Breast Disorders Flashcards
- Adult female breast is actually a what?
- Histologically primarily composed of:
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- modified sebaceous gland, located within the superficial fascia of the chest wall.
- Lobules or glands
- Milk ducts
- Connective tissue
- Fat
- Younger breasts are predominately made of what tissue?
- Glands are replaced by ______. This process accelerates with ________?
- What are key components of breast cancer detection programs? 2
- glandular tissue.
- fat, menopause.
- Differences in palpable consistency and
- in radiographic density between the glands and fat are
- Organized into 15 to 25 lobules, with a disproportionate amount of the glandular or lobular tissue present in the _______ _______ quadrants of each breast.
- Lobules consist of clusters of _____________ arranged in an alveolar pattern and surrounded by _______________?
- Glands drain into a series of collecting _________ that course through the breast.
- Come together into approximately _______ collecting ducts that lead to and drain at the nipple.
- upper outer
- secretory cells, myoepithelial cells.
- milk ducts
- five to ten
- What can go wrong with connective tissue? 2
- Fat tissue problems?
- Duct system issues? 3
- Connective tissue
- Fibrocystic changes
- Fibroadenomas - Fat tissue
- Necrosis from trauma or may harbor lipomas - Duct system
- May become dilated
- Contain papillary neoplasms
- Undergo malignant transformations
Rich blood supply
1. Blood supply from where? 5
- Huge lymphatic system
Superficial and deep nodal chains throughout the trunk and neck, including those located in the what? 3
(Support _________ and overall breast health)
- internal mammary artery,
- lateral thoracic artery,
- thoracodorsal artery,
- thoracocramial artery,
- intercostal perforating arteries
- -axilla,
-deep to the pectoralis muscles
-and caudal to the diaphragm
(milk production)
- Breast tissue is very sensitive to hormonal changes, especially the glandular cells.
- Circulating levels of what? 2 - What is also responsible for the changes that occur during the normal menstrual cycle and for symptoms often reported by patients receiving hormones in pharmacologic doses?
- estrogen and progesterone
2. Tissue responsiveness to circulating hormones
- During each menstrual cycle, breast tissue tends to _____ from changes in the body’s levels of estrogen and progesterone.
- The milk glands and ducts enlarge, and in turn, the breasts __________.
- During menstruation, breasts may temporarily feel what? 4
- We recommend that women practice monthly breast self exams when?
- swell
- retain water
- swollen,
- painful,
- tender, or
- lumpy.
- the week following menstruation when the breasts are least tender.
Risk factors for breast cancer?
- Age (most significant)
- Family history
- Race
- Genetics
- Early menarche
- Late menopause
- Increased exposure to estrogen
- Use of estrogen
- Nulligravid state
- First pregnancy after age 35
- Fibrocystic conditions, when accompanied by proliferative changes.
- Cancer in one breast
- Endometrial Cancer
- Not breastfeeding
- Hx of epithelial hyperplasia with atypia
- Exposure to ionizing radiation or to other carcinogens.
- Certain dietary factors (fat, ETOH)
Where are most breast cancers found?
Upper outer quadrant
lots of lymphdrainage there
What patients with family history are at risk for breast cancer?
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- 1st degree relative significantly increases risk (sister, mother)
- Two or more relatives with breast or ovarian cancer
- Breast cancer occurring in an affected relative younger than 50 years
- Relatives with both breast cancer and ovarian cancer
- One or more relative with 2 cancers (breast and ovarian cancer or two independent breast cancers)
- Male relatives with breast cancer
- Race: Who is more likely to get breast cancer?
2. What nationality would have the highest risk?
- Caucasian more likely, although incidence in black women is increasing.
- Individuals of Ashkenazi Jewish descent have a 2-times greater risk.
- Early menarche is a risk factor: before what age?
2. Late menopause: after age what?
- under age 12
2. After age 50
- Increased exposure to estrogen is a risk factor: What would cause this? 2
- Use of estrogen therapy is a risk factor: What specifically would make you at risk? 2
- Increased exposure to estrogen
- Obesity
- Persistent anovulation - Use of estrogen therapy
- BSO before age 35 with HRT
- Postmenopausal tx with HRT, especially high doses of estrogen and use of progesterone.
- BRCA 1 and BRCA 2 are what kind of genes?
- Function? 2
- Directly involved in repair in what?
- Mutations that occur with BRCAs to cause cancer? 3
- What do the mutations result in? 2
- Tumor suppressor genes.
- Prevent cells from growing and dividing too rapidly or in an uncontrolled way.
- Inhibits the growth of cells that line the milk ducts in the breast.
- Directly involved in the repair of damaged DNA.
- Mutations is these:
- disrupt protein production, resulting in an abnormally small, nonfunctional version of the BRCA2 protein.
- change one of the protein building blocks (amino acids) used to make the BRCA proteins.
- defective BRCA protein is unable to help fix damaged DNA.
- Results in the build up of mutations.
- Causes cells to divide in an uncontrolled way and form a tumor.
- Harmful BRCA1 mutations may also increase a woman’s risk of developing the following cancers (in addition to breast ca)? 4
- Harmful BRCA2 mutations may also increase the risks of? 4
- cervical
- uterine
- pancreatic
- colon cancer
- pancreatic CA
- stomach CA
- gallbladder and bile duct cancer
- melanoma
- Men with harmful _______ mutations also have an increased risk of breast cancer and, possibly, of pancreatic cancer, testicular cancer, and early-onset prostate cancer.
- However, male breast cancer, pancreatic cancer, and prostate cancer appear to be more strongly associated with ________ gene mutations .
- BRCA1
2. BRCA2
Breast Cancer mass characteristics
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- Solitary nodule
- Non-tender
- Firm to hard
- Ill defined margins
- Not mobile
- Skin nipple retractions
- Axillary lymphadenopathy
Remember, a good number of breast masses are found by mammogram with no palpable mass.
Breast Care Guidelines from the ACS
1. Women ages _______ should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.
- Women age _______ should get mammograms every year.
- Women ________ should switch to mammograms every 2 years, or can continue yearly screening.
- Screening should continue as long as a woman is in good health and is expected to live how long?
- 40 to 44
- 45 to 54
- 55 and older
- 10 more years or longer.
What is the most frequent lesion of the breast?
Fibrocystic change
- Fibrocystic change represents what?
- Common ages?
- Rare in who?
- How will the mass present?
- Exacerbated by what?
- Represents an exaggerated physiologic response to a changing hormonal environment.
- Common in women 30-50 years old.
- Rare in postmenopausal women who are NOT taking HRT.
- Painful mass which often exacerbates or increases in size during the premenstrual phase of the cycle.
- Exacerbated by ETOH
Physical presentation of fibrocystic conditions?
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- Often multiple, usually bilateral masses
- Rapid fluctuation in size is common
- Painful and tender
- Pain occurs or increases during the premenstrual phase of the cycle
- Size increases during the premenstrual phase of the cycle.