Breast Disorders in Women's Health Flashcards
Breast Disorders
Breast fibrocystic change Breast fibroadenomas Mastitis Breast abscess Intra-ductal papilloma nipple discharge Breast tenderness
Breast Disorders
Breast fibrocystic change Breast fibroadenomas Mastitis Breast abscess Intra-ductal papilloma nipple discharge Breast tenderness
Breasts Histologically Composed of
Lobules/glands
Milk ducts
Connective tissue
Fat
Connective Tissue Disorders
Fibrocystic changes
Fibroadenomas
Issues with Duct System
May become dilated
Contain papillary neoplasms
Undergo malignant transformations
Blood Supply to the Breasts
Internal mammary artery Lateral thoracic artery Thoracodorsal artery Thoracocramial artery Intercostal perforating arteries
Lymphatic System of the Breast
Superficial and deep nodal chains through head & neck
Axilla
Deep to pectoralis muscles
Caudal to diaphragm
Breast Cancer
Most common malignancy in women
Risk Factors for Breast Cancer
Age Family history Race Genetics Early menarche Late menopause Increased exposure to estrogen Use of estrogen therapy Nulligravid state First pregnancy after 35 Fibrocystic conditions when accompanied by proliferative changes CA in one breast Endometrial CA
Breast Cancer & Age
Increases with age
Plateau in women 50-55
Most significant risk factor after gender
Breast Cancer & Family History
1st degree relative i 2+ relatives with breast or ovarian CA Breast CA younger than 50 Relatives with both breast CA & ovarian CA 1+ relative with 2 cancers Male relatives with breast cancer
Breast Cancer & Race
Caucasian more likely
Individuals of Ashkenazi Jewish descent
Breast Cancer & Genetics
BRCA1 & BRCA2
Breast Cancer & Early Menarche
Breast Cancer & Late Menopause
> 50 years old
Breast Cancer & Increase Exposure to Estrogen
Obesity
Persisten anovulation
Breast Cancer & Use of Estrogen Therapy
BSO before 35 with HRT
Postmenopausal treatment with HRT
Other Risk Factors for Breast Cancer
Not breastfeeding
Hx of epithelial hyperplasia with atypic
Exposure to ionizing radiation or other carcinogens
Certain dietary factors: fat, ETOH
BRCA 1 & BRCA2 Mutations
Disrupt protein productions
Change in one of the protein blocks to make BRCA proteins
Unable to help fix damaged DNA
Results in build up of mutations
Causes cells to divide in uncontrolled way
Harmful BRCA1 Mutations and Increased Risk of Other Cancers in Women
Cervical
Uterine
pancreatic
Colon
Male BRCA1 & BRCA2 & Increased Risk of Other Cancers
Breast
Pancreatic
Testicular
Early-onset prostate
Male BRCA1 & BRCA2 & Increased Risk of Other Cancers
Breast
Pancreatic
Testicular
Early-onset prostate
Breasts Histologically Composed of
Lobules/glands
Milk ducts
Connective tissue
Fat
Connective Tissue Disorders
Fibrocystic changes
Fibroadenomas
Issues with Duct System
May become dilated
Contain papillary neoplasms
Undergo malignant transformations
Blood Supply to the Breasts
Internal mammary artery Lateral thoracic artery Thoracodorsal artery Thoracocramial artery Intercostal perforating arteries
Lymphatic System of the Breast
Superficial and deep nodal chains through head & neck
Axilla
Deep to pectoralis muscles
Caudal to diaphragm
Breast Cancer
Most common malignancy in women
Risk Factors for Breast Cancer
Age Family history Race Genetics Early menarche Late menopause Increased exposure to estrogen Use of estrogen therapy Nulligravid state First pregnancy after 35 Fibrocystic conditions when accompanied by proliferative changes CA in one breast Endometrial CA
Breast Cancer & Age
Increases with age
Plateau in women 50-55
Most significant risk factor after gender
Breast Cancer & Family History
1st degree relative i 2+ relatives with breast or ovarian CA Breast CA younger than 50 Relatives with both breast CA & ovarian CA 1+ relative with 2 cancers Male relatives with breast cancer
Breast Cancer & Race
Caucasian more likely
Individuals of Ashkenazi Jewish descent
Breast Cancer & Genetics
BRCA1 & BRCA2
Important Previous Pregnancy History of a Patient when Presenting with a Breast Lump
Age at first pregnancy
Term pregnancies
Abortions
Breastfeed
Breast Cancer & Late Menopause
> 50 years old
Breast Cancer & Increase Exposure to Estrogen
Obesity
Persisten anovulation
Breast Cancer & Use of Estrogen Therapy
BSO before 35 with HRT
Postmenopausal treatment with HRT
Other Risk Factors for Breast Cancer
Not breastfeeding
Hx of epithelial hyperplasia with atypic
Exposure to ionizing radiation or other carcinogens
Certain dietary factors: fat, ETOH
BRCA 1 & BRCA2 Mutations
Disrupt protein productions
Change in one of the protein blocks to make BRCA proteins
Unable to help fix damaged DNA
Results in build up of mutations
Causes cells to divide in uncontrolled way
Harmful BRCA1 Mutations and Increased Risk of Other Cancers in Women
Cervical
Uterine
pancreatic
Colon
Harmful BRCA2 Mutations & Increase Risk of Other Cancers in Women
Pancreatic
Stomach
Gallbladder & Bile duct
Melanoma
Male BRCA1 & BRCA2 & Increased Risk of Other Cancers
Breast
Pancreatic
Testicular
Early-onset prostate
Presentation of Breast Cancer
Mass Solitary nodule Non-tender Firm to hard Ill define margins Not mobile Skin nipple retractions Axillary lymphadenopathy
ACS Breast Care Guidelines
40-44: have choice to start mammograms
45-54: yearly mammograms
55+: yearly or every other year mammograms
Define Fibrocystic Change
Exaggerated physiologic response to a changing hormonal environment
Fibrocystic Change
Most frequent lesion of breast
Common in women 30-50
Rare in postmenopausal women NOT taking HRT
Painful mass exacerbates or increases in size during premenstrual phase
Exacerbated by ETOH
Presentation of Fibrocystic Change
Multiple, bilateral masses Rapid fluctuation in size Painful & tender Occurs or increases during premenstrual phase Size increases during premenstrual phase
Diagnostics & Treatment of Fibrocystic Changes
Re-examine at intervals
Reassure patient that discomfort is not a sign of CA
Symptoms improve with cyclical decrease in hormonal stimulation
OCPs offer no benefit
Use support bras
Vitamin E supplements
Avoid chocolate, alcohol, & caffeinated beverages
Teach & encourage monthly BSE
May need to be biopsied
Fibroadenoma
Benign neoplasm made from overgrowth of glandular & fibrous breast tissue
Occur alone, in groups, or as complex
Most frequently in young women (20 years after puberty)
Earlier age in black women
Multiple tumors in 10-15% of patients
Women over 30 need to distinguish from fibrocystic change or CA
Presentation of Fibroadenoma
Round or ovoid Non-tender Smooth margins Rubbery Discrete Relatively movable 1-5 cm in diameter
Diagnostics & Treatment of Fibroadenoma
US can distinguish cystic FNB can confirm cytology Teach & encourage BSE Treatment varies on diagnosis If small, treatment usually not necessary but follow-up with US If large, tumor can be removed Removed in women over 40
Important History of a Patient when Presenting with a Breast Lump
Age of patient Disease history Family history Medication history Onset of menarche Where they are in cycle Onset of menopause Social habits Ingestion habits Previous Pregnancies Mammogram history Frequency of SBE Last exam by provider
Important Social Habits of a Patient when Presenting with a Breast Lump
ETOH
Smoking
Important Ingestion Habits of a Patient when Presenting with a Breast Lump
Caffeine
high fat
Important Previous Pregnancy History of a Patient when Presenting with a Breast Lump
Age at first pregnancy
Term pregnancies
Abortions
Breastfeed
Imaging of Breast Conditions
Ultrasound
Mammography
Ultrasound and Breast Conditions
Preferred if palpable mass, patient
Mammography & Breast Conditions
Palpable mass, >30-35 years old, & not pregnant
Follow up US if need determination between cystic & solid
When to Refer for a Breast Condition
Further investigation
Biopsy
Types of Breast Biopsies
FNA
Core needle aspiration
Excisional
FNA Biopsy
Small gauge needle (21-25)
Need adequate specimen
Core Needle Aspiration Biopsy
Large gauge needle (14-18)
Need adequate specimen
Excisional Biopsy
Mass & surrounding tissue excised for histological exam
Definitive diagnosis of breast CA
therapeutic without additional surgery
Mastitis
Breast tenderness Warm to touch Malaise Swelling of breast Pain/burning continuously or while breastfeeding Skin redness Fever 101+
Mastitis Presentation
Unilateral
Begins 3 months post delivery
Start as sore or fissure nipple
Lump possible if beginning to form an abscess
Mastitis Treatment
Antibiotics against PCN-resistant staph Regular emptying of breast by nursing Warm compresses Failure to response within 3 days should prompt consideration of MRSA Possibly admitted for IV therapy Delay in treatment = abscess
Prevention of Mastitis
Breastfeed equally from both breasts Empty breasts completely Use good breastfeeding techniques Avoid dehydration Practice careful hygiene: hands, breasts, baby
Define Breast Abscess
Redness, tenderness, induration on breast during nursing or otherwise
Define Intraductal Papilloma
Tiny wart-like growth in breast tissue that sometimes punctures a duct
Intraductal Papilloma
Most often in women 35-55
Most common cause of spontaneous nipple discharge from single duct
Types & Related Condition of Intraductal Papilloma
Solitary intraductal papillomas
Multiple papillomas
papillomatosis
Solitary Intraductal Papillomas
One lump
Near nipple
Causes discharge
Multiple Papillomas
Groups of lumps
Further from nipple
Doesn’t cause discharge
Can’t be felt
Papillomatosis
Small groups of cells inside the ducts
Type of hyperplasia
More scattered than multiple papillomas
Tests for Intraductal Papilloma
Breast biopsy
Examination of discharge
X-ray with contrast dye
Treatment of Intraductal Papilloma
Duct is surgically removed
Cells checked for CA
Causes of Nipple Discharge
Papilloma Premenopausal women: spontaneous Prolactinoma OC agents Abscess Medications Hypothyroidism
Suspicious Nipple Discharge
1 breast 1 duct Associated with lump Leaks out on it's own Most days of month Water or bloody A lot
Not Suspicious Nipple Discharge
Both breasts Several ducts Squeezing brings it on Occasional Different colors A little
Breast Tenderness
Unilateral or bilateral Usually not related to trauma Usually related to fibrocystic changes May be associated with breast CA May be related to dietary habits: caffeine, chocolate, salt
Evaluation of Breast Tenderness
Breast exam checking for areas of tenderness, mass, trauma, nipple discharge
US/mammogram
Treatment of Breast Tenderness
NSAIDs
Eliminate caffeine, chocolate, salt
Monthly SBE
Return to recheck if symptoms don’t resolve within 1-2 months
