Breast Disorders Flashcards
Young breasts are predominantly made up of what type of tissue? older?
Describe breast anatomy
Younger breasts predominately glandular tissue. Older breasts are replaced by fat..
Anatomy:
- organized into 15-25 lobules, the lobules consist of clusters of secretory cells arrange in an alveolar pattern.
- lobules drain into a series of collecting milk ducts that come together into approximately 5-10 collecting ducts that lead to and drain at the nipple.
- rich blood supply from the internal mammary artery
- huge lymphatic system
What are the types of changes that may occur in each of the following:
- connective tissue
- fat tissue
- duct system
CT:
- fibrocystic changes
- fibroadenomas
Fat:
- necrosis from trauma
- lipomas
Duct:
- dilated
- contain papillary neoplasms
- undergo malignant transformations
Breast CA :
-risk factors
Risk factors:
- age; most significant risk factor after gendder.
- rare in those younger than 25
- FHx; 1st degree relative or two or more relatives with breast/ovarian CA
- Race: caucasian more likely
- Genetics: BRCA1 and BRCA 2
- Early menarche
- late menopause
- increased exposure to estrogen: obesity, anovulation
- use of estrogen therapy:
- -BSO before 35 with MHT
- -post menopausal tx with MHT
-nullgravid state
-first pregnancy after
age 35
-fibrocystic conditions
- CA in one breast
- endometrial CA
- Not breastfeeding
- exposure to ionizing radiation
- Fat, ETOH
BRCA1 & 2
- what are these?
- function
- mutation in these cause?
- mutations may also increase risk of what other CA?
What: tumor suppressor genes
Function: prevent cells from growing and dividing too rapidly or in an uncontrolled way. Directly involve in the repair of damaged DNA.
Mutation:
- disrupt protein production, resulting in an abnormally small, nonfunctional version of the BRCA2 protein.
- unable to fix damaged DNA
- causes cells to divide in an uncontrolled way and form a tumor.
CA:
- ovarian?
- cervical
- uterine
- colon
- pancreatic
- stomach
- gallbladder
- melanoma
Breast CA:
- presentation
- screening
Presentation:
- solitary nodule
- non-tender
- firm to hard
- ill defined margines
- not mobile
- skin nipple retractions
- axillary lymphadenopathy
- 70% are found in the upper outer quandrant!*
Screening:
- women 40-44 choice to start annual mammograms
- women 45-54 mammograms every year
- women 55+ switch to mammograms every 2yrs or can continue yearly screening.
- these should be continued as long as a women is in good health and is expected to live 10 more years or longer.
-monthly self-breast exams
Fibrocystic changes:
- cause
- MC in what ages?
- sx
- dx
- tx
Cause: exaggerated physiologic response to a changing hormonal environment.
MC in 30-50YO
Sx:
- painful mass
- may increase in size &pain during premenstrual phase
- often multiple, bilateral masses
- fluctuate in size
Dx:
-re-examine pt at intervals, may need bx
Tx:
- -supportive;
- ibuprofen
- warm compress
- cool compress
- avoid chocolate, alcohol, anything with caffiene
- vitamin E
- wear good supporting bra without wire
- danazol (heather not comfortable rx this with just breast pain d/t drugs SE)
Fibroadenoma:
- what is this?
- MC in what age?
- sx
- dx
- tx
What: benign neoplasm made from an overgrowth of glandular and fibrous breast tissue; may occur alone or in groups
-MC in young women usually within 20yrs after puberty
- Sx:
- round or ovoid
- non-tender
- smooth margin
- rubbery
- discrete
- relatively mobile
- 1-5cm in diameter
Dx:
- US**
- FNB can confirm cytology
- BSE
Tx:
- if small, painless, remains same size, and bx shows no probs, further tx is not needed, f/u w/ US.
- if large (more than 3cm) painful growing, or bx results in atypical cells, the tumor can be removed.
- if greater than 40YO it should be removed, has greater chance of malignant transformation
How do you differentiate between fibroadenomas and phyllodes?
Phyllodes tend to grow more quickly(may be benign or malignant) and develop about 10 yrs later in life in the 40s as opposed to the 30s.
Imaging:
-what determines the preferred imaging method?
- what imaging is preferred if palpable mass found?
- what imaging is preferred if younger than 30YO?
- what imaging is preferred if pregnant?
- what test can differentiate cystic from solid palpable mass?
A pts age determines the preferred imaging
palpable mass: US
Younger than 30: US
pregnant: US
solid vs cystic: US
Mammography:
-when to use?
use: pt has palpable mass, is older than 30-35YO, and is not pregnant
* sensitivity is much reduced in younger or denser breasts; therefore mammography is considered inappropriate in pts younger than 35YO.
What are the types of bx?
Fine needle aspiration(21-25 gauge)
Core needle aspiration (14-18)
Excisional Bx: mass and surrounding tissue are excised. ONLY definitive dz of breast CA.
Mastitis:
- sx
- MC seen in who?
- MC cause
- tx
- prevention
Sx:
- breast tenderness or warmth to touch
- malaise
- swelling of the breast
- pain or burning sensation continuoulsy or while breast feeding
- skin redness
- fever of 101F or greater
- unilateral
- may start as sore or fissured nipple
- may have lump if starting to form abscess.
MC seen in nursing moms
MC cause: staph aureus
Tx:
- lanolin cream
- keep nursing, pump afterwards to completely empty ducts
- Dicloxacillin or Keflex for 5-7d
- warm compress
Prevention:
- breast feed equally from both breasts
- empty breasts completely to prevent engorement and blocked ducts
- avoid dehydration by drinking plenty of luds
- handwashing, cleaning the nipples. keeping baby clean
Intraductal Papilloma:
- what is this?
- MC in what ages?
- MC cause of what?
- Dx
- Tx
What: tiny wart-like growth in breast tissue that sometimes punctures a duct.
MC in 35-55YO
MC cause of spontaneous nipple discharge from a single duct.
Dx:
- bx to r/o CA
- examination of discharge to see if cells are cancerous
- x-ray with contrast dye injected into the affected duct.
Tx:
-involved duct is surgically removed and the cells are checked for CA.
Causes of nipple dischrage
papilloma
premenopausal women
prolactinoma
oral contraceptives
abscess
medications
hypothyroidism
Nipple Discharge:
-characteristics of suspicious and not suspicious discharge
Suspicious:
- 1 breast
- 1 duct
- associated with lump
- leaks out on its own
- most days of the month
- watery or bloody
- a lot of discharge
Not suspicious:
- both breasts
- several ducts
- squeezing brings it on
- occasional
- different colors (green, yellow, white)
- a little
