Breast Disorders

Question 1

Mastalgia

Answer 1

Breast pain: burning, aching, soreness

• Dx to exclude cancer
• T: low caffeine and dietary fat, cold compresses, Vitamins E/A/B, primrose oil

Question 2

Mastitis

Answer 2

Inflammatory condition usually in lactating women (2-4 wks after birth)

• warm, infuriated, painful, often unilateral, due to staph contracted via cracked nipple
• T: antibiotics, nipple shield, may breast feed unless abscess or purulent drainage

Question 3

Fibrocystic changes

Answer 3

Painful changes in breast tissue, ages 30-50
-excess fibrous tissue
-hyperplasia of lining
-proliferation of mammary ducts
-cysts
-watery milky, yellow, or green discharge
Not associated with increased risk for breast cancer

Question 4

Fibrocystic changes diagnosis and care

Answer 4

Mammogram, ultrasound, biopsy

-aspiration removal, surgical excision, Tx similar to mastalgia

Question 5

Fibroadenoma

Answer 5

Discrete, small, benign breast lumps; in young women age 15-40

• possibly caused by increased estrogen
• 2-3cm, painless, round, well delineated, mobile without retraction or nipple discharge
• Dx: mammography, ultrasound, image guided core needle or excisional biopsy
• care: regular monitoring, surgical excision, cryoablation

Question 6

Gynecomastia

Answer 6

Transient, noninflammatory enlargement of one or both breast

• usually temporary and benign
• may be an indicator of other disease or side effect of meds, heroin/marijuana use
• Men: senescent (with aging, common), typically disappears within 6-12 months

Question 7

Breast cancer

Answer 7

Risks: BRCA gene, reproductive/menstrual history, hormone replacement

• noninvasive: ducal or lobular carcinoma in situ (DCIS, LCIS)
• invasive: metastasis of cancer cells
• lump or thickening, hard irregular and non mobile
• nipple retraction, inverted, tenderness
• asymmetry in breast

Question 8

Breast cancer Dx studies

Answer 8

• estrogen and progesterone status: receptor positive means lower chance of recurrence
• HER-2: greater risk of recurrence and poor prognosis
• MammaPrint and Oncotype

Question 9

Stage I vs IV

Answer 9

I: very small tumor, no lymph node
IV: metastatic cancer regardless nodal involvement

Question 10

Mastectomy complications

Answer 10

Pain syndrome: injury to nerves, chest & upper arm pain, itching, numbing, treat with NSAIDs, antidepressants
Lymphedema: caused by removal of nodes, fluid build up in arm and hand, protect hand and arm for rest of life

Question 11

Aromatase inhibitors

Answer 11

Suppress estrogen synthesis