-
What are the 4 quadrants of the breast & what % of breast cancer occurs in each?
- 1. Upper outer quadrant (50% incidence of breast cancer) which contains Tail of Spence (part of breast tissue extending into axillae) – most common
- site of malignancy
- 2. Upper inner quadrant (15% incidence…)
- 3. Lower inner quadrant (6% incidence….)
- 4. Lower outer quadrant (11% incidence…)
-
Landmarks of the Breast?
- 1. Nipple
- 2. Areola
- 3. Montgomery's (sebaceous) gland
-
What is breast tissue comprised of?
- 1. Adipose tissue (most of breast tissue)
- 2. Glandular tissue (secretes milk)
- 3. Suspensory ligaments (Cooper's
- Ligaments)
-
What are the determining factors of breast tissue composition?
- 1. Age
- 2. Nutritional status
- 3. Pregnancy
- 4. Lactation
- 5. Genetics
-
What is the % incidence of breast cancer of the nipple?
18%
-
What does the Pectoral Lymph drain?
Drains anterior chest wall & breast
-
Where are the lymphatics (Lymph System) of the breast located?
- 1. Pectoral (behind anterior axillary fold)
- 2. Subscapular (located along lateral edge of the scapula just inside posterior axillary fold)
- 3. Lateral (along the humerus inside the upper arm)
- 4. Central axillary (high middle axillae)
-
What is the Suspensory Ligaments (Cooper's Ligaments) made of?
Fibrous bands that attach breast tissue to chest wall muscles. • Cancer may cause the ligaments to contract causing pits or dimples in theoverlying skin
-
What does the Subscapular Lymph drain?
Drains posterior chest wall & arm
-
What does the Lateral Lymph drain?
Drains the arm
-
What does the Central Axillary lymph drain?
- Receives drainage from all axillary nodes
- 75% of drainage will go to infraclavicular & supraclavicular nodes on the same side
- 25% of drainage will go to the opposite breast, abdomen, or deep into breast (a problem for metastatic disease) - increases spread to the other side
-
What does Estrogen in Newborns of either sex cause?
White nipple fluid which resolves in few days to few weeks
-
What hormone stimulates breast development in female adolescents?
Estrogen
-
At what age does breast development occur?
Onset 8 - 13 years; average 10 - 11) - occurs over 3 yrs
-
At what age does Precocious Development of the breasts occur in adolescents?
Before 8 years of age
-
At what age is breast development (puberty) considered Delayed?
- After 13 1/2 (needs endocrine
- evaluation)
-
What noted changes occur in the female breast during pregnancy?
- 1. Nipples enlarge, darken & become
- more erect
- 2. Increased venous pattern over skin (superficial vessels)
- 3. Note elevated Montgomery glands
- 4. Colostrum forms in the 4th month (precursor to milk) – thick yellow fluid
-
When does Colostrom change to milk?
3 days postpartum
-
What will relieve the sensation of tenderness, engorgement in a nursing mother?
Frequent nursing
-
What can be a complication of the breast of a nursing mother?
Mastitis (inflammation or infection of breast tissue after childbirth) - red, swollen, hot, painful breasts
-
What happens to the breast tissue during Menopause?
- 1. Glandular tissue atrophies - decreased breast size
- 2. Decreased elasticity (r/t decreased adipose) - pendulous, flattened, sagging breasts
- 3. Axillary hair decreases
-
What is the Lifetime Risk of breast cancer in a Male?
1 in 1,000
-
Gynecomastia & when it can occur?
- Nub of breast tissue under areola (of males) – feels like a large grape
- May normally have enlargement in adolescence (usually unilateral & temporary) - excess testosterone is converted to estrogen
- May occur in the aging male (unilateral or bilateral); Occurs when testosterone levels drop and estrogen becomes unopposed; May also be due to medication effects (e.g., Cimetadine) or a pituitary tumor
-
What is an initial symptom of breast cancer?
Pain that can be Localized or Generalized
-
What are the characteristics of Breast Pain?
Burning, pulling, vague discomfort
-
What are the common causes of Cyclic Breast Pain?
OCs (oral contraceptive) & fibrocystic changes
-
What are associated factors to Breast Pain?
underwire bras & exercise
-
Fibrocystic (non cancerous) lumps
- May enlarge and become more tender prior to the menstrural period
- Caffeine intake may increase size and tenderness of cystic lumps
-
Associated skin changes (Lumps)
- Redness
- Warmth
- Dimpling
- Swelling
-
Nipple Discharge
Needs evaluation, e.g., prolactin levels
-
Clear discharge (Nipple)
- May be due to meds:
- OCs
- Phenothiazides [thorazine]
- Diuretics
- Digitalis
- Steroids
- Tricyclic antidepressants [amitriptyline]
- Reserpine
- Aldomet)
Or a pituitary tumor
-
Galactorrhea
Milk discharge associated with a pituitary tumor
-
Bloody discharge or thick yellow with blood (Nipple)
(always significant, especially when associated with a lump) – may indicate ductal cancer
-
Paget’s disease
(advanced ductal CA) - starts as a small crust on the nipple with surrounding erythema
-
Screening Recommendations
- Mammograms
- Clinical Breast Exam
- Breast Self Exam (BSE)
-
Mammograms
- Yearly starting at age 40 (ASC)
- Biennial (every 2-years) between ages 50 – 74 (USPSTF)
-
Clinical Breast Exam
- 20 – 30 years old - Q 3 years
- ≥ 40 years old - Yearly
-
Breast Cancer (Stats)
- 2nd major cause of cancer death in women; lung CA #1
- 1 in 8 women will develop breast CA before age 45 (incidence increases with age)
- Incidence increases with age (80% of breast CA after age 40)
- Need to identify early & treat early for good results
-
How many more times will a female get breast cancer compared to a male?
100 X
-
Age as a Risk Factor (breast cancer)
1 in 8 before age 45 & progressively increases with age
-
If cancer in one breast, how many times is chance in other breast?
increases risk 3-4 x
-
1st degree relative
Family Hx of breast cancer before age 50
-
What % of breast cancer pts have a Family Hx?
20 - 30%
-
How many % of females do not have Family Hx of breast cancer?
70%
-
Gene mutations for breast cancer (men & women)?
BRACA 1 or BRACA 2
-
Are breast symmetric or asymmetric?
Asymmetric - left breast larger than rt
-
Peau d' orange (orange peel skin)
- Caused by blocked lymph ducts
- Common with CA
- Edema may exaggerate hair follicles causing bumpy texture & large pores appearing like an orange peel
-
Palpate?
- High into axilla
- Anterior axilla
- Posterior axilla
- Down chest wall
- Supraclavicular and infraclavicular areas (metastatic nodes)
-
Inverted nipples
Suspect malignancy if a recent change & unilateral
-
Supernumerary nipple
- 2 nipples along the mammary ridge at MCL
- Occurs in 1% of men and women
- Appear like a nevus
-
Retraction Maneuvers
- Observe breasts with hands at sides
- Lift arms overhead
- Push hands on hips
- Push palms together
- Lean forward (to see underside of large
- breasts)
-
What are you looking for when performing the Retraction Maneuvers?
Observe changes in contour, symmetry, retraction, & dimpling associated with CA
-
CA characteristics
painless lump, ulceration, retraction, nipple discharge
-
Mobility of Breast Lump
- Mobile = fibrocystic
- Fixed = CA
-
Educate re Self Breast Exam
- Educate during or after completing the exam
- Examine 5 to 7 days after 1st day of menses
- Postmenopausal (examine at same time each month)
- Emphasize the importance of early detection
- Watch her demonstrate
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