Chapter 19: The Breasts Flashcards
prepubertal. no breast tissue
tanner stage 1
areolar enlargement with breast bud
tanner stage 2
enlargement of breast and areola as a single mound
tanner stage 3
projection of areola above breast as double mound
tanner stage 4
adult; papilla projects out of areola that is part of breast contour
tanner stage 5
most commonly found in the armpits or on the lower chest ______ and ______ to the normal breasts
accessory breasts and nipples
below
medial
fully developed breasts are usually similar in size but not identical, and sometimes one fails to develop as much as its counterpart
unequal development
sometimes at puberty, one or both breasts over-respond to hormonal stimulation; the hypertrophy is caused by overgrowth of ______, not glandular or fat
breast hypertrophy
fibrous
caused by pus producing bacteria like ______ or ______. complication during ______.
- symptoms usually deal with pain and ______ (pus/blood).
- treatment: ______
acute mastitis strep or staph lactation discharge antibiotics
unknown cause that affects premenopausal women and produce nonspecific symptoms. sometimes from ______
chronic mastitis
secondary tuberculosis
in post menopausal women. dilation of ______ due to inflammation.
-symptoms: ______ with green brown nipple discharge
ductal ectasia
milk ducts
periareolar mass
necrosis of fat tissue in breast due to trauma
fat necrosis
- benign breast tumors
- tumors of ______ tissue and glands
- most common benign neoplasm of the breast; usually seen in ______ women
- presents as a well-circumscribed, ______ marble-like mass
- ______ sensitive- grows during pregnancy and may be painful during the menstrual cycle
- benign, with no increased risk of ______
fibroadenoma fibrous premenopausal mobile estrogen/progesterone carcinoma
-it is a very common benign condition also called fibrocystic disease: premenopausal women
-they are proliferation of ______ and ______ tissue (lump). Cysts have a ______ appearance on gross exam
-it is an ______ response of the breast to hormones during phases of the ______
-______ examination is very helpful in distuinguishing a ______ from a ______ mass int the breast
-Treatment: ______ of cyst
______ if no aspirate
benign cystic breast disease glandular fibrous blue-dome irregular cyclic menstrual cycle ultrasound cystic solid aspiration surgical excision
due to temporary imbalance of female and male hormones (increase in estrogen), a distinct nodule of tissue develops under the nipple of the male breast
- usually presents as a sub areolar mass in older males
- highest density of breast tissues in males is ______
- may produce nipple ______
- associated with BRCA2 mutations and klinefelter syndrome
gynecomastia
underneath the nipple
discharge
-the most common malignant tumor in women. 1 in 9 women will have it during her lifespan
carcinoma of the breast
risk factors of carcinoma of the breast
- sex:
- early ______
- birth of first child after age ______
- genetic factors- family history, BRCA-1, 2, 3
- Race:
- age- tumor rare before ______
- hormones- ______ estrogen
- ______ (dehydroepiandrosterone)- steroid pro-hormone. present in high quantity in western diet and linked to breast cancer
female>male whose breast are not subject to stimulation by ovarian hormones menarche 30 white>africans>east asians puberty exogenous DHEAS
begins in the cells lining of the milk ducts, which supply milk to the nipple and accounts for more than 3/4 of the breast cancer. this type includes 20-30% of breast cancer
ductal carcinoma in situ
begins in the milk ducts but breaks through the walls of the ducts, invading the surrounding breast tissue. it can also spread to other other parts of the body. it accounts for 65-80% of breast cancers
invasive ductal carcinoma
characterized by well differentiated tubule- good prognosis
tubular carcinoma
characterized by extracellular mucin
mucinous carcinoma
characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells
-linked to BRCA 1
medullary carcinoma
characterized by carcinoma in dermal lymphatics. poor prognosis
inflammatory carcinoma
begins in milk-secreting glands of the breasts. it often occurs in several areas of both breasts
lobular carcinoma in situ
begins in the milk- producing glands of the breast but invades surrounding breast tissue and spreads to other parts of the body. It is more likely than other types of breast cancer to occur in both breasts. It accounts for 10 to 15% of breast cancers.
invasive lobular carcinoma
Represents 10% of breast cancer cases. Clinical features that suggest hereditary breast cancer include multiple first- degree relatives with breast cancer, tumor at an early age (premenopausal), and multiple
tumors in a single patient.
-______ mutations are the most important single gene mutations associated with heredity breast cancer
hereditary breast cancer
BRCA 1, 2, 3
Women with a genetic predisposition of developing breast cancer may choose to undergo removal of both breasts (______) to decrease the risk of cancer.
-Cancer risk may remains due to breast tissue sometimes extends into the ______ of the chest wall.
bilateral mastectomy
subcutaneous tissue
Invasive breast cancer that originates in the ducts of the breast and spread to the skin of the nipple area. Prognosis is often not good due to misdiagnosis since the disorder resembles as eczema near the nipple area.
pagets disease of the breast
- Rare in comparison to breast carcinoma
- Arises from ______ tissue or ______
- Large bulky tumor
- May ______ widely
- Treatment is by ______ of the involved breast
breast sarcoma fibrous blood vessels metastasize surgical resection
clinical manifestations breast carcinoma
• ______ in the breast
• Nipple or skin may be ______
• Skin ______ (orange peel sign)
• Tumor infiltrates breast and becomes fixed to chest wall
• ______
Lump
retracted
edema
Metastasis
Inspection, palpation, examination of ______, first with arms at the sides, then arms are ______ and ______, and finally with hands on ______, begun at the periphery, all parts of breast palpated in a ______ direction, and finally the tissues under the nipples are examined
clinical examination axillary tissues elevated lowered hips clockwise
May identify lesions not detected on clinical examination; recommendations are for a baseline at age 35–40, followed by annually or biannually up to age 50, followed by annually thereafter
mammogram
The ______ is most useful for examining the breasts of ______ women because they contain more fat and less glandular tissue than the breasts of younger women.
mammogram
postmenopausal
- Breast size (compression)
- Breast density
- Motion
- Deodorants, talcum. Lotions
- The technician
variables that can influence radiographic readings of mammograms
treatment of breast carcinoma
-Modified radical mastectomy, also called total
mastectomy with axillary lymph node dissection:
-Partial mastectomy / lumpectomy with lymph node dissection and radiotherapy
resecting the entire breast along with the axillary tissue but leaving the pectoral muscles overlying the chest wall
Modified radical mastectomy, also called total
mastectomy with axillary lymph node dissection
removing only part of the breast with the tumor or only the tumor along with a small amount of adjacent breast tissue
Partial mastectomy / lumpectomy with lymph node dissection and radiotherapy
- Prognosis in breast cancer is based on ______.
- ______ is the most important factor, but most patients present before metastasis occurs.
- Spread to ______ is the most useful prognostic factor (given that metastasis is not common at presentation).
- Most important factors are ______, ______, and HER2/neu gene amplification (overexpression) status.
TNM staging Metastasis axillary lymph nodes estrogen receptor (ER) progesterone receptor (PR)
Presence of ER and PR is associated with response to ______ (e.g., tamoxifen, ICI\Faslodex) or ______ (RU486); both receptors are located in the ______.
anti-estrogenic agents
anti-progesterone
nucleus
HER2/neu amplification is associated with response to ______, a designer antibody directed against the HER2 receptor; HER2/neu is a ______ receptor present on the cell surface.
Herceptin (trastuzumab)
growth factor
‘Triple-negative’ tumors are negative for ______ and have a poor prognosis; African American women have an increased propensity to develop triple-negative carcinoma.
ER, PR, and HER2/neu
‘Triple-negative’ tumors are negative for ______ and have a poor prognosis; African American women have an increased propensity to develop triple-negative carcinoma.
ER, PR, and HER2/neu
cells have receptors called ______ receptors that help them grow. Breast cancer cells with too many HER-2/neu receptors tend to be very ______.
HER-2/neu
fast growing
