Class notes breast/lymph Flashcards
What is the site of most breast tumors?
upper outer quadrant is site of most breast tumors.
Breast has an extensive lymphatic drainage; most (75%) drain into what side?
ipsilateral side.
What are the 4 groups of axillary lodes?
Central axillary
Pectoral (anterior)
Subscapular (posterior)
Lateral
in the adolescent mean age of onset breast development is: (caucasian & a. american)
mean age 8-9 (African American); 10 (Caucasian)
Now—onset of breast development is earlier or later?
earlier.
early breast development linked to:
greater BMI and reflects rise in obesity in U.S.
Beginning of breast development precedes menarche by how many years?
2 years.
Pregnant woman: after 4 months—what may be expressed in the breast?
colostrum
how long can colostrum be expressed in the pregnant woman after birth?
until 1st few days after delivery.
Colostrum rich with _____?
antibodies
Changes to nipples during pregnancy:
areolae larger, darker
Aging adult: after menopause—ovarian secretion of what hormones are decreased.
estrogen and progesterone
Breast glandular tissue atrophies, replaced by what type of tissue?
fibrous connective tissue.
Decreased ____, _____ in breast in aging adult
size and elasticity
Drooping in aging adult breast—accentuated by what in some older women.
kyphosis
Breast lumps may also be more or less palpable in aging adult?
more
Male breast: during adolescence—temporary enlargement is called what?
gynecomastia
Gynecomastia may also occur in aging males as a result of what deficiency?
testosterone deficiency
Tumor suppressor genes are called ____, ____ affecting breast cancer
BRCA1 , BRCA2
BRCA1 & BRAC2 mutation increases risk for developing what type of cancers?
breast and ovarian cancers.
3 reasons women would be least likely to have had a mammogram:
Less than a high school education
No health insurance
Recent immigrant
Pain: assess for:
PQRST
Common pain to assess for:
cyclical pain
Assess for lump:
how long have you had it?
Assess for relationship of lump to:
menstrual cycle
Assess for discharge in breast:
color, consistency, odor
Assess for rash in breast:
Where did it start?
If rash involving nipple—think about what disease?
Paget’s disease
Assess for swelling of breast:
local or generalized? May be related to menstrual cycle, pregnancy, breastfeeding.
Assess for trauma in breast:
can sustain a hematoma from blunt trauma.
Assess history of breast disease:
Increased risk of breast cancer with past history breast cancer.
Need to know relatives and their age at diagnosis of breast cancer.
Some have what type of breasts? (which may make breast exam difficult)
Some have lumpy breasts (benign)
Assess for surgery/radiation by asking:
Has the client had a breast biopsy, breast surgery (partial mastectomy; mastectomy)?
what medications increases risk for breast cancer?
Oral contraceptive use; combined hormonal therapy after menopause
What to assess in axilla?
assess for tenderness, swelling, lump.
What 3 screening exams should you ask about:
Screening exams: ask about BSE, CSE, mammograms.
Who would you teach about normal breast changes.
adolescents and pregnant women
Is slight asymmetry normal in general appearance of breasts?
yes
What do you inspect the breast for?
Redness, heat, vascular pattern (normal in pregnancy).
Edema—exaggerates hair follicles
“orange peel” look is called:
“peau d’orange” occurs with edema in breast
Assess axilla for:
edema, discoloration.
Assess nipples for:
assess for discharge, nipples usually protrude
Have client lift arms over her head and assess for:
assess for retraction;
note lag in movement in one breast;
note dimple or puckering.
Axilla palpation:
rest arm on your arm—palpate in 4 directions
Breasts—palpate with client in what position?
Supine position.
Tuck pad under side the to be palpated
Raise arm over head
When tucking pad under side the to be palpated and raising arm over head does what to breasts:
(flattens tissue and displaces medially)
Assess nipple discharge; if discharge, note what:
quadrant producing discharge.
Location of lump—using a clock face note what:
note distance in cm from nipple or diagram breast and mark the location of the lump.
Breast lump assess:
Location 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 shows signs of:
Breast mass Retraction Edema Axillary mass Scaly nipple Tender breast
Breast may normally be what right before menstruation?
tender and edematous
Post-mastectomy—What is common sequela (complication of previous disease) of upper arms?
lymphedema-
due to interruption of lymphatic drainage and removal of nodes.
When is it best to do Breast Self Exam (BSE)?
Right after menstrual period
What is the steps of BSE? (supine)
Supine—palpate using vertical strip pattern.
What is the step of BSE? (sitting)
Sitting up—palpate under arm, with arm raised.
What is the step of BSE? (hand on hips)
Hand on hips with shoulder hunched—inspect in mirror, noting surface changes.
Male breast cancer usually presents with:
retroareolar lump;
In the male what is rare but strongly associated with breast cancer.
nipple discharge
Adolescent gynecomastia is:
benign and temporary
Adolescent gynecomastia is seen in:
seen in ½ adolescent boys (age 13, 14)
Neonate—can have ____, _____ nipple discharge called:
clear, white discharge— called witch’s milk
In the pre-pubertal child, nipples are located:
Just lateral to the mid-clavicular line between 4th and 5th ribs
In adolescent—breast development begins between ___ - ____ years old:
8-10 years.
Record child breast development using:
Tanner staging.
Pregnant woman breast may appear:
visible blue vascular pattern; breast and nipples increase in size; striae may develop.
Nipples appear in pregnant woman:
darker, more erectile; areolar widens, darkens; Montgomery glands elevated
In pregnant woman- on palpation breasts are:
more nodular; colostrum may be expressed after first trimester.
