Disease of the Breast Flashcards
What are coopers ligament?
are bands that attach to the pectoralis major muscle and the fascia of the skin of the breast
Support the breast in the upright position
If these bands are being compressed or invaded by a tumor
What is the breast made up of?
Lies on top of the pectoralis major muscle
Made up of glandular ducts and lobules, connective tissue (Cooper’s ligaments) and fat
Lobes, lobules and alveoli do what?
produce and secrete milk
Ductule, ducts and lactiferous duct are what?
tubes that connect the lobes and nipple to excrete milk
What is the Lactiferous sinus?
Enlargement of the lactiferous duct at the base of the nipple where milk accumulates
What is adipose tissue in the breast
80-85% of breast tissue Holds lobules in place Gives the breast its shape *1/2 of glandular tissue is in the UOQ All women, regardless of size, have the same # of lobes (15-25) w/ 6-10 major ducts that exit the nipple
What are the 7 lymph nodes used to drain the breast?
lateral axillary nodes pectoral nodes subscapular nodes central axillary nodes infraclavicular nodes parasternal nodes supraclavicular nodes
breast development before puberty
Formed early in fetal life from an invagination of the ectoderm
15-25 ducts form the fetal breast at term
Fetal male and female breast tissue
development is the same
Only organ not fully developed at birth
At puberty (in response to stimulation of hypothalamus, pituitary and ovaries) female breast development
Increase in alveolar tissue and ductal size
extensive branching of the ductal system
fat deposits
Nipple and areola enlargement
takes 3 to 4 years
usually complete by age 16
What are the 5 Tanner Stages of Breast Development
Stage I: No breast buds
Stage II: Breast buds develop, papillae slightly elevated and areola enlarges
Stage III: Breasts and areolae confluent, elevated
Stage IV: Projection of areola and papilla to form a secondary mound
Stage V: Projection of papillae only, mature stage
Pregnancy/ lactation changes to the breast
Size and turgor increase, increased pigmentation of nipple/areola, nipple enlargement, areolar widening increased # and size of glands, increased branching of ductal system, ducts widen
Protective against breast cancer
Breast size has no relation to amount of milk produced
Postmenopausal changes to the breast
Atrophy of breasts, lobes involute, gets replaced by adipose tissue which is softer, lose support
PE and mammography are easier to interpret
Accessory Nipples
2-6% of population
Located anywhere along the milk line
Frequently multiple are present
Often appear to be moles
Accessory Breast Tissue
Most often occurs in the underarm area
Breast cancer has been reported in these tissues
3 normal abnormalites of the breast
inverted nipples–> sudden needs to be eval
asymmetrical breast
large breasts
What can cause the underdevelopment of breast tissue
Trauma Radiotherapy Breast biopsy (removal of breast bud no breast development during puberty) Gonadal dysgenesis Hypogonadotropin hypogonadism
What are 6 types of exams to do during breast evaluation?
EXAM Mammogram Ultrasound Digital Mammogram MRI Biopsy
What can you not see on a mammogram
Not all cancers will show up
Cannot tell if a nodule is cystic or solid
3 types of biopsy for the breast
Fine needle
Sterotactic
Sentinal node
Mammogram used for?
Only screening method found to decrease mortality of breast cancer
False positives and false negatives can occur
can be used for diagnostic or just screening
U.S. Preventive Services Task Force (USPSTF) screening for women
Routine screening of average-risk women should begin at age 50, instead of age 40.
Routine screening should end at age 74
Women should get screening mammograms every two years instead of every year.
Breast self-exams have little value, based on findings from several large studies.
2 Special circumstances for screening recommendations for women
Women w/ a genetic predisposition to Breast cancer: Combo screening mammo and MRI beginning at age 25 or based on the age of the earliest onset breast cancer in the family
Women w/ FH of Breast cancer but w/o a genetic mutation: Data is inconclusive. Some suggest 5 years before the age of diagnosis
mammography film
Less expensive Readily available Comparable to old films May be less accurate Dense breasts hard to read
digital mammography
More expensive Limited access Difficult to compare to old films Higher rate of false positives Better for premenopausal and dense breasts
Of every 1,000 U.S. women who are screened about how many are called back?
how many are positive for malignancy?
have cancer?
About 7% (70) will be called back for a diagnostic session
About 10 of the 70 will be referred for a biopsy
3.5 will be positive for malignancy
6.5 will be benign
The remaining 60 are found to be of benign cause
Of the 3.5 who do have cancer
2 have a low stage cancer
What is MRI used for with breast evaluation
MRI can be used along with mammograms for screening women at high risk
Used to better examine suspicious areas found by a mammogram
Used for better calculation of size/other cancerous lesions once a diagnosis of Breast Cancer has been made
What is breast U/S used for with breast evaluation
Breast US is used to target a specific area of concern found on the mammogram
Helps distinguish between cysts (fluid-filled sacs) and solid masses and sometimes can help tell the difference between benign and cancerous tumors
What are some indications for MRI in breast eval
Evaluate breast implants for leaks or ruptures
Imaging very dense breast tissue
Palpable breast abnormalities which are not visible with mammography or ultrasound
Determine the extent of breast cancer
To assess abnormal areas after breast surgery or radiation therapy
What is Fine needle aspiration (FNA) biopsy
A thin needle is injected into the suspicious lump and fluid or tissue is aspirated pathology
May be US guided
Limited- could miss cancerous cells based on technique, unable to distinguish invasive from noninvasive disease
What are core needle biopsy
A larger, hollow needle is used to withdraw small cylinders (or cores) of tissue from the abnormal area
The needle is put in 3 to 6 times to get the core samples
May be US guided or mammogram guided (stereotactic)
Able to distinguish invasive from noninvasive disease
What is a sentinal node biopsy
Surgeon removes the first lymph node(s) to which a tumor is likely to drain which is called the sentinal node which is the one most likely to contain cancer cells if the cancer has spread into the lymph
2 major breast cancer predisposition genes
BRCA1 and BRCA2
What occurs with mutations to the 2 predisposing genes for breast cancer?
Mutations in these genes result in increased risk for breast cancer as well as ovarian, colon, prostate and pancreatic cancers
5-10% of all women w/ BRCA have a mutation
Risk of developing BRCA if you have a mutation is 40-85%
Ashkenazi Jewish population has an increased risk of certain mutations
Genetic testing is recommended for members of high risk families
What are 4 benign breast disorders?
Fibrocystic
Fibroadenoma
Gynecomastia
Nipple discharge
