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PSP > Breast Lump > Flashcards

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

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2
Q

Milk (mammary) lines

A

Anatomic precursors to mammary glands and nipples

. Ventral epidermal ridges appearing by 6th week of gestation

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3
Q

Polythelia

A

. Supernumerary nipples

. Presence of 2+ nipples on individual

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4
Q

Mastodynia (Mastalgia)

A

Breast pain

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5
Q

Skin dimpling

A

Retraction of skin causing the appearance of a pit below general skin contour
. May be secondary to underlying mass

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6
Q

Nipple eversion

A

Outwardly positioned nipple

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7
Q

Nipple inversion/retraction

A

Inwardly positioned nipple

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8
Q

Pedunculated

A

Having peduncle/elongated stalk

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9
Q

Montgomery glands/tubercles of nipple

A

Sebaceous glands that appear as small bumps around dark area surrounding nipple papilla

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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

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11
Q

Peau d’ orange

A

Giving appearance as skin of orange assoc. w/ some forms of breast cancer

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12
Q

Abscess

A

Local accumulation of puss w/in body tissue

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13
Q

Pus

A

Thick, opaque/yellowish liquid produced in affected tissue consisting of white blood cells, bacteria, serum, and tissue debri

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14
Q

Breast lump differential factors to consider

A

Age variation, biological sex, genetics, external influences

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15
Q

Breast cancer

A

Malignant proliferation of epithelial cells lining ducts/lobules of breast

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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
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17
Q

Fibroadenoma of breast

A

. Common benign neoplasm occurring most frequently in young women w/in 20 years of puberty

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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

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19
Q

Breast abscess

A

Painful collection of pus that forms in breast usually appearing as lump under skin

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20
Q

Breast abscess signs and symptoms

A

Usually patient present w/ fever, skin, erythema, warmth, swelling/induration and pain/tenderness

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21
Q

Mastitis

A

Inflammation of mammary glands w/in breast, usually bacterial in origin

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22
Q

Mastitis signs and symptoms

A

Presents w/ breast pain, swelling, tenderness, skin erythema, and warmth

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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

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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

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25
Q

Breast boundaries

A 
. 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.
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26
Q

Tail of Spence

A

Axillary tail of breast tissue extends to ant. Axillary fold

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27
Q

Glandular tissue in breast

A

. 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

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28
Q

Fibrous CT in breast

A

. Form fibrous bands/suspensions ligaments (Cooper ligaments) connected to skin and underlying fascia

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29
Q

Factors that affect proportion of fibrous CT and adipose tissue

A 
. Age
. Nutritional status
. Pregnancy
. Exogenous hormone use 
. After menopause atrophy of glandular tissue and dec. lobules
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30
Q

Breast feeding physiology

A

. 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

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31
Q

Male breast tissue

A

. 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

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32
Q

Central nodes

A

. Palpable most frequently
. Lie along chest wall
. High in axilla and midway btw ant. And post. Axillary folds

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33
Q

Pectoral nodes

A

. Anterior
. Lower border of pec major inside the ant. Axillary fold
. Nodes drain ant. Chest wall and much of the breast

34
Q

Subscapular nodes

A

. Posterior
. Located along lat. border of scapula
. Palpated deep in post. Axillary fold
. Drain post. Chest wall and portion of the arm

35
Q

Lateral nodes

A

Located along upper humerus

. Drain most of arm

36
Q

Lymphatics clinical significance in breast

A

. 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
Q

T/F All lymph of breast drains to axilla

A

F, can go to infraclavicular nodes or into mammary chain of lymph nodes w/in chest

38
Q

Cyclic breast discomfort qualities

A

Onset w/ menses
Bilateral
Lasts for several days and varies in intensity

39
Q

When is mastitis most common?

A

Breastfeeding women

40
Q

What percent of palpable breast masses are benign?

A

90% or more

41
Q

What is a crucial step is assessment of breast mass?

A

Excluding breast cancer

42
Q

Family history related to breast cancer

A

. Pattern of breast/overran cancer in maternal or paternal family members
. Include men
. Suspicious for autosomal dominant genetic mutations

43
Q

Gail Model breast cancer risk assessment tool and when to and to not use

A

. 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
Q

What 5 year risk percent or higher is high risk?

A

1.67

45
Q

7 risk factors for breast cancer

A 
. 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
Q

Mammography w/ self-reported palpable masses miss ___percent of invasive cancers

A

13%

47
Q

concerning findings in clinical breast exam

A

. Changes in contour (puckering/swelling)
. Skin changes (dimpling of skin over breasts/inflammation)
. Discharge from nipple (color/spontaneous)

48
Q

Common breast lesion and characteristics in 15-25 yr olds

A

. Fibroadenoma

. Smooth, rubbery, round, mobile, nontender

49
Q

Common breast lesions and characteristics in 25-50 yr olds

A

. Cysts (Usually soft to firm, round, mobile, often tender)
. Fibrocystic changes (modular, rope like)
. Cancer (irregular firm, mobile or fixed)

50
Q

Common lesion in breast in people over 50

A

Cancer until proven otherwise

51
Q

Common breast lesion during pregnancy/lactation

A

. lactating adenomas, cysts, mastitis, and cancer

52
Q

Malignant features in breast

A 
. Hard consistency
. Non-mobile 
. Irregular shelf
. Dimpling
. Assoc. retraction of nipple
. Non-tender
. Bloody discharge
. Palpable lymph nodes
53
Q

Features of benign breast

A 
. Cyclical
. No skin changes
. No bloody discharge
. Well circumscribed
. Tenderness
54
Q

Lactational infection/inflammation causes, signs and symptoms

A 
. Fullness or mass w/ erythema and tenderness 
. Cellulitis
. Abscess
. Serous or bloody nipple discharge 
. Fever
55
Q

Cellulitis treatment

A

. Oral ABX covering gram+ cocci, apply warm packs, keep breast emptied

56
Q

Abscess treatment

A

Surgical drainage

57
Q

Non-lactational infection/inflammation causes

A

. Peripheral

. Assoc. w/ DM, RA. Steroids, or trauma

58
Q

Triple assessment for breast mass

A

. Exam
. Imaging (mammography, ultrasound, MRI)
. Tissue/cytology sampling (fine needle aspirate, core needle biopsy, excisional biopsy)

59
Q

Guidelines for diagnostic imaging evaluation for breast mass for people under 30 w/ no risk factors

A

. Ultrasound to determine cyst, tumor, or abscess
. Ultrasound better dur to high density of breast tissue
. Confirm w/ cytology/tissue sampling

60
Q

Simple cyst evaluation w/ ultrasound

A

Likely benign if it has symmetry, round borders, no internal echoes

61
Q

Complex cyst evaluation w/ ultrasound

A

. Septation/internal echoes

. Send for referral

62
Q

Solid tumor evaluation in ultrasound

A

. Fibroadenoma

. Benign if symmetric. Round borders w/ no internal echoes

63
Q

Diagnostic evaluation for people over 30

A

. Diagnostic mammography
. Ultrasound after mammogram may guide FNA or biopsy
. If high index of suspicion and have normal imagine still refer for biopsy

64
Q

If suspicious mass palpated what is protocol?

A

. No matter what age mammogram
. Can have ultrasound
. Refer for biopsy

65
Q

Breast MRIs

A

. Use limited

. May be helpful as adjunct study to guide core biopsy when localization would be difficult w/ conventional imaging

66
Q

Fine needle aspiration and result evaluation

A

. 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
Q

Core needle biopsy

A

. Larger hollow needle
. Preferred method for solid/suspicious mass
. Can mark suspicious area for future
. Requires specialist
. Sn. And Sp* approaches excisional biopsy

68
Q

Excisional biopsy

A

. 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
Q

When it is worthwhile to screen for a disease

A

. 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
Q

United States preventative services task force (USPSTF)

A

. Independent panel of experts in primary care and prevention
. Highly evidence-based guidelines on when and how to screen

71
Q

BRCA1 and BRCA2

A

. 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
Q

Risks if you have mutated BRCA genes

A

. Inc. risk ovarian cancer (occurs at younger age)

. Inc. risk other organs (male breasts, pancreas, prostate, Fallopian tubes)

73
Q

Prevalence of BRCA1 and 2

A

Less than 1% of population but causes 5-10% of female breast cancers

74
Q

BRCA1 mutations

A

. Inc. risk by 70 yrs old to 44-78%

75
Q

BRCA2 mutation risk

A

31-51% developing cancer

76
Q

High risk factors for familial breast cancer

A

. 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
Q

If no family history is present what are next steps:

A

.BRCAPRO calculator
. Referral for genetic counseling
. Genetic testing
. Appropriate specialty referrals

78
Q

BRCA positive patients risk management

A

. Intensive screening (yearly mammogram/MRI, CBE, chemo prevention
. Surgical forms of risk reduction (mastectomy, bilateral salpingo-oophorectomy btw age 35-50)

79
Q

Male breast cancer incidence inc. btw ages ___

A

60 and 70

80
Q

Risk factors for breast cancer in men

A 
. Higher in African American men 
. Radiation exposure
. BRCA
. Klinefelter syndrome
. Testicular disorder
. Family history of breast cancer
. Alcohol use, cirrhosis, and obesity
81
Q

When to screen trans patients

A

. Over 50 yrs old
. Had estrogen therapy for over 5 yrs
. Family history
. BMI over 35

82
Q

How to screen Trans men

A

. If there are intact breasts routine screening

. Postmastectomy: yearly chest wall and axillary exams

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