibroadenoma
tumor of lactiferous ducts, presents with nipple discharge
intraductal papilloma
large bulky mass of cysts and connective tissue, rapidly growing
cystosarcoma phyllodes
Is it a good idea to examine breasts during menstruation?
no, enlargement can occur 3-5 days prior to menstration. DO NOT examine breasts at this time. should be examined 5-7 days AFTER onset of menses
What kind of changes would you see in the breasts of pregnant women?
fuller and more firm (can change two cup sizes)
areola darken
nipples enlarge and become erect
colostrum is secreted during the third trimester
What are the 3 most important symptoms of breast disease?
1) presence of a mass
2) breast pain
3) nipple discharge (red can be cancerous while yellow can be inflammation)
Is breast pain (mastalgia) commonly associated with breast cancer?
no, it is rarely associated with breast cancer, it is usually associated with fibrocystic changes in premenopausal women
If nipple discharge is only with compression is it malignant?
no, it is most likely non-maglinant, usually involving multiple duct, and frequently bilateral
Bilateral secretion (nipple discharge) without pregnancy is usually related to what?
hormones
if unilateral, then it is consider pathologic
dilation of lactiferous duct, disorder of premenopausal age, can include nipple retraction, inversion, pain, and bloody discharge
duct ectasia
