Breast Lymph Flashcards
Most common place for breast cancer
Upper outer quadrant
Axillary nodes—4 groups:
a) Central axillary
b) Pectoral (anterior)
c) Subscapular (posterior)
d) Lateral
DC: adolescents
onset breast development—mean age 8-9 (African American); 10 (Caucasian)
Now—earlier onset of breast development; early breast development linked to greater BMI and reflects rise in obesity in U.S.
Beginning of breast development precedes menarche by 2 years
DC: pregnant women
After 4 months—colostrum may be expressed—until 1st few days after delivery.
Colostrum rich with antibodies
During pregnancy, nipples, areolae larger, darker
DC: Aging adult
after menopause—ovarian secretion of estrogen and progesterone decreased.
Breast glandular tissue atrophies, replaced by fibrous connective tissue.
Decreased breast size and elasticity, drooping—accentuated by kyphosis in some older women.
Breast lumps may also be more palpable.
DC: Males
during adolescence—temporary enlargement—gynecomastia
Gynecomastia may also occur in aging males as a result of testosterone deficiency.
Breast cancer
Tumor suppressor genes—BRCA1 , BRCA2—mutation increases risk for developing breast and ovarian cancers.
Women least likely to have mammogram
Less than a high school education
No health insurance
Recent immigrant
SD: Pain
assess PQRST; cyclical pain common
SD: Lump
how long? Relationship of lump to menstrual cycle
SD: Discharge
color, consistency, odor
SD: Rash
Where did it start? If involving nipple—think about Paget’s disease
SD: Swelling
local or generalized? May be related to menstrual cycle, pregnancy, breastfeeding
SD: trauma
can sustain a hematoma from blunt trauma
SD: History of breast disease
increased risk of breast cancer with past history breast cancer.
Some have lumpy breasts (benign), which may make breast exam difficult.
Need to know relatives and their age at diagnosis of breast cancer.
SD: Surgery/Radiation:
Has the client had a breast biopsy, breast surgery (partial mastectomy; mastectomy)?
SD: Medications
oral contraceptive use; combined hormonal therapy after menopause—increases risk for breast cancer.
SD: Axilla
Ask if pt. has experienced tenderness, swelling, lump
Screening exams
ask about BSE, CSE, mammograms
OD: Inspection
Inspect for redness, heat, vascular pattern (normal in pregnancy).
Edema—exaggerates hair follicles—“orange peel” look—peau d’orange
Assess axilla for edema, discoloration.
Nipples—usually protrude; assess for discharge.
Have client lift arms over her head—assess for retraction; note lag in movement in one breast; note dimple or puckering.
OD: Palpation
Axilla—rest arm on your arm—palpate in 4 directions.
What are the 4 directions?
Breasts—palpate with client in supine position (tuck pad under side to be palpated and raise arm over head (flattens tissue and displaces medially).
Palpate nipple/assess for discharge; if discharge, note quadrant producing discharge.
Breast lump documentation/assessment
- Location—using a clock face—note distance in cm from nipple or diagram breast and mark the location of the lump.
- Size
- Shape
- Consistency (soft, firm, hard)
- Movable
- Distinctness—single or multiple
- Nipple displaced or retracted
- Skin over lump—erythema, dimpled, retracted
- Tenderness
- Lymphadenopathy
More advanced cancer
Breast mass Retraction Edema Axillary mass Scaly nipple Tender breast
Breast may normally be tender and edematous before
meals
Post-mastectomy
lymphedema of upper arms common sequela—due to interruption of lymphatic drainage and removal of nodes
Breast Self Exam (BSE), positions, best time
- Supine—palpate using vertical strip pattern.
- Sitting up—palpate under arm, with arm raised.
- Hand on hips with shoulder hunched—inspect in mirror, noting surface changes.
Male breast cancer
- usually presents with retroareolar lump; nipple discharge rare but strongly associated with cancer.
Adolescent gynecomastia
benign—seen in ½ adolescent boys (age 13, 14)—temporary
OD: DC: Aging adult
Breasts pendulous, flattened, sagging; on palpation, more granular.
Terminal ducts around nipples feel more prominent and stringy; more prominent inframammary ridge.
Teach to use talcum powder for BSE—helps fingers glide over skin.
