Breasts Flashcards
Supernumerary Nipple- pathophysiology
An extra nipple
Supernumerary Nipple- S/S & PE
Found along milk line
Not dangerous
Darken w/ pregnancy
Inc in size/location - hormones during pregnancy
Gynecomastia- pathophysiology
Enlargement/swelling of breast
Gynecomastia- epidemiology
Meds - resparadone, spiralactone
Gynecomastia- S/S & PE
Unilateral or bilateral
Indicator of hormone imbalance - inc estrogen
Males - during puberty or in elderly - dec testosterone
Mastodynia (Mastalgia)- pathophysiology
Common
Mastodynia (Mastalgia)- S/S & PE
Cyclical - hormonal changes
Inc w/ OCPs or HRT
During luteal phase
Mastodynia (Mastalgia)- treatment
Reassurance
Vit B6
Mastitis- pathophysiology
Breast infection
Mastitis- cause
Staph aureus
Mastitis- epidemiology
Lactating women
- poor latch
- incomplete emptying of breast
Mastitis- S/S & PE
Abscess Unilateral tenderness, heat Fever/chills Body aches Classic - one quadrant breast/lobule affected
Mastitis- labs & imaging
Culture - milk
- not usually done
Mastitis- treatment
Abx
- Dicloxacillin - 500mg PO Q6hr x 10 days
- Cephalosporin 10-14 days
Continue breastfeeding
Surgery - abscess
Breast Abscess- epidemiology
Lactation
Subareolar abscess in nonlactating - nipple piercing
Breast Abscess- S/S & PE
Painful
Swollen
Red, tender
Induration - filled w/ pus
Breast Abscess- treatment
I&D
Abx
Don’t respond to treatment - suspect inflammatory breast cancer
- esp if axillary lymphadenopathy
Fat Necrosis of Breast- pathophysiology
Benign
Damaged/dead breast tissue
Fat Necrosis of Breast- cause
Hx - trauma or surgery
Post - breast biopsy, surgery, radiation
Fat Necrosis of Breast- S/S & PE
Firm nodule
Fat Necrosis of Breast- diagnosis
Biopsy - to confirm
Fat Necrosis of Breast- labs & imaging
Imaging - can look like carcinoma
Fat Necrosis of Breast- treatment
Excision not needed
Fat Necrosis of Breast- prognosis
No inc risk of breast cancer
Fibrocystic- pathophysiology
Benign - most common
Fibrocystic- cause
Hormonal changes – inc in size w/ estrogen or progesterone
Fibrocystic- epidemiology
30-50
Fibrocystic- S/S & PE
Bilateral - multiple
Mobile
Cyclic pain
Breast tenderness
Multiple lesions - not carcinoma
- get biopsy w/ any concern
Fibrocystic- treatment
Supportive Bra Avoid caffeine Low salt diet Vt E Evening primrose oil
Fibrocystic- prognosis
Will stop w/ menopause
Fibroadenma- pathophysiology
Benign - glandular breast tissue
Fibroadenma- epidemiology
Young W
AA
Fibroadenma- S/S & PE
Round or ovoid Firm, smooth, rubbery Discrete Mobile Non tender
Fibroadenma- diagnosis
Core needle biopsy OR
3-6m f/u - w/ repeat U/S and breast exam
Fibroadenma
None if diagnosis by biopsy
Surgery - if pt wants
Cryoablation
Nipple Discharge- S/S & PE
Nl Lactation
Galactorrhea
- Milky white discharge - bilateral
- frequent result of hyperprolactinemia - meds or tumor
Pathologic Nipple Discharge
- Causes - duct ectasia, intraductal papilloma, carcinoma
- unilateral - single duct
- Serous, bloody, serosanguineous
- Purulent w/ breast abscess
Nipple Discharge- diagnosis
Pathologic
- U/S or Mammogram
- cytogological of discharge - not helpful -> neg doesn’t rule out cancer
Nipple Discharge- treatment
Pathologic:
Refer
Surgery - involved duct
- tx and diagnosis
Breast Cancer- pathophysiology
Estrogen excess
- length of reproductive life
- Parity
- age at first birth
Breast Cancer- cause
BRCA1 and BRCA2
Breast Cancer- epidemiology
inc w/ age 61 Risk: - Nullparity - Early menarche - Late menopause - long term estrogen or radiation exposure - Delayed childbearing >30 - 1st deg relatives - hx of endometrial
Breast Cancer- S/S & PE
Non-invasive
Ductal carcinoma in-situ
- no palpable mass
Lobular carcinoma in-situ
Invasive Invasive ductal carcinoma - 80-85% - underlying palpable mass Invasive lobular carcinoma Special types
Breast Cancer- diagnosis
Early - mammographic changes and no mass
PE, mammography, US, fine need biop, core biopsy, excisional biopsy
Tumor marking - estrogen and progesterone receptor
- HER2/NEU
- histologic
Additional testing - MRI, CT, chest xray, bone scan, PET scan
Breast Cancer- labs & imaging
Breast Self-Awareness
- be familiar w/ breasts
- report any changes to PCP
Clinical Breast Exam
- No real benefit if getting mammograms
Mammography - best screening
- ACS - yearly at 40, every 2 yr at 55yo
- USPSTF - yearly at 50-75
- start before 50 is pt decision - higher rates of false pos and unneeded biopsies -> more estrogen
MRI
- high risk - MRI + mammogram yearly at 30yo
- BRCA, 1st deg relat w/ BRCA, prior radiation to chest
Breast Cancer- treatment
Stage Early - lumpectomy w/ sentinel node biopsy Mastectomy Radiation Chemo or hormonal therapy Tamoxifen - estrogen + receptor Palliative
Breast Cancer- prognosis
Factors
- Tumor size, grade
- Lymph node involvement
- age
F/U Care
- long term f/u - most will recure w/in 2-5 yr
- first 2yr - examine every 6m w/ mammogram -> then annually
Pagaet Disease of Breast- pathophysiology
Rare - 1% of BC
Pagaet Disease of Breast- S/S & PE
Eczematous/ulcerated lesion on nipple
Pruritic
Burning
Painful
Pagaet Disease of Breast- diagnosis
Full thickness biopsy
Pagaet Disease of Breast- treatment
Refer
mastectomy
Lobular Carcinoma- pathophysiology
Incidental finding
Inc risk of developing into breast Cancer
Lobular Carcinoma- treatment
Refer
Excise lesion
Chemo
Invasive Carcinoma- S/S & PE
Fixed firm nodule non tender - but can have pin Dimping Nipple discharge Breast size change Skin thinkening - peau d'orange Eczematous chnge Axillary node enlargemtn Palpable supraclavicular/infraclvicular nodes Arm edema
Upper, outer quadrant - most common area
Breast Cancer in Men- pathophysiology
Rare
Breast Cancer in Men- cause
BRCA2
Breast Cancer in Men- epidemiology
> 50yo
Inc w/ prostate ca
Breast Cancer in Men- S/S & PE
Painless lump beneath areola
Nipple discharge
retraction
ulceration
Breast Cancer in Men- prognosis
Poor - worse than women
