Midterm-Breast Flashcards
breast
located between 2nd and 6th ribs, from sternum to midaxillary line
divided into tail of spence + 4 quadrants
breast development begins during 5th week of gestation in utero
at birth, males and females have the same breast anatomy
estrogen drives further breast development in females (occurs between age 8-13)
tail of spence
superior lateral corner of axilla (many breast cancers are found here)
start palpation here
glandular tissue
15-20 lobes radiating from nipple
contain lobules within that produce milk
leads to milk ducts then to sinus behind nipple that is used for storage of milk
could have cyst or cancer here
suspensory ligaments (coopers)
fibrous bands extending vertically from breast surface and attach to chest wall
supports breast tissue- large/heavy breast and age stretch ligaments
become contracted in cancer, causing dimpling/pits in overlaying skin
adipose tissue in breast
lobes embedded in this tissue
layers of subcutaneous and retromammary fat provide bulk of breasts
proportion depends on women’s age, menstrual cycle, pregnancy, lactation, and nutritional state
lymphatic system
extensive lymphatic drainage from breasts
75% of drainage leads to the ipsilateral (same side) axillary nodes
important to assess these areas and know what you’re checking for
four different lymph nodes to check for in breast assessment
central axillary- high up in axilla
pectoral (anterior)- lateral edge of pectoralis muscle inside axillary fold
subscapular (posterior)- lateral edge of scapula, deep in posterior fold
lateral (brachial)- inside upper arm, along the humerus
male breast CA presentation
painless firm mass
nipple retraction- nipple involvement 40-50% as tumor usually close to nipple
ulceration of the nipple or skin, discharge (serosanguinous/bloody)
fixation of tumor to skin/underlying muscle- dimpling
tumor tenderness, palpable axillary nodes
painless firm mass for male breast CA
infiltrating ductal= most common breast CA in males
lump behind areola= most common location
fewer than 1% of cases are bilateral
gynecomastia
male development of breast tissue
may be driven by estrogen, certain meds, testosterone depletion, etc.
problematic for a man’s self esteem and image
may require surgical correction
infant breast inspection
breast engorgement/white discharge- NORMAL due to MATERNAL ESTROGEN- may last 1-2 weeks, should go away on its own
concerning if swelling is unilateral, or if REDNESS/signs of infection-mastitis
documentation of adolescent breast development
TANNER STAGING
assessing if hormonally competent
stage 1: no breast development
stage 2: breast bud
stage 5: full growth
nipple abnormal findings
deviation/pointing in different directions
scaling-paget’s disease
fissures/ulcerations
dimpling/tucking- always abnormal/concerning
fixation of tissue to chest wall
recent nipple retraction (change from normal)
MASTITIS- skin is red but still smooth (not peur d’orange)
mastitis
sx: pain, redness, swelling, fever, enlargement, changed nipple sensation, discharge, itching, tenderness, lump
tx: antibiotics
palpation of breast
concentric circles
spokes of wheel/wedge
vertical strips
axilla assessment
examine with pt sitting up
lift pt’s arm and support it so that chest/axilla muscles are loose
reach fingers high into the axilla
move firmly in 4 directions
abnormal to feel nodes- infection/cancer
TENDERNESS may be normal- menstruating/breastfeeding
if mass found document like face of a clock, distance from areola, gross size estimate, and shape/texture/movability
pain in breast lump
less worrisome for breast CA
mastitis
male breast cancer
average age of onset is 65 (5-10 years older than in women)
**family hx/genetics*- BRCA1 and BRCA2
HIGH MORTALITY RATE (often has already metastasized)- higher in african american men/radiation exposure to chest/ heavy alcohol intake (liver function)
ELEVATED ESTROGEN LEVELS increase risk
elevated estrogen levels increase risk of what in men?
klinefelter syndrome
liver cirrhosis- changes to hormones, low androgens/high estrogen
prostate cancer treatment- androgen deprivation leaves unopposed estrogen
gynecomastia
never being married- no partner to “take care” of them
obesity- fat cells convert androgens into estrogens
hx of testicular conditions- undescended testes, mumps, testicular removal
occupation- hot environment, gasoline fume exposure
new fracture after age 45 not associated with trauma= warning sign
klinefelter syndrome
pt has Y chromosome plus at least 2 X chromosomes
congenital condition, leads to higher estrogen
breast cancer in woemn
RISK FACTORS present in 55% of cases
FAMILY HX present in 10% of cases (+fam hx increases risk; brca 1/brca 2)
AGE: 3/4 of women are >50 yo, 1/2>65 yo
HIGHER EDUCATION/INCOME double the risk- r/t parity
higher rates in CAUCASIANS
all related to longer periods of ESTROGEN EXPOSURE
HISTORY OF BREAST BX=atypical hyperplasia
increased ETOH consumption (2-5 drinks a day=1 1/2 times risk)
OVERWEIGHT AFTER MENOPAUSE- increased estrogen in fat tissue
BIRTH CONTROL- OC/depo have a slightly increased risk; no risk after 10 years off pill
hormone replacement therapy- may have flawed date r/t this
personal hx of breast disease
longer periods of estrogen exposure that increase risk of breast cancer in women
early menarche
delayed menopause
1st live birth after 35 (when pregnant/breastfeeding, no period so no estrogen fluctuations)
reduced risk for breast cancer in woemn
physical activity/recreational exercise
higher parity
breastfeeding (estrogen respite)
post-menopause BMI <23
oophorectomy at <35 yo
american cancer society screening recommendations
women ages 40-44 should have the CHOICE TO START ANNUAL BREAST CANCER SCREENING WITH MAMMOGRAPHY if they wish to do so (average risk)
women ages 45-54 should get a mammogram EVERY YEAR
women ages 55 and older can switch to mammograms EVERY TWO YEARS or continue with yearly screening (depending on risk/preference)
screening should continue as long as a woman is in GOOD HEALTH and is EXPECTED TO LIVE 10 MORE YEARS OR LONGER
all women should know how their breasts normally look/feel (self breast exam) and report any changes to their health provider right away
benign breast disease (fibrocystic)
6 diagnostic categories
very common- 50% of all women have some form
nodularity occurs bilaterally
regular, rope-like, firm, mobile (can move it), rubbery
pain may be dull, cyclic (with menstruation), or none
CYSTS are discrete, fluid-filled sacs- must be investigated to r/o breast cancer
breast cancer presentation
solitary UNILATERAL mass
SOLID, hard, dense, NOT MOBILE, fixed to underlying tissue
BORDERS, are POORLY DELINEATED
GROWS, often PAINLESS
most commonly in UPPER OUTER QUADRANT
found in women ages 30-80 yo but MORE COMMON >50 yo
as it advances: enlargement of axillary nodes, nipple discharge/retraction, dimpling
fibroadenoma
solitary, UNILATERAL, NON-TENDER mass
firm, RUBBERY, ELASTIC (less solid than cancer)
ROUND, oval, or lobulated (1-5 cm)
FREELY MOVING, slippery, slides through tissue
most common in 20-30 yo, but can occur up to age 55
GROWS QUICKLY and constantly
diagnosed by BIOPSY- must rule out malignancy
paget’s disease
malignant lesion of areola and/or nipple
usually has a corresponding tumor, but not always
1-4% of breast cancers
occurs in both women and men
average age is 57 yo but can occur in young or elderly
presentation of paget’s disease
flaky/crusty/scaly dermatitis to areola/nipple
can be friable
tingling, redness, itching
flattened nipple, sometimes inversion
discharge from nipple, may be yellowish or bloody
itching/crusting can eventually lead to erosion
ANY REDNESS/THICKNESS ON THE NIPPLE SHOULD BE CONSIDERED SUSPICIOUS
