Breast and Lymphatic System Flashcards
Breast changes does not always indicate ________
Cancer. Women’s bodies change as they age (normal developmental changes), so health professionals would like to examine them as soon as the patient finds something that is not normal to them.
What is the significance of Breast Self-Examinations?
Women should be told about the benefits and limitations of breast self-examination to encourage familiarity of their breasts and report any abnormal changes to a healthcare professional who could better assess the issue
What should you not examine your breasts or a patient’s breasts?
When it is not tender or swollen
Breast awareness
Occasionally feeling your breasts to check for abnormalities
How frequent should you assess your breasts? If you are not interested in doing BSE, what should you at least consider to monitor your health?
BSE should be assess on a regular basis to ensure health. If a women chooses not to do BSE, they should still be familiar with the normal look and feel of their breasts in order to identify any abnormal changes.
Where is the axillary tail of spence?
Located upwards towards the axilla
What area of the breast should monitor signs of breast cancer (lumps)”?
The axillary tail of spence where breast lumps tend to grow.
What are the four quadrants of the breast?
Upper outer, upper inner, lower outer, and lower inner
Montgomery’s glands
Located around the areola that are sebaceous glands that keep the nipples moisturized and supple
What region is more likely to be the gate keeper, trap a malignancy from entering the rest of the lymphatic system?
Upper, outer quadrant due to axillary tail of spence
Function of the glandular tissue in the breast
Produces milk. It increase in size to prepare the function of producing milk when a pregnancy is occurring
Function of fibrous tissue of the breast
Supports the breast
Function of adipose tissue of the breast
Stores the excess energy and release it when required by the body. However, breast adipose tissue also plays a major role in breast development and maturation
Name the axillary (lymph) nodes that drain the impurities from the breast
Central (midaxillary)
Pectoral (anterior)
Subscapular (posterior)
Lateral (brachial)
How much breast lymph fluid drains into the axillary node?
75 percent
What are we going to collect for the subjective data?
- History of present heath concern: COLDSPA
- Past health history
- Family history (women who have family history of breast cancer can increase the likelihood)
- Lifestyle and health practices (women who smoke have a higher risk of breast cancer. Poor diet can increase the likelihood)
What type of subjective questions would we ask about the breast?
Pain: Pain or tenderness? When first noticed? Location? Sore to touch? Burning or pulling sensation? Is pain cyclic? Related to menstrual cycle? Related to strenuous activity, change in activity, manipulation during sex, exercise, underwire bra?
Lump: Lump or thickening? Location? When first noticed? Change since first noticed? Related to menstrual cycle? Changes in skin (redness, warmth, dimpling, swelling)?
Discharge: When first noticed? Color? Consistency (thick or runny)? Odor?
Rash: When first noticed? Where did it start (nipple, areola, surrounding skin)?
Swelling: Location? Related to menstrual period, pregnancy, breastfeeding? Change in bra size?
Trauma: Result in swelling, lump, break in skin?
History of breast disease: Type? How diagnosed? When? Treatment? Family history? Who? At what age?
Surgery: Was it biopsy? Results? Was it mastectomy? Mammoplasty (augmentation, reduction)?
Self-care behaviors:
Breast self-exam: Been taught? How often do you perform? How do you remember to perform?
Mammogram: When was last exam?
What type of subjective data questions would we ask about the patient’s axilla?
Tenderness, lump, swelling: Location? When first noticed?
Rash: Describe. Reaction to deodorant?
How could we prepare the patient for a breast examination?
We should explain to the patient about we are going to do during the breast exam. Also, explain how you will drape, provide draping and allow enough privacy to the patient
Let the patient know about the equipment and sequence of how the exam will occur.
To begin, have the patient sit upright so you could compare both breasts for symmetry and inspect any changes
Inspection of the Breasts includes:
The breasts are inspected bilaterally to check for:
General appearance: Size, symmetry (slightly asymmetric, but should be smooth and normal coloration) , shape
Skin: discoloration (does not include suntan), dimpling, striae (usually occurs after weight gain or during puberty), retraction
Lymphatic drainage: inspect for edema
Nipple: symmetry, color, size, shape, texture of areola, nipple direction (ask them if the nipple usually look like that)
What is considered abnormal during inspection in the breasts?
- Edema
- Discharge of the nipples
- Dry Lesions
- Ulcers
- Bleeding
- Bruising
Inspection of the axilla include:
Inspect and palpate the skin
Be aware of any lumps or swelling that we see
If a women has a lymph node that we are able to palpate and it is very painful, what would that indicate?
The chances of cancer are very small. The patient may be experiencing an inflammatory process that may be occurring in their breast
What to ask a patient who complains of lumps or swelling of the breast?
Ask them if the lump changes during their menstrual cycle.
What should you know about women with fibrocystic breasts?
They often have lumpy areas in the breast that increase in size in the 2 weeks prior to their menstrual period. Then, it would decrease in size in the 2 weeks after their menstruation.
What should not be palpable? If so, what would it be most likely related to?
Axillary nodes should not be palpable. Central nodes are small, soft and nontender.
If it is palpable and enlarged, it mostly related to either an infection or cancer
What is the order of operation for the breast exam?
- Inspect the breasts
- Inspect the axilla
- Palpate the breasts and axilla
Palpation of the breasts include:
Make sure to cover all of the areas of the breasts
Palpate:
- Position of the nipple
- Feel the texture and elasticity of skin
- Palpate for temperature, inflammation, and/or tenderness
What position should the patient be in when palpating the breasts?
The patient should be in a supine position with their back shoulder blade, elevated with a pillow. Their arms should be over their head
What are the three palpation patterns?
Vertical strip, Spokes on a wheel, and Concentric circles
What are normal findings when palpating the breasts?
- Normal: firm, smooth, elastic
- Post pregnancy: softer & looser
- Premenstrual the breasts feel more enlarged, engorged, perhaps tender, maybe more lobes are prominent
What are abnormal findings when palpating the breasts
Heat, asymmetric firm lumps. This could probably be:
- Cancerous tumors
- Fibroadenomas
- Benign breast disease
How many fingers do you use when palpating the breasts? What motion should you use and how should you gradually palpate?
- Use pads of your 3 fingers
- Rotate in a gentle circle
- Start with light palpation, medium, and then deep in each location with overlap.
How to palpate the nipples?
Palpate with thumb & forefinger with a downward, in toward the nipple pressure.
Unless pregnant or lactating, no discharge should be present.
High incidence of pituitary tumors occur when nipple discharge is present (when it should not be). Doctor would collect the discharge and also check for blood coming out of the nipple.
What type of palpation should we do if the patient has bigger breasts?
Bimanual palpation. It takes a little more time to complete those exams, but we want to make sure we are covering all of the breast tissue and axilla.
If a lump is present, what should we make note of?
- Location (what quadrant?)
- Size in Centimeters
- Shape (defined borders: benign; undefined borders: malignant)
- Consistency
- Mobility (mobile: most likely benign; immobile: malignant)
- Distinctness
- Nipple retraction
- Overlying skin
- Tenderness
- Lymphadenopathy (enlarged lymph nodes)
Why should we examine the male breasts?
Male breast cancer is evident. Men are usually not aware that they could actually have breast cancer. We would inspect and palpate their breasts
Gynecomastia
Enlarged mammary tissue of a male patient. Typically, it is found in overweight patients, but it could happen in some men during puberty.
Abnormalities of the breasts during inspection
Peau d’orange
Paget disease
Retracted nipple
Dimpling
Retracted breast tissue
Mastitis
Mastectomy
Peau d’orange (po-da-ron-ja)
Causes edema of the skin, an orange peel appearance of the breast is associated with cancer.
Paget disease
Redness and flaking of the nipple may be seen early in Paget disease and then disappear. However, further assessment is needed as this does not mean the disease is gone. Tingling, itching, increased sensitivity, burning, discharge, and pain in the nipple are late signs of Paget disease. It may occur in both breasts, but is rare.
Retracted nipple
A retracted nipple suggests malignancy. The nipple is becoming inverted and lie flat, rather than pointed out
Retracted breast tissue
Pulling of the breast skin. More obvious when the patient raises the arms over their head.
Mastitis
Inflammation or infection of the mammary ducts and mammary tissue. This causes the area to be reddened and painful. The breast warm to the touch during palpation. Typically, in women that breastfeed.
Define Mastectomy and identify the types of mastectomies
Mastectomy: removal of part or the entire breast
(A) Radical mastectomy: Removal of the entire breast as well as the underlying tissue and lymph nodes (not frequent)
-Causes lymphedema of the hands and arms of the side where the removal occurred
B) Modified radical mastectomy: Does not remove all of the muscle tissue underneath (more frequent)
Cancerous tumors
These are irregular, firm, hard, not defined masses that may be fixed or mobile. They are not usually tender and usually occur after age 50.
Fibroadenomas
These lesions are lobular, ovoid, or round. They are benign, firm, well defined, seldom tender, and usually singular and mobile. They occur more commonly between puberty and menopause. They tend to shrink during menopause.
Benign breast disease
Also called fibrocystic breast disease, benign breast disease is marked by round, elastic, defined, tender, and mobile cysts. The condition is most common from age 30 to menopause, after which it decreases.
What are signs of retraction and inflammation?
- Dimpling of the nipples
- Fixation (immobile lump)
- Edema (peau d’orange)
- Deviation in nipple pointing
- Nipple retraction
What are some lactation disorders?
Plugged duct
Breast abscess
Mastitis
List conditions that show signs of abnormal nipple discharge
Mammary duct ectasia: Benign cancer that widens the mammary duct and thickens its walls
Carcinoma: a cancer that starts in the skin or the tissues that line other organs
Intraductal papilloma: benign, wart-like tumor that grow within the milk ducts.
Paget’s disease (intraductal carcinoma)
What are some expected changes to see in aging women?
- Decrease in size
- Decrease in firmness
- Glandular tissue decreases, whereas fatty tissue increases
Dimpling
Pitting of the nipples, more deeper than a retracted nipple. Suggest malignancy. The nipples look like facial dimples.
What palpatation pattern is this?
Vertical strip
What palpatation pattern is this?
Spokes on a wheel
What palpation pattern is?
Concentric
How to do a breast exam on yourself?
The exam is done while lying down, not standing up, because when lying down the breast tissue spreads evenly over the chest wall as thinly as possible, making it much easier to feel all the breast tissue.
- Lie down and place your right arm behind your head.
- Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping, dime-sized circular motions of the finger pads to feel the breast tissue.
- Use three different levels of pressure to feel all the breast tissue:
- Light pressure is needed to feel the tissue closest to the skin.
- Medium pressure to feel a little deeper.
- Firm pressure to feel the tissue closest to the chest and ribs.
- Use each pressure level to feel the breast tissue before moving on to the next spot.
