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Flashcards in Breast Disorders Deck (54)
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1

1. Adult female breast is actually a what?

2. Histologically primarily composed of:
4

1. modified sebaceous gland, located within the superficial fascia of the chest wall.

2.
-Lobules or glands
-Milk ducts
-Connective tissue
-Fat

2

1. Younger breasts are predominately made of what tissue?

2. Glands are replaced by ______. This process accelerates with ________?

3. What are key components of breast cancer detection programs? 2

1. glandular tissue.

2. fat, menopause.

3.
-Differences in palpable consistency and
-in radiographic density between the glands and fat are

3

1. Organized into 15 to 25 lobules, with a disproportionate amount of the glandular or lobular tissue present in the _______ _______ quadrants of each breast.

2. Lobules consist of clusters of _____________ arranged in an alveolar pattern and surrounded by _______________?

3. Glands drain into a series of collecting _________ that course through the breast.

4. Come together into approximately _______ collecting ducts that lead to and drain at the nipple.

1. upper outer

2. secretory cells, myoepithelial cells.

3. milk ducts

4. five to ten

4

1. What can go wrong with connective tissue? 2

2. Fat tissue problems?

3. Duct system issues? 3

1. Connective tissue
-Fibrocystic changes
-Fibroadenomas

2. Fat tissue
-Necrosis from trauma or may harbor lipomas

3. Duct system
-May become dilated
-Contain papillary neoplasms
-Undergo malignant transformations

5

Rich blood supply
1. Blood supply from where? 5

2. Huge lymphatic system
Superficial and deep nodal chains throughout the trunk and neck, including those located in the what? 3
(Support _________ and overall breast health)

1.
-internal mammary artery,
-lateral thoracic artery,
-thoracodorsal artery,
-thoracocramial artery,
-intercostal perforating arteries

2.
-axilla,
-deep to the pectoralis muscles
-and caudal to the diaphragm
(milk production)

6

1. Breast tissue is very sensitive to hormonal changes, especially the glandular cells.
-Circulating levels of what? 2

2. What is also responsible for the changes that occur during the normal menstrual cycle and for symptoms often reported by patients receiving hormones in pharmacologic doses?

1. estrogen and progesterone


2. Tissue responsiveness to circulating hormones

7

1. During each menstrual cycle, breast tissue tends to _____ from changes in the body’s levels of estrogen and progesterone.

2. The milk glands and ducts enlarge, and in turn, the breasts __________.

3. During menstruation, breasts may temporarily feel what? 4

4. We recommend that women practice monthly breast self exams when?

1. swell

2. retain water

3.
-swollen,
-painful,
-tender, or
-lumpy.

4. the week following menstruation when the breasts are least tender.

8

Risk factors for breast cancer?

1. Age (most significant)
2. Family history
3. Race
4. Genetics
5. Early menarche
6. Late menopause
7. Increased exposure to estrogen
8. Use of estrogen
9. Nulligravid state
10. First pregnancy after age 35
11. Fibrocystic conditions, when accompanied by proliferative changes.
12. Cancer in one breast
13. Endometrial Cancer
14. Not breastfeeding
15. Hx of epithelial hyperplasia with atypia
16. Exposure to ionizing radiation or to other carcinogens.
17. Certain dietary factors (fat, ETOH)

9

Where are most breast cancers found?

Upper outer quadrant
(lots of lymphdrainage there)

10

What patients with family history are at risk for breast cancer?
6

1. 1st degree relative significantly increases risk (sister, mother)
2. Two or more relatives with breast or ovarian cancer
3. Breast cancer occurring in an affected relative younger than 50 years
4. Relatives with both breast cancer and ovarian cancer
5. One or more relative with 2 cancers (breast and ovarian cancer or two independent breast cancers)
6. Male relatives with breast cancer

11

1. Race: Who is more likely to get breast cancer?


2. What nationality would have the highest risk?

1. Caucasian more likely, although incidence in black women is increasing.

2. Individuals of Ashkenazi Jewish descent have a 2-times greater risk.

12

1. Early menarche is a risk factor: before what age?

2. Late menopause: after age what?

1. under age 12

2. After age 50

13

1. Increased exposure to estrogen is a risk factor: What would cause this? 2

2. Use of estrogen therapy is a risk factor: What specifically would make you at risk? 2

1. Increased exposure to estrogen
-Obesity
-Persistent anovulation

2. Use of estrogen therapy
-BSO before age 35 with HRT
-Postmenopausal tx with HRT, especially high doses of estrogen and use of progesterone.

14

1. BRCA 1 and BRCA 2 are what kind of genes?

2. Function? 2

3. Directly involved in repair in what?

4. Mutations that occur with BRCAs to cause cancer? 3

5. What do the mutations result in? 2

1. Tumor suppressor genes.

2.
-Prevent cells from growing and dividing too rapidly or in an uncontrolled way.
-Inhibits the growth of cells that line the milk ducts in the breast.

3. Directly involved in the repair of damaged DNA.

4. Mutations is these:
-disrupt protein production, resulting in an abnormally small, nonfunctional version of the BRCA2 protein.

-change one of the protein building blocks (amino acids) used to make the BRCA proteins.

-defective BRCA protein is unable to help fix damaged DNA.

4.
-Results in the build up of mutations.
-Causes cells to divide in an uncontrolled way and form a tumor.

15

1. Harmful BRCA1 mutations may also increase a woman’s risk of developing the following cancers (in addition to breast ca)? 4

2. Harmful BRCA2 mutations may also increase the risks of? 4

1.
-cervical
-uterine
-pancreatic
-colon cancer

2.
-pancreatic CA
-stomach CA
-gallbladder and bile duct cancer
-melanoma

16

1. Men with harmful _______ mutations also have an increased risk of breast cancer and, possibly, of pancreatic cancer, testicular cancer, and early-onset prostate cancer.

2. However, male breast cancer, pancreatic cancer, and prostate cancer appear to be more strongly associated with ________ gene mutations .

1. BRCA1


2. BRCA2

17

Breast Cancer mass characteristics
7

1. Solitary nodule
2. Non-tender
3. Firm to hard
4. Ill defined margins
5. Not mobile
6. Skin nipple retractions
7. Axillary lymphadenopathy


Remember, a good number of breast masses are found by mammogram with no palpable mass.

18

Breast Care Guidelines from the ACS
1. Women ages _______ should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.

2. Women age _______ should get mammograms every year.

3. Women ________ should switch to mammograms every 2 years, or can continue yearly screening.

4. Screening should continue as long as a woman is in good health and is expected to live how long?

1. 40 to 44

2. 45 to 54

3. 55 and older

4. 10 more years or longer.

19

What is the most frequent lesion of the breast?

Fibrocystic change

20

1. Fibrocystic change represents what?

2. Common ages?

3. Rare in who?

4. How will the mass present?

5. Exacerbated by what?

1. Represents an exaggerated physiologic response to a changing hormonal environment.


2. Common in women 30-50 years old.

3. Rare in postmenopausal women who are NOT taking HRT.

4. Painful mass which often exacerbates or increases in size during the premenstrual phase of the cycle.

5. Exacerbated by ETOH

21

Physical presentation of fibrocystic conditions?
5

1. Often multiple, usually bilateral masses
2. Rapid fluctuation in size is common
3. Painful and tender
4. Pain occurs or increases during the premenstrual phase of the cycle
5. Size increases during the premenstrual phase of the cycle.

22

Specific diagnostics and treatments: Fibrocystic changes?
8

1. Reexamine patient at intervals
(Negative cyst that does not resolve over several months may need to be excised.)

2. Reassure patient that discomfort is not a sign of cancer

3. Symptoms usually improve with the cyclical decrease in hormonal stimulation

4. Use support bra

5. Vitamin E supplements

6. Avoid chocolate, alcohol, and caffeinated beverages.

7. Teach and encourage monthly BSE.

8. May need to be biopsied.

23

Fibroadenoma:
1. What is it?
2. Can occur in what pattern and which is indicitive of cancer?
3. Occurs most frequently in who?
4. Tends to occur early in what population?
5. Women over ____, need to distinguish from fibrocystic change or cancer.

1. Benign neoplasm made from an overgrowth of glandular and fibrous breast tissue.

2. Can occur alone, in groups or as complex. Complex fibroadenomas can raise risk of breast cancer slightly

3. Occurs most frequently in young women, usually within 20 years after puberty. Clinical diagnosis is not difficult.

4. Tends to occur at an earlier age in black women.

5. 30

24

Physical presentation
Fibroadenoma?
7

Fibroadenoma
-Round or ovoid
-Non tender
-Smooth margins
-Rubbery
-Discrete
-Relatively movable
-1-5cm in diameter

25

Fibroadenomas: Specific diagnostics 3



Rx?
4

Fibroadenomas
1. Ultrasound can distinguish cystic. Fibroadenomas show up well on ultrasound.
2. FNB can confirm cytology.
3. Teach and encourage BSE.

1. Since fibroadenomas are benign, treatment will vary depending on the diagnosis.
2. If it is small, painless, remains the same size, and a biopsy shows no problems, further treatment not needed but likely follow-up ultrasounds.
3. If it is large (more than 3cm), painful, growing, or a biopsy results in atypical cells, the tumor can be removed.
4. It is recommended that fibroadenomas be removed in women over age 40.

26

If rapidly growing need to rule out what?

phyllodes

27

Two key differences between fibroadenomas and phyllodes tumors are?

1. phyllodes tumors tend to grow more quickly and
2. develop about 10 years later in life — in the 40s as opposed to the 30s. These differences can help doctors distinguish phyllodes tumors from fibroadenomas.

28

History we need for patient with a breast lump?
8

1. Age of patient (already have)
2. Disease History
3. Family History
4. Medication History
5. Onset of menarche
6. LMP
7. Where are you in your cycle?
8. Onset of Menopause

29

1. What on social history would be pertinant info for a breast mass? 2

2. Ingestion habits? 2

3. Previous pregnancies? 4

4. Have you had a mammogram? 1

5. Exams? 2

1. Social habits
-ETOH
-Smoking

2. Ingestion habits
-Caffeine
-High fat

3. Previous pregnancies
-How old were you with your first pregnancy?
-Was it term?
-Abortions?
-Did you breastfeed?

4. Have you ever had a mammogram?
0When was the last time you had a mammogram?

5. Exams
-How often do you do breast self exam?
-When was the last time you had an exam by a provider?

30

HPI questions to ask about a lump?
6

1. When did you discover this lump?
2. Is it only in one breast?
3. Where is it located?
4. Is there any pain or tenderness associated with this lump?
5. Is there any correlation between the mass and your menstrual cycle?
6. Any discharge from the nipple?
How does it feel?