Conditions of the Breasts and Axilla Flashcards
What age group is most susceptible to breast cancer?
50-70
What are the risk factors for developing breast cancer?
Gender
Increasing Age
Nulliparity, first pregnancy over the age of 30, menarche< 12 years, menopause >55
Family hx of breast cancer ( greater if relative was first degree and menopause)
Obesity, high-fat diet, sedentary lifestyle
BRCA 1/2 gene mutation
>5 year hormone replacement, > 10 year oral contraceptive pill
Excessive Alcohol use; 2-3 servings per day
What are the major types of breast cancer?
Non-Invasive
Ductal Carcinoma in Situ: cannot penetrate basement membrane; non-palpable, mammogram
Lobular Carcinoma in Situ: completely contained within breast lobule, rubbery and ill defined, non-palpable, mammogram
Invasive
Inflammatory Carcinoma: Ductal Carcinoma that invades into dermal lymphatics, most aggressive
Invasive Ductal Carcinoma of the Breast: infiltrates thoracic fascia to become fixed to chest wall; cooper ligaments
Invasive Lobular Carcinoma
Paget’s disease of the nipple
Inflammatory breast cancer IBC
What are the early signs of breast cancer?
Unilateral, solitary, firm to hand, fixed and non-tender lump in the breast
What are the later signs of breast cancer?
Erythema over the area
Local edema in breast and/or arm
Fixation of the part of the breast to chest wall
LAO: Left Anterior Oblique
Skin or nipple retraction/inversion
Orange Peel Skin
Nipple Discharge
How is breast cancer diagnosed?
Biopsy of suspicious breast lesion
What is the DDX for breast cancer?
Fibroadenoma, fat necrosis, fibrocystic breast changes, intraductal papilloma, Paget’s disease of the nipple
What carbohydrate antigen is associated with breast cancer?
CA 27-29
What is the most common benign breast tumor in women?
Fibroadenoma
What does a fibroadenoma feel like?
Non-tender, firm, smooth, rubbery, mobile, well-circumscribed
How is fibroadenoma diagnosed?
Core or excisional biopsy
Does having a fibroadenoma increase your risk for breast cancer?
Yes, 1.5-2 times more likely
What are the possible risk factors for fibrocystic breast?
Women of reproductive age: mostly age 25 through menopause
Hormone imbalance: estrogen dominance
Methylxanthine use: Coffee, tea, and chocolate
High or low iodine in the diet
What are signs and symptoms of fibrocystic breasts?
1) Generalized premenstrual breast tenderness and lumpiness
2) Often Bilateral
3) Multiple nodules and palpable lumps
4) Monthly increase in breast pain or lumpiness from mid-cycle (ovulation) to just before period
5) May regress during pregnancy
6) Symptoms improve with onset of menses
How are fibrocystic breasts diagnosed?
Clinical breast exam on physical exam; followed by ultrasound and/or mammogram, biopsy if necessary
Ultrasound distinguish the difference between fluid-filled cyst and solid masses
What’s in the DDx for fibrocystic breasts?
Fibroadenoma
Intraductal Papilloma
Fat Necrosis
Carcinoma
A deficiency in what mineral is associated with fibrocystic breasts?
Iodine
What herb might be indicated in fibrocystic breast disease?
Phytolacca Americana
What part of the breast does Paget’s disease of the breast affect?
Nipple and ducts (an intraductal carcinoma)
What are the signs and symptoms of Paget’s Disease?
1) Eczema-like rash on and around the nipple
2) Unilateral
3) Palpable
4) Nipple retraction
What population is at risk for Paget’s disease of the breast?
Affects Postmenopausal women; poor prognosis
What do you do when, during the clinical breast exam, you find an eczematous rash on the nipple of a postmenopausal woman?
Order a mammogram and biopsy
What are the symptoms of mastitis?
Unilateral localized breast pain
Tenderness
Erythema
Heat and Hardness of the breast
Possible fever, chills
Malodorous breast milk, feels worse with nursing
What causes mastitis?
Usually S.aureus infection of the breast
What predisposes a woman to get mastitis?
Bacteria from baby’s mouth entering milk duct through cracks in nipple
What kind of nipple discharge is seen with mastitis?
Creamy purulent discharge
What herbs are used for mastitis?
Baptisia tinctoria (internal)
Berberis aquifolium (topical and internal)
Echinacea spp. (internal)
Hydrastis canadensis (topical and internal)
Phytolacca Americana (topical and internal)
Symphytum officinalis (topical)
What homeopathic remedy would you consider for mastitis especially if the pain radiates from nipple outward and is right sided?
Phytolaca
What are some causes of gynecomastia?
Low testosterone
Excess estrogen exposure
Drugs
Idiopathic
What are some of the causes of low testosterone in men?
Kleinfelter’s Syndrome
Pituitary Syndrome
Anorchia
Orchitis
Renal Failure
Aging
Obesity
What are the various causes of estrogen exposure in men?
Exogenous estrogen exposure
Obesity leading to aromatization
What drugs can cause gynecomastia in men?
Spironolactone
Testosterone inhibitors used for prostate cancer
Methyldopa and isoniazid
Tricyclic antidepressants and diazepam
Marijuana and heroin
Calcium Channel Blockers and ACE inhibitors
Estrogen or Anabolic Steroids
