Women's health: breast Flashcards
The Breast Ducts are influenced by:
the lobes are influenced by:
Ducts:Estrogen
Lobes: Progesterone
Nerves to:
Seratus anteriour
Lat Dorsi
sensory nerve to medial arm and axilla
SA: Long thoracic
LD: Thoracodorsal n
intercostobrachial nerve
Vessels
Seratus anteriour
Breast:
thoracodorsal artery – latissimus dorsi
Internal thoracic artery (superior epigastric), intercostal arteries, thoracoacromial artery, lateral thoracic artery all supply the breast
Lymphatic drainage of the breast:
97% goes to the axillary nodes, 1-2 % go to the internal mammary nodes.
Any quadrant can drain into the internal mammary nods, but what is most common?
Usually the lower inner Quadrent
If supraclavicular nodes are + what are you thinking?
it is from a metastic disease
if there is primary axillary lymphadenopathy what are you thinking?
it is usually lymphoma not BC
Gail Model
What is it:
what does it consider?
Tool to assess risk for breast cancer (cannot use if patient has had breast cancer or LCIS/DCIS)
– Age – Age at menarche – Age at first live birth – Number of first degree relatives with breast cancer – Number of previous breast biopsies – Atypical hyperplasia – Race
Gail Model
** if greater than 1.66%, the patient should be considered for
tamoxifen therapy to reduce the risk of breast cancer
*If you do not feel a discrete mass but feel something that is coarsely nodular (bag of peanuts) what do you need to do?
note whether or not it is symmetrical bilaterally. If it is not symmetrical, evaluate further with imaging
US
• Great for _____
• Much more sensitive than:…… esp…..
• Cannot be used for
• When you order an ultrasound, specify the
US • Great for cysts!! • Much more sensitive than mammogram, especially in the dense breast • Cannot be used for screening • When you order an ultrasound, specify the area of the breast to be examined (UOQ, etc.)
Mammogram
• Best for
• Only about 85% sensitive for:
• If you have a patient with a mass and a negative mammogram, that patient still needs
Mammogram
• Best for screening!!
• Only about 85% sensitive for breast cancer
• If you have a patient with a mass and a negative mammogram, that patient still needs a biopsy!!!***
BIRADS classification: 0-6 –
- 0- needs additional imaging
- 1- negative, re-mamm in 1 year
- 2-benign finding, re-mamm in 1 year
- 3-probably benign ~1% malignant, re-mamm in 6 months
- 4-posssibly malignant ~10-50% malignant, biopsy
- 5-probably malignant ~90-97% malignant, biopsy
- 6-knownmalignancy
Galactogram/ductogram - Used to evaluate • A catheter is placed into the • This shows the • Filling defects in the duct are • The duct must be actively
Used to evaluate nipple discharge from a single duct
• A catheter is placed into the draining duct and contrast is injected, a mammogram is taken
• This shows the shape of the duct
• Filling defects in the duct are suspicious for
malignancy
• The duct must be actively draining in order for this test to be done
MRI • Very • Indications: – To assess for – Following – To screen for – Evaluating – Evaluating
MRI
• Very expensive, so do not use as a general screening tool
• Indications:
– To assess for extent of disease in newly diagnosed
breast cancer
– Following neoadjuvant chemotherapy to plan surgery
– To screen for cancer in young patients with extensive family history of pre-menopausal breast cancer
– Evaluating breast implants
– Evaluating lumpectomy sites for recurrence (after a year)
Lipoma
– benign fatty tumor
– treatment is surgical – don’t diagnose this clinically – biopsy is necessary
Fat necrosis –
– benign
– lump occurring following trauma
– common in breast reduction
Mondor’s disease • Superficial • Feels • Often • Associated with • Usually occurs in the • Treat with
- Superficial thrombophlebitis of the breast
- Feels cordlike
- Often painful
- Associated with trauma or strenuous exercise
- Usually occurs in the lower outer quadrant
- Treat with NSAIDs
Fibroadenoma – Benign tumor of the – Most common lesion in – Painless, – Can change in size with – NEED – Core biopsy – Therefor, often treated – Can be confused with – Can have large coarse
Fibroadenoma
– Benign tumor of the fibrous stroma (compresses epithelial cells on pathology)
– Most common lesion in adolescents and young women
– Painless, slow-growing, well circumscribed, firm, rubbery,
very mobile
– Can change in size with menses and grow in pregnancy
– NEED BIOPSY
– Core biopsy can be useful in establishing diagnosis but the lump is not removed
– Therefor, often treated surgically
– Can be confused with phylloides tumor on ultrasound
– Can have large coarse (popcorn) calcifications on mammogram
Juvenile hypertrophy or prepubertal gynecomastia
– Symmetrical enlargement
– Can be treated
– Symmetrical enlargement of breast tissue before age 12
– Can be treated surgically if severe
Poland’s syndrome
• hypoplasia of
• Surgical
- hypoplasia of the chest wall, amastia, hypoplastic shoulder, no pectoralis muscle
- Surgical reconstruction of the breast after puberty
Polythelia
Accessory nipples – most common anomaly
Cyclical Mastalgia
• Pain usually occurs
• No differences in
• Women with Cyclical Mastalgia may have
- Pain usually occurs prior to the start of menses each month, suggesting a hormonal link
- No differences in hormone levels between women with mastalgia and women with no pain
- Women with Cyclical Mastalgia may have breast tissue that is more sensitive to hormones
Treating Cyclical Mastalgia • Properly •) • • • • •
- Properly fitting bra
- Caffeine cessation (not reduction)
- Vitamin E supplementation (400 IU/day)
- Oil of Evening Primrose
- Change in any exogenous or endogenous hormones
- NSAIDs
- Tamoxifen 10mg/day for six weeks – Aspirin daily while on this medication
Mastodynia what is it: cause is: - - - - -
Constant severe breast pain unrelated to the menstrual cycle
• Cause is unknown
– Periductal mastitis or adenosis
– Can be musculoskeletal
– Tietze’s syndrome is costochondritis causing breast pain
– Consultation with a pain specialist for injection
– OMM consultation for manipulation
