Breasts and Axillae Flashcards
Invasive breast cancer
- Has spread from milk duct or nodule to the rest of the breast
- most breast cancers are invasive.
Breast cancer
- Breast cancer usually begins either in the cells of the lobules, which are milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple
- normally happens at age 30 or older, most commonly over 50
- usually single, although may coexist with other nodules
- irregular or stellate
- firm or hard
- not clearly delineated from surrounding tissues
- may be fixed to skin or chest wall
- usually no tender
- Ask if it happened before or after menopause
- either invasive or non-invasive
non-invasive breast cancer
- stays within the milk ducts or lobules in the breast
- does not grow into or invade normal tissues within or beyond the breast
- sometimes called carcinoma in situ (“in the same place”) or pre-cancers
what is glandular breast tissue composed of?
15-20 lobes radiating from the nipple composed of lobules (where milk is produced)
What are the 4 axillary nodes?
- central axillary nodes
- pectoral nodes
- subscapular nodes
- lateral axillary nodes
Tanner Stage 1
- pre-adolescent
- elevation of nipple only
Tanner Stage 2
- breast bud stage
- elevation of breast and nipple as a small mound
- enlargement of aerolar diameter
Tanner Stage 3
further enlargement of breast and areola
Tanner Stage 4
projection of aerola and nipple to form a secondary mound above the level of breast
Tanner Stage 5
- mature stage
- projection of nipple only
- areola has receded to general contour of breast
Male breast
- rudimentary structure consisting of thin disk of undeveloped tissue underlying the nipple
- areola is well developed, although nipple is small
- May appear in aging male due to testosterone deficiency
- Most cancers under the nipple
What are some breast cancer risk factors that patients are unable to change?
- Female gender > 50
- Personal history of breast cancer
- Mutation of BRCA 1 and BRCA 2
- First-degree relative with breast cancer
previous breast irradiation - Menarche 50
What are some lifestyle-related breast cancer risk factors?
- Nulliparity or first child after 30
- Long-term use combined HRT
- Alcohol intake of 2-5 drinks daily
- Obesity and high-fat diet
- Physical inactivity
- Not breast-feeding
10 points on subjective data - health history
- Pain
- Lump
- Discharge
- Rash
- Swelling
- Trauma
- History of breast disease
- Surgery
- Breast Cancer Risk
- Self-care behaviors
- Perform breast self-examination
- Last mammogram
Objective Data- Physical Exam (preparation, equipment needed)
Preparation
- Position
- Draping
Equipment Needed
- Small pillow
- Ruler marked in centimeters
- Pamphlet or teaching aid for BSE
How to palpate breasts, and how long should you spend on each breast?
- Best position is when tissue is flattened
- A thorough exam should take 3 minutes /breast.
- Use fingertips with light, medium and deep pressure
- Rectangular area
- Bimanual palpation
- concentric circles or spokes-on-a-wheel
if any lumps are present, note (10 things):
- Location – clock or quadrants
- Size – width x length x depth
- Shape – oval, round, lobulated
- Consistency – soft, firm, hard
- Mobility – movable, fixed
- Distinctness – solitary or multiple
- Nipple - displaced or retraction
- Overlying skin – erythema, dimpling, retraction
- Tenderness
- Lymphadenopathy
Fibroadenomas
- solid, noncancerous breast tumors that occur most often in adolescent girls and women under the age of 30
- Usually single, may be multiple
- Round, disclike, or lobular
- May be soft, usually firm
- Well delineated
- Very mobile
- Usually nontender
- need biopsy but not cancerous
- might feel like a marble in the breast, moving easily when touched
- Treatment may include monitoring to detect changes in the size or feel of the fibroadenoma, a biopsy to evaluate the lump, or surgery to remove it
Fibrocystic breast disease
- Common way to describe painful, lumpy breasts
- Age 30-50, regress after menopause except with estrogen therapy
- Single or multiple
- Round
- Soft to firm, usually elastic
- Well delineated
- Mobile, often tender
- can cause discomfort especially if too much caffeine or chocolate
Edema (Peau d’orange)
- a mammographic pattern of skin thickening, increased parenchymal density, and interstitial marking
- skin looks like an orange peel
nipple retraction
- If nipple retraction is something new, that would be a concern
- If it’s always been inverted, that’s not as much as a problem
Mastalgia
- pain in the breast
- Can come from trauma, inflammation, infection, then benign breast disorders
what should the breasts feel like?
- Firm, smooth, elastic if a woman has never had a baby
- Premenstrual engorgement/enlargement is common due to increased progesterone
- Under the breast, the tissue gets compressed together over time, so you can feel an inframammary ridge
- In large-breasted woman, it’s a good idea to do a bimanual examination
anatomical details of breast exam
The glandular tissue of the breast is suspended within the superficial fascia of the anterior chest wall, extending roughly from the second to the sixth or seventh anterior intercostal space and from the edge of the sternum to the midaxillary line. About two-thirds of it rests upon the fascia covering the pectoralis muscle and the rest upon the fascia of the serratus anterior muscle. Toward the axilla, the axillary tail of Spence passes through an opening in the pectoral fascia, the foramen of Langer, into the axilla.
checking Male breast for cancer
- Inspect the chest wall noting skin surface and any lumps or swelling
- Palpate the nipple: It should feel even with no nodules.
- The normal male has a flat disk of undeveloped breast tissue beneath the nipple
Gynecomastia
an enlargement of this breast tissue in men/boys. It feels like a smooth firm movable disk. common during adolescence, usually unilateral and temporary.
what is the Tail of Spence?
superior lateral corner of the breast tissue – most common place for breast cancer to develop
Where is the female breast located?
located between the 2nd and 6th rib, from the side of the sternum to the middle of the axilla
nipple retraction with distortion
Retraction with distortion is when suspensory ligaments have gotten tightened up from cancer and are pulling in on the breasts (also could be a scar)
When should you perform the breast exam in relation to the menstrual cycle?
5 days after start of menstrual cycle
What is the function of the breast?
To produce milk
what is fibrous breast tissue (including suspensory ligaments)?
Cooper’s ligaments: fibrous bands that extend vertically from the surface to attach on the breast wall (become contracted in cancer of the breast - producing pit or dimples
What kind of tissue are the lobes embedded in in the breast
adipose
More than 75% of lymphatic drainage from the breast goes in to…
ipsilateral axillary area
What are supernumerary nipples?
common minor congenital malformations that consist of nipples and/or related tissue in addition to the nipples normally appearing on the chest. Supernumerary nipples are located along the embryonic milk lines
Are black women or white women more likely have breast cancer?
Black women – largely b/c of diagnosis at a later age
70% of breast cancers occur in women that have…
no identifiable risk factors except their gender or age
