Breast Examination Flashcards
Average age of breast cancer
62
What proportion of women get breast cancer
1/8
Why is breast cancer incidence increasing
- increasing age
- increased sensitivity of mammogram screening
Why is breast cancer mortality reducing
- earlier recognition
- tamoxifen
4 presentations of breast cancer
- asymptomatic
- early symptomatic breast cancer
- locally advanced breast cancer
- metastatic
Mainstays of breast cancer diagnosis
Clinical examination Mammography Ultrasound Biopsy Staging
Presenting symptoms of breast cancer
Painless lump Nipple discharge Nipple in drawing Distortion Pagets disease Axillary nodes
Presenting signs of breast cancer
Painless lump
Skin tethering
Indrawn nippling
Breast history: presenting complaint
- how long has lump been there
- tender?
- cylical (with period)
- pregnant/breast feeding?
- size increasing
- nipple discharge/bleeding
What is the classic feel of a breast cancer lump
irregular, hard, fixed
Breast history: general factors
Use of oestrogens
General health
Drug history
FHx (and ages)
What does a tender lump at different time of the month suggest
Benign
Which diseases are BRCA gene associated
Prostate, ovary and breast
What is peau d’orange
Skin resembles orange peel as it is oedematous.
What are the two options for breast cancer surgery
Masectomy
*Lumpectomy and radiotherapy
Lung mets presentation
Cough
Haemoptysis
SOB
What can a pleuritic metastasis result in
Pleural effusion
How to prepare for the breast examination
Introduce, identify
CHAPERONE
Clean your hands
Patient to be undressed to waist
Breast examination steps
Patient sits on couch facing you Observe the breast Look Lift arms above head Look Ask woman to put her arms on her hips and push in Look Feel
What are you looking for in a breast examination
Assymetry
Skin tethering
Nipple retraction
Discolouration
How do you feel in a breast exam
Press breast vertically down onto ribs
Be thorough through quadrants
Watch facial reactions
Arms raised helps
What to do if you find a lump
Size Mobility Site and proximity to nipple Symmetry Skin tethering Consistency Smooth or irregular surface
How does benign feel
Rubbery
How does aggressive feel
Hard
What if its a triple negative
Be careful as this can resemble fibroadenoma
What if they are complaining of discharge
Ask them to produce some
Examination of the axilar
Feel behind pectoral muscle
Feel in front of the lattisimus dorsi
Which structures is in improtant to preserve in the axilar
Long thoracic nerve of bell and thoracodorsal pedicle
What are the levels of the axillary nodes catergorised by
Relation to pectoralis minor
1- lateral
2-under
3-medial
Where else apart from the axilla should you investigate in a breast exam
Supraclavicular fossa
Metastatic breast cancer survey
Liver, lung bases for effusions and spine for tenderness
How to finish a breast exam
Thank
Sit up and dressed
Explain findings
Tests for breast cancer
Mammogram and core biospy
Breast implants complications
Caspule formation, infection, rupture and shape changes with age
What is a consequence of removing all the axillary lymp
Lymphoedema
How do you test if the axilla is involved
Sentinel node biopsy
Adjuvant therapies for breast cancer
Endocrine therapy
Chemotherapy
Radiotherapy
Trastuzumab (Her-2 ab)
Endocrine therapies for breast cancer
Tamoxifen Aromatase inhibitors (anastrozole)
Where can skin be moved from to create a new breast
Latissimus dorsi
TRAM
Superior gluteal artery perforator flap (SGAP)
