Breast Disorders Flashcards
components of a breast inspection?
skin changes/erythema, retraction, scaling, and edema (peau d’orange)
breast palpation includes:
all breast tissue, axillae, and supraclavicular area
3 components of the full breast exam:
breast inspection, breast palpation, lymph node evaluation
what is “witch’s milk”?
bilateral milky discharge in newborns due to maternal hormone stimulation; transient (several weeks)
thelarche refers to?
start of breast growth, usually between 8-13 y/o.
younger = less fat, more dense
older = more fat, less dense
cyclic mastalgia
usually bilateral and related to normal hormonal changes (like menstrual cycle or cyclically adminstered hormones)
non-cyclic mastalgia
*more concerning for pathology.
* causes:
- lesions of breast/chest wall (cyst, tumor, malignancy)
- mastitis
- trauma
- thrombophlebitis
* consider breast imaging for focal mastalgia not explained by obvious causes.
mastalagia associated with breast cancer is more likely ________
unilateral, intense, and progressive [non-cyclic mastalgia].
consider breast imaging for focal mastalgia not explained by obvious causes.
what is Mondor disease?
what is found on exam?
what is it associated with?
superficial thrombophlebitis of lateral thoracic vein. palpable cord on exam. associated with breast CA.
mastalgia trx?
supportive measures:
NSAIDs/APAP
diet changes
evening primrose oil
danazol 100mg bid
tamoxifen 10mg qd
causes of extramammary pain?
- costochondritis
- chest wall trauma
- rib fractures
- herpes zoster
- angina
- GERD
- variety of meds
puerperal mastitis
Inflammation of breast within 6 weeks of giving birth.
Causes warmth, tenderness, and diffuse erythema.
Systemic sx - fever, myalgias, leukocytosis
Most common cause is Staph aureus.
Pt should continue to breastfeed to prevent stasis.
Nonpuerperal mastitis
Uncommon.
Inflammation of breast not related to pregnancy/lactation/birth.
Includes periareolar/periductal mastitis, or Peripheral Abscesses.
Periareolar/Periductal Mastitis
Nonpuerperal mastitis.
Presents w/ areolar inflammation +/- abscess.
Common in younger women.
Trx - oral abx
Peripheral abscesses (mastitis)
Nonpuerperal, non-periductal mastitis.
Can be associated with trauma, DM, steroids, RA
Trx - aspiration or I&D, culture
galactorrhea
Spontaneous milky nipple discharge, usually bilateral and with amenorrhea.
Caused by hyperprolactinemia (NOT by intrinsic breast disease).
Trx - depends on cause;
bromocriptine; cabergoline. Observation may be sufficient if mild.
Causes of galactorrhea
Hyperprolactinemia due to:
- meds (antipsychotics*, antidepressants, hormones, etc)
- physio conditions
- neoplastic processes
- chest wall irritation
Causes of nipple discharge (aside from galactorrhea)
- intraductal papilloma
- milk duct polyps
- if discharge is unilateral, uniductal, or spontaneous - and clear, serous, or bloody - then higher risk of malignancy»_space; eval with US
What kind of nipple discharge is concerning for malignancy?
if it is unilateral, uniductal, or spontaneous
and
clear, serous, or bloody
- eval with US
breast cysts - source, description, diagnostic
- benign; arise from apocrine metaplasia of lobules
- SOFT, SMOOTH, MOBILE
- breast US
breast cyst types and what is seen on US for each
simple - sonolucent on US (clear, black, anechoic fluid)
complicated - internal echoes; should be drained; if does not resolve, then biopsy
complex - septa or masses; excission recommended
breast fibroadenoma - source, description
- proliferation of epithelial and stromal elements
- RUBBERY, SMOOTH, MOBILE, W/ DISTINCT MARGINS
- *MCC of breast masses in adolescents and young women (med. age:25yo)
breast fibroadenoma - source, description, diagnostic
- benign; proliferation of epithelial and stromal elements
breast cyst trx
observe; may be aspirated if painful
breast fibroadenoma trx
Monitor. if growing or bothersome, excise it.
galactocele
- cystic dilation of ducts
- painless mass palpable usually in central portion of breast
- most commonly presents during breastfeeding; can get infected
trx for galactocele?
supportive; usually self resolves
fat necrosis of breast
- breast mass that can develop after blunt trauma, breast surgery, radiation or injection of foreign substance
-SOLITARY, IRREGULAR, ILL-DEFINED MASS - clinically difficult to distinguish from malignant mass
phyllodes tumor
- fibroepithelial tumor; rare
- single enlarging breast mass (FIRM, CIRCUMSCRIBED, MOBILE)
- VARIES; can be benign, intermediate, or malignant
trx for phyllodes tumor?
if biopsy confirms, then wide local excision with 1+ cm margins to decrease likelihood of local recurrence
Breast cancer is the ____ most common cancer diagnosed in women.
second most common
breast cancer mortality rate has ______ significantly over the past 50 yrs due to _________.
decreased; early detection and improvements in trx
risk factors of breast CA in women
- FMHx of breast, ovarian, prostate, or pancreatic cancer
- known deleterious gene mutation (BRCA)
- nulliparity
- early menarche/late menopause
- hx of LCIS or atypical hyperplasia
- age
- HRT
- hx of chest irradiation
breast cancer trx
depends on staging and hormone receptor status; surgery, chemo, radiation, hormonal therapy
breast cancer screening for avg risk women
- mammogram (offer at 40 y/o, then done annually; allows detection at early stage; sojourn time)
- clinical breast exam
- self exam
US for breast cancer screening
NOT RECOMMENDED AS SCREENING FOR WOMEN AT AVG RISK.
used for: inconclusive mammograms, young pts w dense breast tissue, differentiating cyst vs solid mass, and guiding tissue core needle biopsy
MRI for breast cancer screening
- used as adjunct to mammogram
- ACS rec’s for women with >20% liftetime risk (have BRCA1/BRCA2, first degree relative with BRCA, hx of chest rads at 10-30yo)
