Gynaecology_Breast Mass Flashcards
On breast exam, which positions are used to aid with the inspection of breasts?
- Seated with arms to the side
- arms over the head (to expose the lateral and inferior aspects of the breast)
- hands pressed against hips (contracting the pectoral muscles can cause dimpling of the skin suggesting that a tumor has entrapped a Cooper ligament)
what can be observed while visually inspecting breasts?
- Symmetry
- breast contour looking for masses
- skin retraction or skin dimpling
- skin color and texture
During the breast exam, when should lymph nodes be palpated?
When the patient is seated, the axillary fat pad moves anterior exposing the axillary lymph nodes (but don’t forget to palpate the infraclavicular and supraclavicular lymph nodes as well).
Describe the examination of breasts while the patient is supine.
- The patient’s ipsilateral arm should be placed above the head.
- Palpate the breast tissue with the second, third, and fourth finger pads.
- Other hand supports the breast tissue.
- Move finger pads in a systematic fashion (spiral pattern from the nipple to the outer breast or a vertical strip pattern).
- Compress each nipple between your thumb and index fingers, and inspect for discharge.
- Examine the contralateral side.
In which quadrant is breast cancer typically found?
upper, outer quandrant
What two entities comprise breast lumps?
- Cysts
- Solid masses
What are the questions to ask when evaluating a patient with a breast lump?
- Personal history of breast cancer
- prior breast biopsy (especially one indicating atypical hyperplasia)
- risk factors for breast cancer
- age
- family history of breast cancer
- age of menarche
- age at first pregnancy
- age at menopause
- alcohol use
- hormone replacement therapy
- relationship with menstrual cycle
- breast pain
- nipple discharge
What percentage of women born in the United States will develop breast cancer at some time in their lives?
12.7% (1 in 8)
In Australia its 1 in 7
According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, what are the odds of developing breast cancer for 30-39 year olds?
1 in 233
What are the odds of developing breast cancer for 60-69 year olds?
1 in 27
What percentage of all breast cancers is associated with inherited genetic mutations?
5%-6% (most of the mutations involve BRCA1 and BRCA2)
According to the US Preventive Services Task Force, who should be offered testing for BRCA mutations among the non-Ashkenanzi women?
- Anybody with two 1st-degree relatives with breast cancer (at least one diagnosed at age ≤50)
- a combination of three or more 1st- or 2nd-degree relatives with breast cancer, regardless of age at diagnosis
- a combination of both breast and ovarian cancer among 1st- and 2nd-degree relatives
- a 1st-degree relative with bilateral breast cancer
- a combination of two or more 1st- or 2nd-degree relatives with ovarian cancer, regardless of age at diagnosis
- a 1st- or 2nd-degree relative with both breast and ovarian cancer at any age or
- history of breast cancer in a male relative
According to the US Preventive Services Task Force, who should be offered testing for BRCA mutations among women of Ashekenazi Jewish descent?
Any 1st-degree relative (or two 2nd-degree relatives on the same side of the family) with breast or ovarian cancer
What are the options for breast and ovarian cancer surveillance and/or prophylaxis in patients with BRCA1 or BRCA2 mutations?
3 options can be consdered
- increased surveillance
- mammography
- breast MRI
- clinical/self-breast exams
- transvaginal ultrasounds
- serum CA-125 levels
- chemoprevention
- tamoxifen
- oral contraception pills
- riskreducing surgery
- bilateral mastectom
- bilateral salpingooporectomy
What is the role of ultrasound in evaluating breast lumps?
- It distinguishes cysts from masse
- determines whether a mammographically suspicious mass is amenable to ultrasound-guided biopsy
