Disorders of the Breasts Flashcards
Benign breast disorder
-Noncancerous
-Fibroadenomas and mastitis
Fibrocystic breast changes
-Nonproliferative lesions
-Overgrowth of fibrous tissues in connective tissue
-Fluid-filled cysts
-Exam breasts 1 week after menses, once swelling subsides
-Triple touch method: 3 finger pads and make dime-sized overlapping circle to feel breast using light, medium, firm touch
-Late-stage cysts feel like bumpy oatmeal under skin
-s/s: dull, aching pain, masses in both breast in upper outer quadrant, spontaneous clear to yellow nipple discharge
-Dx: mammography, ultrasound, fine-need aspiration biopsy
-Mgmt: diet and lifestyles, supportive bra, OTC painkillers, limit Na
-Tx: bromocriptine, tamoxifen, danazol
Fibroadenomas
-Proliferative lesions w/o atypia (cell abnormalities)
-Solid breast tumors
-Larger > 5 cm, more common in lactating women
-s/s: firm, rubbery, mobile nodules
-Dx: ABBI
-Mgmt: return for eval in 6 m, BSE
-Tx: shrink on own, cryoablation
Mastitis
-Infection of connective tissue in breast
-Lactational: shows during 2-3 weeks of lactation
-Nonlactational: caused by duct ectasia, milk ducts become congested w/ secretions and debris; periareolar and peripheral lesions
-s/s: infection symptoms
-Dx: hx and exam
-Mgmt: supportive bra, increase fluids, change positions, milk removal, , warm compresses
-Tx: pain meds, abx
Malignant breast disorder
-Most common cancer in women, 2nd leading cause of death in US for women
Invasive ductal carcinoma
-Most common
-Carcinomas metastasize to axillary and other lymph nodes
Invasive lobular carcinoma
-Ill-defined thickening, not palpable mass
-Prognosis is poor
Staging of breast cancer
-0: in situ
-1: localized, < 1 in
-2: 1-2 in, spread to axillary nodes
-3: > 2 in, spread to other nodes
-4: metastasis to other organs
Risk factors
-Aging (greatest in 6th decade)
-Gender
-Delayed childbearing
-Genetic influences
-BRCA1/2 genetic mutations
-Receiving ionizing radiation
-High density on mammogram
-Postmenopausal obesity
-Fhx of cancer
-Early menarche < 12 yrs
-Late menopause > 50 yrs
-1st term pregnancy > 30-35 yrs
-HRT w/ estrogen + progestin
-Obesity
-Lifelong physical inactivity
-White race
-2+ alc drinks per day
Breast cancer dx
-Mammography
-MRM
-Fine-needle aspiration
-Stereotactic needle-guided biopsy
-Sentinel lymph node biopsy
-Hormone receptor status
-Infrared thermal status
-DNA ploidy status
-Cell proliferative indices
-HER2/neu genetic marker
Mammography
-4 views, 2 per breast
-Detects lesions as small as 0.5 cm (average size of tumor detected by woman practicing BSE is 2.5 cm)
-Performed d/t suspicious clinical findings
-Preparing: schedule after menses, don’t use deodorant or powder (may appear as Ca spots), pain meds after procedure, remove necklaces
-Start annual exams at age 40-45
Magnetic resonance mammography (MRM)
-Earlier detection, can detect smaller lesions and finer details
-Highly accurate but costly
-Detects tumor angiogenesis (vessel growth)
Fine-needle aspiration biopsy or core biopsy
-Identify solid tumor, cyst, or malignancy
-Done w/o anesthesia
-Fine needle: small needle inserted into breast and suctions its contents
-Core: larger needle to withdraw contents, more tissue sent to lab
Stereotactic needle-guided biopsy
-Detects nonpalpable lesions in breast
-Lie prone and still
-Spring-loaded gun obtains tissue samples
Sentinel lymph node biopsy
-1st lymph nodes that breast drains into is sentinel one
-Radioactive blue dye is injected 2 hrs before procedure
-1-3 nodes removed
-Benefit of avoiding lymphedema
Hormone receptor status
-Reveals if tumor is stimulated by hormones
-Postmenopausal women tend to be ER-pos
Breast cancer mgmt
-Genetic testing for BRCA1/2 mutations (mendelian genetics)
-Genetic mutation –> lumpectomy w/ radiation or mastectomy
-Preventive mastectomy
Breast cancer mgmt: surgical options
-Tumors > 5 cm need neoadjuvant chemo to shrink tumor before surgical removal
-Breast conserving surgery (lumpectomy w/ radiation) or mastectomy w/ or w/o reconstruction
-No lumpectomy for tumors > 5 cm, 2+ cancer sites in dif locations, active lupus or scleroderma
Breast cancer mgmt: breast-conserving surgery
-Least invasive
-AKA lumpectomy
-Radiation 2-4 weeks after
Breast cancer mgmt: avoiding lymphedema after mastectomy
-Avoid using affected arm fro drawing blood, inserting IVs, or measuring blood pressure
-Seeking emergency care if affected arm swells
-Wearing gloves when engaging in activities such as gardening
-Wearing well-fitted compression sleeve to promote drainage return
Breast cancer mgmt: reconstructive surgery after mactectomy
-Saline implants or natural tissue from abdomen (TRAM flap or LAT flap method)
-Immediately after mastectomy
-Implants last 10 years
Breast cancer mgmt: radiation therapy
-Given 5 days a week to tumor site for 6-8 weeks post op
-Changes in skin will resolve in a year
-Prone w/ affected arm above head
-Brachytherapy: only 4-5 days, daily cleansing of catheter insertion site
-IMRT: reduces radiation exposure to underlying structures
Breast cancer mgmt: chemotherapy
-For tumors > 1 cm, pos lymph nodes, aggressive cancer
-Myelosuppression: increased risk of infection, bleeding, reduced RBC count
-Autologous hematopoietic stem cell transplantation has been used to avoid myelotoxic effects of high-dose chemo
Breast cancer mgmt: hormonal therapy
-Endocrine therapy blocks its effects
-Take daily for up to 5 yrs after initial tx
-Best known SERM is tamoxifen
