Disorders of the Breast and Lactation- Paulson Flashcards
Anatomy of the breast:
nodes
?
Supernumerary Nipple/Breast:
- found ?
- Dangerous: Y/N?
- Found along milk line
- Not dangerous
- May darken during pregnancy
Hormonal changes in pregnancy may cause increase in size/possible lactation
Gynecomastia=
Enlargement/swelling of breast tissue
T/F: gynecomastia can be unilateral or bilateral
True
gynecomastia is an indicator of ______ imbalance
hormone (increased estrogen)
Gynecomastia:
-demographic?
Occurs in males often during puberty or in elderly (decreased testosterone)
Gynecomastia often occurs 2/2 ____
meds–> ie Spironolactone, risperidone
-*also seen in cirrhosis or other dz processes
Mastodynia(Mastalgia)=
Breast tenderness
Mastodynia(Mastalgia):
- How common?
- often ____
- Common
- Often cyclical (hormonal changes)
- **Cyclic pain is usually during luteal phase
Mastodynia(Mastalgia):
-increased in women taking ____
OCP’s or HRT
Mastodynia(Mastalgia):
-tx?
Treat with reassurance, vitamin B6
Mastitis= _____ infection
breast
Mastitis:
- +/- breast _____
- MC organism?
- May have breast abscess
- ***Most often caused by Staph aureus (KNOW)
Mastitis:
-MC demographic?
- Occur primarily in lactating women
- Poor latch or incomplete emptying of breast
- Unilateral tenderness, heat, significant fever/chills, body aches (flu-like symptoms)
- Usually one quadrant of breast/lobule affected
Mastitis:
- Cultures needed?
- tx? KNOW
- Culture of purulent material/milk usually not done
- Treat with antibiotics usually with ***(dicloxacillin)=1st line. or cephalosporin and warm compress (example: Dicloxacillin 500mg po q 6 hours x 10 days) or a cephalosporin for 10-14 days.
Mastitis:
- can mothers continue breastfeeding?
- tx for abscess?
- *Continue breastfeeding
- Surgical treatment may be necessary for abscess
Breast Abscess=
Painful, swollen area of redness, tenderness, and induration (filled with pus)
Breast abscesses usually develop during ______
lactation
Breast Abscess:
-tx?
- Need I&D and antibiotics
- **Usually dicloxacillin
Breast abscess:
-Subareolar abscess may develop in _______
non-lactating women
-(hint: nipple piercing)
Breast Abscess:
-If patient DOES NOT respond to treatment, suspect:
inflammatory breast cancer especially if associated with axillary lymphadenopathy**
Fat Necrosis of Breast is a malignant or benign condition?
-benign
Fat Necrosis of Breast:
- etiology?
- Hx of?
- Damaged/dead breast tissue
- Hx of trauma or surgery
- Firm nodule
- Can occur after breast biopsy, surgery, or radiation
Fat Necrosis of Breast:
-May look like _______ on imaging
breast carcinoma
Fat Necrosis of Breast:
- dx?
- Risk factors?
Need biopsy to determine
Excision not needed
No increased risk of breast cancer
Fibrocystic Breast changes are the most frequent _____
benign condition of the breast
Fibrocystic Breast changes:
- MC age?
- associated Sx
Most common age is 30-50 years
- Usually bilateral, mobile
- Can have cyclic pain or breast tenderness
Fibrocystic Breast changes:
______ ______ usually distinguish from carcinoma but any suspicious lesion should be biopsied or excised
Multiple lesions
Fibrocystic Breast changes are related to Related to _____ changes
hormonal changes**
(estrogen and progesterone stimulate increase in size) that produce the lumps
Fibrocystic Breast changes:
-describe the pain assoc. with menstrual cycles
Bilateral pain and size fluctuation during menstrual cycle (common to have symptoms during premenstrual period)
-Treat with supportive bra
Fibrocystic Breast changes:
-Possible role of _______
caffeine avoidance, low salt diet, Vitamin E, evening primrose oil
Fibrocystic Breast changes:
-Sx subside at ________
menopause
Fibroadenoma:
- what is it?
- how common?
- Pt demographic
=Benign tumor of glandular breast tissue
-Second most common benign breast disorder
- Occur in young women
- More common in Black women
Fibroadenoma:
-Typical appearance:
Typically round or ovoid, firm, smooth, rubbery, discrete, mobile, non-tender
Fibroadenoma:
-dx?
Core needle biopsy or 3-6 month follow up with repeat ultrasound and breast exam
Fibroadenoma:
-tx?
- No tx necessary if dx made by core needle bx
- May surgically remove if patient wants
- Cryoablation is an alternative
Nipple Discharge:
-can be normal _______
lactation
Nipple Discharge:
- Galactorrhea=
- -what does it result from?
- Milky white discharge, usually bilateral
- Frequently result of hyperprolactinemia (meds or tumor)
- Pathologic Nipple Discharge :
- -causes?
- -discharge is usually _______
- Causes are duct ectasia, intraductal papilloma, and carcinoma
- Discharge is usually unilateral, from single duct
- Pathologic Nipple Discharge:
can be serous, bloody or _________
serosanguineous
Pathologic Nipple Discharge
is purulent with breast _______
abscesses
Pathologic Nipple Discharge:
-dx?
- Order imaging (ultrasound/mammogram)
- Refer
-Cytological exam of nipple discharge rarely helpful b/c negative does not R/O cancer
Pathologic Nipple Discharge:
tx?
Surgical excision of involved duct usually for treatment and diagnosis
intraductal papilloma:
small, benign tumor that forms in the duct, made of glandular and fibrous tissue as well as blood vessels
duct ectasia=
duct widens and its walls thicken. Can lead to duct blockage and fluid buildup.
Breast Cancer:
-General stats and risk factors
- Increases with age
- 1 in 8 American women will develop breast cancer
- Mean age dx is 61 years
- **Genetic predisposition BRCA1 and BRCA2
-Risk factors include: nulliparity, early menarche, late menopause, long-term estrogen or radiation exposure, delayed childbearing >30yo, first degree relatives (especially if more than 1), hx of endometrial cancer
Breast Cancer Types: (list 2 types)
- Non invasive
- invasive
Breast Cancer:
-Describe Non-invasive (2 Ex’s)
- Ductal carcinoma in-situ
- Lobular carcinoma in-situ
Breast Cancer:
-describe invasive (list 2 ex’s)
- Invasive ductal carcinoma (80-85% of breast cancers)
- Invasive lobular carcinoma
OVERALL, increased ______ exposure, increases one’s risk of developing breast CA
estrogen
Ductal Carcinoma:
-describe the process of a normal duct—> invasive ductal carcinoma
Normal duct–> Ductal hyperplasia–> Atypical hyperplasia–> DCIS (in situ)–> invasive
Paget Disease of Breast:
-how common?
RARE– 1% of all breast CA
Paget Disease of Breast:
-if there is an underlying palpable mass:
usually invasive infiltrating ductal carcinoma
Paget Disease of Breast:
-if NO palpable mass:
usually DCIS or noninvasive breast cancer
“looks like eczema of their nipple”
THINK paget disease
Paget Disease of Breast:
-only about ___% NOT associated w cancer
15%
Paget Dz of the breast:
-describe the presentation
Presents as eczematous or ulcerated lesion of the nipple
May be pruritic, burning, or painful
Paget Dz of the breast:
- refer?
- tx?
Refer for full thickness biopsy
-Usually treated with mastectomy
Lobular Carcinoma:
-LCIS is usually an ______
incidental finding
-**Lobular = Lucky find!
Lobular Carcinoma:
- increased risk of _____
- discuss?
Increased risk of developing breast cancer
-Discuss options – excise lesion, offer chemoprevention, refer
Invasive Carcinoma:
-S/Sx
Fixed firm nodule
Usually non-tender but can also have breast pain
Dimpling of skin
Retraction of nipple
Nipple discharge
Breast size changes
Skin thickening: peau d’ orange (orange peel skin)
Eczematous changes
Axillary node enlargement
Arm edema
Palpable Supraclavicular/infraclavicular nodes
Remember MC area for breast cancer to occur is ___________
upper outer quadrant
Self and Clinical Breast Exam:
Describe Breast Self awareness
- Women should be familiar with breasts
- Report any changes to your doctor
Self and Clinical Breast Exam:
-describe clinical breast exam
Research hasn’t shown a clear benefit to clinical breast exam or self breast exam if a woman is getting mammograms (ACS, 2020)
Mammography:
-annually starting at age ___
**40yo and continuing for as long as a woman is in good health. Can switch to every other year at age 55. (ACS)
- Biennial screening mammogram between the ages of 50yo – 74yo (USPSTF, 2016)
- Women ages 60-69 are most likely to avoid breast cancer death due to screening mammography
The decision to start screening mammography before age 50 is ________
individual
-If a woman/her provider decide to proceed, biennial screening between the ages of 40-49 recommended (USPSTF, 2016)
Cons of mammographies
Larger numbers of false positives and unnecessary biopsies
For women at high-risk, recommend ____ in addition to mammogram every year starting at age 30 (ACS)
MRI**
For a Pt with Known BRCA mutation or untested but have first degree relative with a BRCA mutation, what imaging study should they undergo?
-MRI
-also MRI for Pts:
w/ Greater than 15-20% lifetime risk based primarily on family hx
Risk calculator:
https://bcrisktool.cancer.gov/calculator.html
-OR Prior radiation to chest
Breast CA: dx
- Early carcinoma may appear with mammographic changes and no palpable mass
- Combination of physical exam, mammography (best screening tool), ultrasonography, fine needle, or core needle biopsy, and/or excisional biopsy (core biopsy is preferred**)!!
- Biopsy specimen undergo tumor marker testing - estrogen and progesterone receptor analysis as well as Her2/neu testing, and histologic analysis
Breast CA: dx
-additional testing?
May require additional testing such as MRI, CT, chest x-ray, bone scan, PET scan
Breast CA: tx
- Staging should occur before treatment begins
- Lumpectomy with sentinel node biopsy is often preferred with early stage cancer
- Mastectomy
- Radiation therapy
- Adjuvant chemotherapy or hormonal therapy benefit some
- Palliative
Breast CA:
-Major prognostic factors
Tumor size
Tumor grade
Lymph node involvement/metastasis
Age
Breast CA:
-F/U care?
- Monitored long term to detect recurrence, most commonly occur within first 2-5 years
- First 2 years, examine every 6 months with mammogram, then annually after
Breast Cancer in Men
-**Rare, breast cancer in men only 1% of that in women
=A painless lump beneath areola in a man usually >50yo
- Nipple discharge, retraction, or ulceration may be present
- Generally a poorer prognosis than in women
- Possible increased incidence in men with prostate cancer
_____ mutations are common in men with breast cancer
BRCA2
Lactation:
-breast milk has the right amount of:
fat, sugar, water, protein, and minerals needed for a baby’s growth and development. As a baby grows, breast milk changes to adapt to the baby’s changing nutritional needs.
T/F: breast milk is easier to digest than formula
true
Breast milk contains antibodies that:
protect infants from certain illnesses, such as ear infections, diarrhea, respiratory illnesses, and allergies.
**The longer baby breastfeeds, the greater the health benefits.
Breastfed infants have a lower risk of ________
sudden infant death syndrome (SIDS).
American Academy of Pediatrics recommends exclusive breastfeeding for the first __ months of a baby’s life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby
6 months
Breast changes in pregnancy
Breast development during pregnancy -> hormone dependent growth -> growth and branching of the ductal system and fat deposition
-Estrogen
-Prolactin
-Growth Hormone
-Adrenal Glucocorticoid
Insulin
Breastfeeding: Let Down Reflex
-Prolactin:
- Released by anterior pituitary
- Stimulated by signals from nipple to hypothalamus
- Promotes mammary glands to start producing milk/milk secretion
- Stimulates colostrum
Breastfeeding: Let Down Reflex
-oxytocin:
- Released by posterior pituitary, stimulated by signals from suckling or crying
- Stimulates smooth muscle contraction, helps eject milk
- Milk letdown from the mammary gland of the breast into the ductal system
