Paulson - Disorders of the Breast and Lactation Flashcards
found along the milk line
not dangerous
may increase w. hormonal changes in pregnancy
supernumerary nipple
milk line
enlargement/swelling of breast tissue that can be unilateral or bilateral
gynecomastia
gynecomastia is an indicator of increased __
estrogen
what 2 male pt populations are often affected by gynecomastia dt
males during puberty
elderly
why do elderly males experience gynecomastia
decreased testosterone
breast tenderness that is often cyclical dt hormonal changes
mastodynia (same-same mastalgia)
what patients often experience mastodynia/mastalgia
women taking OCPs/HRT
tx for mastodynia/mastalgia
reassurance
vit B6
what is this showing?
mastitis
mastitis is an __ of the breast,
often caused by __
infection
staph aureus
mastitis mc occurs in __
dt __
lactating women
poor latch/incomplete emptying
sx of mastitis
unilateral tenderness
heat
significant f/c
body aches
flu-like sx
mastitis is unilateral and affects __ of the breast
one quadrant/lobule
is culture of purulent milk/material commonly used for mastitis
no!
tx for mastitis
abx: dicloxacillin OR cephalosporin
warm compress
+/- surgery if abscess
can women breastfeed w. mastitis
yes!
painful swollen area of redness, tenderness, and induration (filled w. pus)
breast abscess
pt at risk for breast absess
lactating women
tx for breast abscess
I&D
abx → dicloxacillin
what type of breast abscess might you see in a non lactating woman
subareolar abscess
what do you think when you see refractory breast abscess
inflammatory breast ca
what sx might especially make you consider inflammatory breast ca in a pt w. a refractory breast abscess
axillary LAD
what is this showing
fat necrosis of the breast
what might you see on a hx with a pt that has fat necrosis of the breast (2)
trauma/surgery
beast bx, surgery, or xrt
fat necrosis of the breast is a __ condition,
but may look like __ on imaging,
and needs __ for definitive dx
benign
carcinoma
bx
do you need to treat fat necrosis of the breast
no! → excision not needed
no increased risk for breast ca
mc benign condition of the breast
fibrocystic breast changes
fibrocystic breast changes are usually __
and __,
and are related to __
bilateral
mobile
hormonal changes
what distinguishes fibrocystic breast changes from carcinoma
multiple lesions
pt’s w. fibrocystic breast changes may experience __ (2)
during __ (2)
cyclic pain, breast tenderness
premenstruation and menstruation
tx for fibrocystic breast changes
supportive bra
avoid caffeine, low fat diet, vitamin E, primrose oil
benign solid tumor containing glandular and fibrous tissue
fibroadenoma
2nd mc benign breast d.o
fibroadenoma
fibroadenoma is more common in what pt populations (2)
young women
AA women
describe fibroadenomas
round/ovoid
firm
smooth
rubbery
discrete
mobile
non-tender
management of fibroadenoma
core needle bx
OR
3-6 mo f.u w. repeat US/breast exam
+/- surgery or cryoablation
fibrocystic changes may be __,
whereas fibroadenomas are typically __
painful
painless
fibrocystic changes may need __ for dx,
fibroadenomas need __
needle aspiration
bx
3 types of nipple discharge
normal lactation
galactorrhea
pathologic nipple discharge
milky white discharge, usually bilateral that results from hyperprolactinemia
galactorrhea
2 common causes of hyperprolactinemia
meds
tumor
3 causes of pathologic nipple discharge
ectasia
intraductal papilloma
carcinoma
describe pathologic nipple discharge
unilateral from single duct
serous vs bloody vs serosanguineous
purulent if abscess
management of nipple discharge
- imaging
- refer
imaging for pathologic nipple d.c (2)
mammography
US
tx and dx for pathologic nipple d.c
surgical excision of involved duct
genetic predisposition for breast ca
BRCA1
BRCA2
rf for breast ca
increasing age
nulliparity
early menarche
late menopause
long-term estrogen or xrt
dealyed childbearing > 30 yo
first degree relative (esp > 1)
hx endometrial ca
2 non invasive types of breast ca
ductal carcinoma in situ
lobular carcinoma in situ
2 types of invasive breast ca
invasive ductal carcinoma
invasive lobular carcinoma
80-85% of breast cancers are
invasive ductal carcinoma
5 stages of ductal carcinoma
normal duct → ductal hyperplasia → atypical hyperplasia → DCIS → invasive ductal carcinoma
very rare form of breast ca that presents w. eczematous or ulcerated lesion of the nipple that may be pruritic, burning, or painful
paget dz of breast
what do you think when you see paget dz w. underlying palpable mass
invasive infiltrating ductal carcinoma
what do you think when you see paget dz of breast w. no palpable mass
DCIS
OR
noninvasive breast ca
management of paget dz of breast
- refer for full thickness bx and mastectomy
lobular carcinoma is usually found __
incidentally
“l for lucky find”
why do we care about lobular breast carcinoma
increased risk for breast ca
management options for lobular carcinoma
excise
chemoprevention
refer
mc location for breast cancer to occur
upper outer quadrant
sx of invasive breast carcinoma (lots!)
fixed firm nodule
non-tender (can be painful)
dimpling of skin
nipple retraction
nipple d.c
breast size changes
peau d’ orange
eczematous changes
axillary node enlargement
arm edema
palpable suprclavicular/infraclavicular nodes
what is this showing
peau d’ orange
has research shown a clear benefit to clinical OR self breast exams for women getting mammograms
no!
when should women get mammograms
annually starting at 40 yo
biennial (every other year) at 55 yo (or 50-74 yo)
what pt population is most likely to avoid breast ca death dt screening mammographies
60-69 yo
for high risk women, what is recommended annually in addition to mammogram starting at 30 yo
MRI
indications for high risk for breast ca
known BRCA mutation
untested for BRCA but have 1st degree relative w. BRCA
greater than 15-20% lifetime risk based on fam hx using risk calculator
prior xrt to chest
benefit of mammogram
early carcinoma may appear w. mammographic changes but no palpable mass
best screening tool for breast carcinoma
mammogram
dx for breast carcinoma
combo of:
PE
mammogram
US
fine needle or core needle bx
+/- excisional bx
+/- MRI, CT, CXR, bone scan, PET
bx for breast carcinoma are tested for (3)
estrogen and progesterone receptor analysis
HER2/neu testing
histologic analysis
what should occur before tx begins for breast carcinoma
staging
preferred tx for early stage breast ca
lumpectomy w. sentinel node bx
other tx options for breast ca
mastectomy
xrt
adjuvant chemo or HRT
palliative
4 major prognostic factors for breast ca
tumor size
tumor grade
lymph node involvement/metastasis
age
after tx for breast ca, pt’s should be monitored q __ for the first 2 years
and __ after
6 months
annually
what do you think when you see painless lump beneath the areola in a man > 50 yo
male breast ca
male breast ca is rare, but is associated with __ than female breast ca
poorer prognosis
which genetic mutation is common in male breast ca
BRCA 2
t/f: breastfed infants have reduced incidence of SIDS
T!
growth of the breast, increased fat deposition, and branching of the ductal system during pregnancy leads to what hormonal changes
estrogen
prolactin
GH
adrenal glucocorticoid
insulin
the letdown reflex is associated w. what 2 hormones
prolactin
oxytocin
prolactin is released by the __,
oxytocin is released by the __
prolactin: anterior pituitary
oxytocin: posterior pituitary
prolactin is stimulated by __
and promotes __
nipple signals to hypothalamus
milk and colostrum production/secretion
oxytocin is stimulated by __
and promotes __
suckling/crying
milk letdown from mammary gland
