breast conditions Flashcards
mastalgia
breast pain
cyclic mastalgia s/s, location, duration
heavy, soreness, radiates to axilla/arm, variable duration, resolves spontaneously, bilateral and poorly localized
noncyclic mastalgia s/s/, location, duration
sharp or burning, unilateral and localized
extramammary
pain is felt in breast but it does originate in it, ex. chest wall pain, cracked ribs
mastalgia work up in <30 if clinical breast exam normal,
no imagining needed, if they want it then order ultrasound
mastalgia work up <30 with abnormal clinical breast exam work up, focal pain, mass, risk breast ca
order ultrasound
mastalgia >30 clinical breast exam abnormal work up, focal mass, risk breast ca
order ultrasound and mammogram
cyclic treatment mastalgia
better bra, evening primrose oil, flaxseed, diet, decrease caffeine, warm compress
first line medication for mastalgia
NSAIDS, diclofenac patch then danzol
danazol (synthetic progestin) is used for?
mastalgia after NSAIDS
side effects of danazol (synthetic progestin)
facial hair, voice changes
causes of cyclic mastalgia
fibrocystic changes, hormonal contraception, normal hormonal changes
stages of fibrocystic changes
- ) stromal proliferation or hyperplasia
- ) adenosis (increased glands)
- ) cyst formation
what do fibrocystic changes feel like? location of breast?
rope-like or lumpy especially in upper quadrants
Fibrocystic changes management
NSAIDS, OC, ultrasound for discrete masses, fine needle aspiration of cysts, surgery, possible biopsy, primerose oil
galactocele
milk-filled cyst thats usually harmless
intraductal papilloma
a benign, wart like growth in a milk duct
Fibroadenoma
fibrous/glandular tissue within the breast
Fibroadenoma s/s
round, mobile, fluctuant (rubbery), defined border
do fibroadenomas change with menses?
no
simple cysts fluid color, mobile?
clear fluid, mobile, ballotable, no echoes
complicated cysts fluid color, mobile?
fluid filled, low level echoes
when do you refer for simple cysts?
if there is severe pain, obstruction of tissue (so you cant see all tissue)
complex cysts characteristics
wall is thicker, septination, cyst is solid, bloody fluid
when do you refer for complicated cysts?
refer for aspiration
when do you refer for complex cysts?
refer for aspiration and/or biopsy
Intraductal papilloma
small,non cancerous tumor in milk duct (can harbor Ductal carcinoma insitu)
when does intraductal papilloma usually occur in women
35-55
Intraductal papilloma s/s, unilateral? bilateral?
breast enlargement, lump pain, nipple discharge (thick cream), unilateral
Intraductal papilloma treatment
surgical removal of duct
Intraductal papilloma diagnostics
ultrasound if discharge, mass may be palpable, aspiration or biopsy, ductogram
Causes of noncyclic mastalgia
mastitis, large boobs, breast ca, HRT, ductal ectasia( dilatedmilk duct)
mastitis labs
CBC, CRP
Mastitis treatment
tylenol, ibuprofen, abx
good standard abx for Mastitis
dicloxacillin 500 mg 4 times a day
breast abscess
mastitis plus fluctuant mass
breast abscess s/s
red, hot, painful, high fever, swelling
steps in evaluating a palpable mass
- ) serial exam : if exam doesn’t present with dominant mass and patient <35 without risk factors, can re-examine 3-10 days after onset of menses or f/unect clinical breast exam
- )ultrasound: <35 with breast compliant (and not following conservatively), determine if mass is solid, complex etc
- ) mammogram: if ultrasound shows complex or solid lesion or if exam is suspicious for breast ca and patient >35
- ) needle aspiration:send to breast center, if fluid clear and cyst resolves, can re-evaluate in 4-6 weeks
- ) Biopsy of mass: done by surgeon
causes of bloody nipple discharge
malignancy vs papilloma….unilateral blood discharge= concerned
causes of purulent nipple discharge
infection, usually related to lactation
causes of milky discharge
hypothyroidism, prolactinomas, tricyclic antidepressants, dopamine agonists, OCPs
causes of green, brown nipple discharge
duct ectasia (inflammation of lactiferous ducts
duct ectasia and what color discharge does it cause
inflammation of lactiferous ducts, causes green, brown discharge of nipple
pathologic nipple discharge work up
diagnostic mammogram, breast ultrasound, refer to breast surgeon even if WNL, NO CYTOLOGY (absence of cancer cells doesn’t r/o cancer)
meds that cause nipple discahrge
HTN meds, GI meds, hormones, reglan, opiates, psychotropic agents, antipsychotics, MAOIs, SSRIs
adenopathy
abnormal enlargement of a lymph node
