Breast Lump Flashcards
1
Q
Breast mass
A
Lesion that persists throughout menstrual cycle, differs from surrounding breast tissue and corresponding area on contralateral breast
2
Q
Milk (mammary) lines
A
Anatomic precursors to mammary glands and nipples
. Ventral epidermal ridges appearing by 6th week of gestation
3
Q
Polythelia
A
. Supernumerary nipples
. Presence of 2+ nipples on individual
4
Q
Mastodynia (Mastalgia)
A
Breast pain
5
Q
Skin dimpling
A
Retraction of skin causing the appearance of a pit below general skin contour
. May be secondary to underlying mass
6
Q
Nipple eversion
A
Outwardly positioned nipple
7
Q
Nipple inversion/retraction
A
Inwardly positioned nipple
8
Q
Pedunculated
A
Having peduncle/elongated stalk
9
Q
Montgomery glands/tubercles of nipple
A
Sebaceous glands that appear as small bumps around dark area surrounding nipple papilla
10
Q
Pager disease of nipple
A
Uncommon form of breast cancer that starts as scaly, eczema-like lesion on the nipple that may weep, crust, or erode
11
Q
Peau d’ orange
A
Giving appearance as skin of orange assoc. w/ some forms of breast cancer
12
Q
Abscess
A
Local accumulation of puss w/in body tissue
13
Q
Pus
A
Thick, opaque/yellowish liquid produced in affected tissue consisting of white blood cells, bacteria, serum, and tissue debri
14
Q
Breast lump differential factors to consider
A
Age variation, biological sex, genetics, external influences
15
Q
Breast cancer
A
Malignant proliferation of epithelial cells lining ducts/lobules of breast
16
Q
Breast cancer signs and symptoms
A
. Weight loss, firm . Non tender breast mass . Non-mobile mass . Nipple discharge . Skin dimpling . Nipple retraction . Corresponding lymph node enlargement
17
Q
Fibroadenoma of breast
A
. Common benign neoplasm occurring most frequently in young women w/in 20 years of puberty
18
Q
Fibroadenoma signs and symptoms
A
. Usually discovered accidentally
. Typical lesion is round, firm, discrete, very mobile, non-tender mass 1-2 cm in diameter
. Skin dimpling or retraction absent
19
Q
Breast abscess
A
Painful collection of pus that forms in breast usually appearing as lump under skin
20
Q
Breast abscess signs and symptoms
A
Usually patient present w/ fever, skin, erythema, warmth, swelling/induration and pain/tenderness
21
Q
Mastitis
A
Inflammation of mammary glands w/in breast, usually bacterial in origin
22
Q
Mastitis signs and symptoms
A
Presents w/ breast pain, swelling, tenderness, skin erythema, and warmth
23
Q
Fibrocystic disease of breast
A
. Not actually disease, classified as process
. Benign often painful bilateral inflammatory breast condition due to monthly hormonal fluctuations in women
24
Q
Fibrocystic disease of breast signs and symptoms
A
Painful lumps appearing in one or both breasts
. Vary daily/monthly in size and tenderness
. Occur in premenopausal women
25
Breast boundaries
```
. Against ant. Thoracic wall
. Extends from clavicle and 2nd rib down to 6th rib
. From sternum across midaxillary line
. Surface area rectangular
. Overlies pec major and serratus ant.
```
26
Tail of Spence
Axillary tail of breast tissue extends to ant. Axillary fold
27
Glandular tissue in breast
. Milk-secreting tubuloalveolar glands and ductules form 15-20 septated lobes radiating around nipple
. Each lobe contains smaller lobules
. Each lobule drains into larger collecting ducts and lactiferous sinuses leading to 5-10 porous openings on surface of areola and nipple
28
Fibrous CT in breast
. Form fibrous bands/suspensions ligaments (Cooper ligaments) connected to skin and underlying fascia
29
Factors that affect proportion of fibrous CT and adipose tissue
```
. Age
. Nutritional status
. Pregnancy
. Exogenous hormone use
. After menopause atrophy of glandular tissue and dec. lobules
```
30
Breast feeding physiology
. Nipple and areola have smooth muscle that contracts to express milk from ductal system
. Rich sensory innervation triggers “milk letdown” following neurohormonal stimulation from infant sucking
. Tactile stimulation makes nipple smaller, firmer, more erect while areola puckers and wrinkles
31
Male breast tissue
. Small nipple and areola overlying thin disc of breast tissue consisting of ducts
. Ductal branching and development of lobules are minimal w/ no estrogen and progesterone stimulation
. Firm button of breast tissue 2 cm+ in diameter in 1 out of 3 men
32
Central nodes
. Palpable most frequently
. Lie along chest wall
. High in axilla and midway btw ant. And post. Axillary folds
33
Pectoral nodes
. Anterior
. Lower border of pec major inside the ant. Axillary fold
. Nodes drain ant. Chest wall and much of the breast
34
Subscapular nodes
. Posterior
. Located along lat. border of scapula
. Palpated deep in post. Axillary fold
. Drain post. Chest wall and portion of the arm
35
Lateral nodes
Located along upper humerus
| . Drain most of arm
36
Lymphatics clinical significance in breast
. Cancer cells tend to spread along lymph passages
. Typical spread sup/lat. to axillary lymph nodes
. More than 75% of drainage via axillary lymph nodes
. Most remaining drainage med. to parasternal nodes
. Unilateral lymph blockage can occur
. Lymph can then drain to opposite side
37
T/F All lymph of breast drains to axilla
F, can go to infraclavicular nodes or into mammary chain of lymph nodes w/in chest
38
Cyclic breast discomfort qualities
Onset w/ menses
Bilateral
Lasts for several days and varies in intensity
39
When is mastitis most common?
Breastfeeding women
40
What percent of palpable breast masses are benign?
90% or more
41
What is a crucial step is assessment of breast mass?
Excluding breast cancer
42
Family history related to breast cancer
. Pattern of breast/overran cancer in maternal or paternal family members
. Include men
. Suspicious for autosomal dominant genetic mutations
43
Gail Model breast cancer risk assessment tool and when to and to not use
. Calculates risk of developing breast cancer w/in 5 yrs and w/in lifetime
. best use for people over 50, no family history of breast cancer or one affected first-degree relative and have screening mammograms
. Don’t use for women w/ history of breast cancer or radiation or are 35 yrs old or younger
44
What 5 year risk percent or higher is high risk?
1.67
45
7 risk factors for breast cancer
```
. Age
. Age at 1st menstrual period
. Age at time of birth of 1st child
. Family history of breast cancer
. # past breast biopsies
. # biopsies showing atypical hyperplasia
. Race/ethnicity
```
46
Mammography w/ self-reported palpable masses miss ___percent of invasive cancers
13%
47
concerning findings in clinical breast exam
. Changes in contour (puckering/swelling)
. Skin changes (dimpling of skin over breasts/inflammation)
. Discharge from nipple (color/spontaneous)
48
Common breast lesion and characteristics in 15-25 yr olds
. Fibroadenoma
| . Smooth, rubbery, round, mobile, nontender
49
Common breast lesions and characteristics in 25-50 yr olds
. Cysts (Usually soft to firm, round, mobile, often tender)
. Fibrocystic changes (modular, rope like)
. Cancer (irregular firm, mobile or fixed)
50
Common lesion in breast in people over 50
Cancer until proven otherwise
51
Common breast lesion during pregnancy/lactation
. lactating adenomas, cysts, mastitis, and cancer
52
Malignant features in breast
```
. Hard consistency
. Non-mobile
. Irregular shelf
. Dimpling
. Assoc. retraction of nipple
. Non-tender
. Bloody discharge
. Palpable lymph nodes
```
53
Features of benign breast
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. Cyclical
. No skin changes
. No bloody discharge
. Well circumscribed
. Tenderness
```
54
Lactational infection/inflammation causes, signs and symptoms
```
. Fullness or mass w/ erythema and tenderness
. Cellulitis
. Abscess
. Serous or bloody nipple discharge
. Fever
```
55
Cellulitis treatment
. Oral ABX covering gram+ cocci, apply warm packs, keep breast emptied
56
Abscess treatment
Surgical drainage
57
Non-lactational infection/inflammation causes
. Peripheral
| . Assoc. w/ DM, RA. Steroids, or trauma
58
Triple assessment for breast mass
. Exam
. Imaging (mammography, ultrasound, MRI)
. Tissue/cytology sampling (fine needle aspirate, core needle biopsy, excisional biopsy)
59
Guidelines for diagnostic imaging evaluation for breast mass for people under 30 w/ no risk factors
. Ultrasound to determine cyst, tumor, or abscess
. Ultrasound better dur to high density of breast tissue
. Confirm w/ cytology/tissue sampling
60
Simple cyst evaluation w/ ultrasound
Likely benign if it has symmetry, round borders, no internal echoes
61
Complex cyst evaluation w/ ultrasound
. Septation/internal echoes
| . Send for referral
62
Solid tumor evaluation in ultrasound
. Fibroadenoma
| . Benign if symmetric. Round borders w/ no internal echoes
63
Diagnostic evaluation for people over 30
. Diagnostic mammography
. Ultrasound after mammogram may guide FNA or biopsy
. If high index of suspicion and have normal imagine still refer for biopsy
64
If suspicious mass palpated what is protocol?
. No matter what age mammogram
. Can have ultrasound
. Refer for biopsy
65
Breast MRIs
. Use limited
| . May be helpful as adjunct study to guide core biopsy when localization would be difficult w/ conventional imaging
66
Fine needle aspiration and result evaluation
. Small gauge needle and syringe
. Good for cystic lesions (need experienced person for complex cystic lesions)
. If aspirate non-bloody and mass disappears reexamine 4-6 weeks (if reoccurs reimage consider referral)
. If aspirating does not cause cyst to disappear refer out
. If aspirate is bloody send for cytology and refer out
67
Core needle biopsy
. Larger hollow needle
. Preferred method for solid/suspicious mass
. Can mark suspicious area for future
. Requires specialist
. Sn. And Sp* approaches excisional biopsy
68
Excisional biopsy
. Surgical removal of suspicious area
. Core needle biopsy mostly replaced this
. Indications to do it: discordance btw imaging characteristics and core biopsy histology, nondiagnostic specimen from core biopsy, lesion automatically unsuitable for core biopsy
69
When it is worthwhile to screen for a disease
. When test accurately detects target disease when asymptomatic
. Test high sensitivity and specificity
. Is reproducible
. Safe and acceptable to patients
. Simple and cost effective
. When there is effective treatment and early detection change w/ disease
70
United States preventative services task force (USPSTF)
. Independent panel of experts in primary care and prevention
. Highly evidence-based guidelines on when and how to screen
71
BRCA1 and BRCA2
. Human genes that produce tumor suppressor proteins
. Repair damaged DNA
. If mutated, DNA damage ma not be repaired properly
. Cells more likely to develop additional genetic alterations that can lead to cancer
. Autosomal-dominant
72
Risks if you have mutated BRCA genes
. Inc. risk ovarian cancer (occurs at younger age)
| . Inc. risk other organs (male breasts, pancreas, prostate, Fallopian tubes)
73
Prevalence of BRCA1 and 2
Less than 1% of population but causes 5-10% of female breast cancers
74
BRCA1 mutations
. Inc. risk by 70 yrs old to 44-78%
75
BRCA2 mutation risk
31-51% developing cancer
76
High risk factors for familial breast cancer
. Age 50 or younger breast cancer diagnosis
. Breast cancer in 2+ individuals in Same lineage
. Multiple primary or ovarian tumors in 1 person
. Breast cancer in male relative
. Ashkenazi Jewish ancestry
77
If no family history is present what are next steps:
.BRCAPRO calculator
. Referral for genetic counseling
. Genetic testing
. Appropriate specialty referrals
78
BRCA positive patients risk management
. Intensive screening (yearly mammogram/MRI, CBE, chemo prevention
. Surgical forms of risk reduction (mastectomy, bilateral salpingo-oophorectomy btw age 35-50)
79
Male breast cancer incidence inc. btw ages ___
60 and 70
80
Risk factors for breast cancer in men
```
. Higher in African American men
. Radiation exposure
. BRCA
. Klinefelter syndrome
. Testicular disorder
. Family history of breast cancer
. Alcohol use, cirrhosis, and obesity
```
81
When to screen trans patients
. Over 50 yrs old
. Had estrogen therapy for over 5 yrs
. Family history
. BMI over 35
82
How to screen Trans men
. If there are intact breasts routine screening
| . Postmastectomy: yearly chest wall and axillary exams
