Ch 17 Breasts And Regional Lymphatics

Front 1

The superior lateral corner of breast tissue is called the axillary_____________ ___ __________

Back 1

Tail of Spence

Front 2

The breast is composed of:

Back 2

1.) Glandular tissue
2.) Fibrous tissue including the suspensory ligaments
3.) Adipose tissue

Front 3

The glandular tissue contains 15 to 20 _________ radiating from the nipple, and these are composed of ___________

Back 3

lobes
lobules

Front 4

Within each lobule are clusters of _________ that produce __________.

Back 4

aveoli
mile

Front 5

Another name for the suspensory ligaments is:

Back 5

Cooper's ligaments

Front 6

Name the 4 quadrants of the breast

Back 6

Upper outer quadrant
Upper inner quadrant
Lower outer quadrant
Lower inner quadrant

Front 7

In which quadrant will you find the Tail of Spence?

Back 7

Upper outer quadrant

Front 8

What quadrant is the site of most breast tumors?

Back 8

Upper outer quadrant

Front 9

Name the 4 groups of axillary lymp nodes that drain the breasts

Back 9

1. Central Axiallry nodes
2. Pectoral
3. Subscapular
4. Lateral

Front 10

What is the name of breast staging for adolescents?

Back 10

Tanner staging

Front 11

What is colostrum?

Back 11

A precussor fluid of milk

Front 12

When is colostrum able to be expressed?

Back 12

After the 4th month of pregnancy

Front 13

When does milk production begin?

Back 13

1 to 3 days postpartum

Front 14

What gives breast milk its whitish color?

Back 14

Emulsified fats & calcium caseinate

Front 15

Define gyneomastia

Back 15

Breast development in the male

Front 16

If a breast lump is found what needs to be noted?

Back 16

Single Ladies Sip Champagne Mooch Diamonds Need Caviar Ask for Total Love
S= Size
L= Location
S= Shape
C= Consistency
M= Moveable or fixed?
D= Distinctness (single/mult?)
N= Nipple
retraction/displacement?
C= Condition of skin
A= Any
redness/edema/dimpling
or retraction of skin?
T= Tenderness?
L= Lymphadenopathy

Front 17

What is mastalgia?

Back 17

Pain in the breast, occurs with trauma, inflammation, infection and benign breast disease or advanced Ca, the early stages of breast Ca, rarely have pain.

Front 18

Define Galactorrhea:

Back 18

Nipple discharge
Blood or Blood-tinged discharge always is significant. Any discharge with a lump is significant

Front 19

What does Paget's disease start with?

Back 19

With a small crust on the nipple apex, then spreads to areola.

Front 20

What screening tool should females age 2- to 39 utilized for Breast Ca?

Back 20

BSE Q month
CBE Q 3 years.

Front 21

What should women 40 years and older have for breast Ca screening

Back 21

BSE Q month
CBE Q year
Mammogram Q years

Front 22

What are risk factors that cannot be changed in breast Ca?

Back 22

sex=female
age > 50 years
Personal hx of breast Ca
1st degree relative w/breast Ca
Previous biopsy w/atypical
hyperplasia
Previous breast irradiation
Menses > 12y/o or menopuase >50y/0

Front 23

Lifestyle risk factors that can be changed in breast Ca

Back 23

Nulliparity or 1st child > 30y/o
Recent oral contraceptive use
PM HRT
Not breast feeding
ETOH intake >1/day
obesity
Physical inactivity

Front 24

Define dimpling

Back 24

A shallow dimpling AKA skin tether, is a sign of skin retraction. Ca causes fibrosis, which contracts suspensory ligaments. the dimple may be apparent at rest, with compression, or with lifting or arms.

Front 25

Define Peau d' Orange

Back 25

Lymphatic obstruction produces edema. This thickens the skin and exaggerates the hair follicles, giving a pig-skin or orange-peel look. This condition suggest Ca. Edema usually begins in the skin around and beneath the areola, the most dependen area of the breast.

Front 26

Define Fixation

Back 26

Asymmetry, distortion, or decrease mobility with the elevated are maneuver. As Ca becomes invasive, the fibrosis fixes the breast to the underlying pectoral muscles.

Front 27

Define deviation in nipple pointing

Back 27

An underlying cancer causes fibrosis in the mammary ducts, which pulls the nipple angle toward it.

Front 28

Define nipple retraction

Back 28

the retracted nipple looks flatter and broader, like an underlying crater. A recent retraction suggests Ca, which causes fibrosis of the whole duct system and pulls in the nipple. It also may occure with benign lesions such as ectasia of the ducts. Do not confuse retraction with the normal long standing type of nipple inversion, which has no broadening and is not fixed.

Front 29

Benign Brease Disease (Formerly Fibrocyctic Breast Disease)

Back 29

Multiple tender masses. "Fibrocystic disease" is a meaningless term because it covers too many entities. Actually, six diagnostic categories exist, based on symptoms and physical findings.

Front 30

S & S of Benign Brease Disease (Formerly Fibrocystic Breast Disease)

Back 30

* Swelling and tenderness (cyclic discomfort)
* Mastalgia (severe pain, both cyclic and noncyclic)
* Nodularity (significant lumpiness, both cyclic and noncyclic)
* Nipple discharge (including intraductal papilloma and duct ectasia)
* Infections and inflammations (including subareolar abscess, lactational mastitis, breast abcess and Mondor's disease)

Front 31

Information on Benign Breast disease

Back 31

About 50% of all women have some form of benign breast disease. Nodularity occurse bilaterally; regular, firm nodules that are mobile, well demarcated, and feel rubbery, like small water ballons. Pain may be dull, heavy, and cyclic or just before menses as nodules enlarge. Some women have nodularity but no pain, and vice-versa. Cysts are discrete, fluid-filled sacs. Dominant lumps and nipple discharge must be investigated carefully and may need biopsy to rule out Ca. Nodularity itself is not premalignant, but my produce difficulty in detecting other cancerous lumps

Front 32

Define Ca in relation to the breast

Back 32

Solitary unilateral nontender mass. Single focus in one area, although it may be interspersed with other nodules. Solid, hard, dense and fixed to underlying tissues or skin as Ca becomes invasive. Borders are irregular and poorly delineated. Grows constantly. Often painless, although the person may have pain. Most comon in UOQ. Usually found in women 30 to 80 years of age; increase risk in ages 40 to 44 years and in women older that 50 years. As cancer advances, signs include firm or hard irregular axillary nodes; skin dimpling; nipple retraction, elevation, and discharge.

Front 33

Define Fibroadenoma

Back 33

Solidary nontender mass. A category of benign breast disease that deserves mention because of its frequency and characteristic appearance. Solid, firm rubbery, and elastic. Round, oval , or lobulated; 1 to 5 cm. Freely movable , slippery; fingers slide it easily through tissue. Most common between 15 and 30 years of age but can occur up to age 55 years. Grows quickly and constantly. Benign, although it must be diagnosed by biopsy.

Front 34

Likely age for Fibroadenoma?

Back 34

15-30 years, can occur up to 55 years

Front 35

Likely shape for Fibroadenoma?

Back 35

Round, lobular

Front 36

Consistency in Fibroadenoma?

Back 36

Usually firm, rubbery

Front 37

Demarcation in Fibroadenoma?

Back 37

Well demarcated, clear margins

Front 38

Numbers in Fibroadenoma?

Back 38

Usually single

Front 39

Mobility in Fibroadenoma?

Back 39

Very mobile, slippery

Front 40

Tenderness inFibroadenoma?

Back 40

Usually none

Front 41

Skin retraction in Fibroadenoma?

Back 41

None

Front 42

Pattern of growth in Fibroadenoma?

Back 42

Grows quickly and constantly

Front 43

Health risks associated with Fibroadenoma?

Back 43

None, they are benign, must diagnose by biopsy.

Front 44

Likely age for Benign Breast disease?

Back 44

30-55 years after menopause

Front 45

Likely shape in Benign Breast disease?

Back 45

Round, lobular

Front 46

Consistency in Benign Breast disease?

Back 46

Firm to soft, rubbery

Front 47

Demarcation in Benign Breast disease?

Back 47

Well demarcated

Front 48

Number in Benign Breast disease?

Back 48

Usually multiple, may be single

Front 49

Mobility in Benign Breast disease?

Back 49

Mobile

Front 50

Tenderness in Benign Breast disease?

Back 50

Tender, usually increases before menses, maybe noncyclic

Front 51

Skin retraction in benign breast disease?

Back 51

None

Front 52

Pattern of growth in benign breast disease?

Back 52

Size may increase or decrease rapidly

Front 53

Health risks associated with Benign Breast disease?

Back 53

Benign, although general lumpiness may mask other cancerous lumps

Front 54

Likely age for breast Ca?

Back 54

30 to 80, risk increases after 50y/o.

Front 55

Likely shape in breast Ca?

Back 55

Irregular, star-shaped

Front 56

Consistency in breast Ca?

Back 56

Firm to stony-hard.

Front 57

Demarcation in breast Ca?

Back 57

Poorly defined.

Front 58

Number in breast Ca?

Back 58

Single

Front 59

Mobility in breast Ca?

Back 59

Fixed

Front 60

Tenderness in breast Ca?

Back 60

usually none, can be tender.

Front 61

Consistency in breast Ca?

Back 61

Firm to stony-hard.

Front 62

Demarcation in breast Ca?

Back 62

Poorly defined.

Front 63

Number in breast Ca?

Back 63

Single

Front 64

Mobility in breast Ca?

Back 64

Fixed

Front 65

Tenderness in breast Ca?

Back 65

usually none, can be tender.

Front 66

Consistency in breast Ca?

Back 66

Firm to stony-hard.

Front 67

Demarcation in breast Ca?

Back 67

Poorly defined.

Front 68

Number in breast Ca?

Back 68

Single

Front 69

Mobility in breast Ca?

Back 69

Fixed

Front 70

Tenderness in breast Ca?

Back 70

usually none, can be tender.

Front 71

Consistency in breast Ca?

Back 71

Firm to stony-hard.

Front 72

Demarcation in breast Ca?

Back 72

Poorly defined.

Front 73

Number in breast Ca?

Back 73

Single

Front 74

Mobility in breast Ca?

Back 74

Fixed

Front 75

Tenderness in breast Ca?

Back 75

usually none, can be tender.

Front 76

Skin retraction in breast Ca?

Back 76

usually

Front 77

Pattern of growth in breast Ca?

Back 77

Grows constatnly

Front 78

Risk to health in breast Ca?

Back 78

Serious, needs early treatment.

Front 79

Define Mammary duct ectasia

Back 79

Pastelike matter in subareolar ducts produce sticky, purulent discharge that may be white, gray, brown, green or bloddy. A stagnation of cellular debris and secretions in the ducts, leading to obstruction, inflammation, and infection. Occurs in women who have lactated; usually occurs inperimenopause.

Front 80

S&S in Mammary duct ectasia

Back 80

Itching, burning, or drawing pain occurs around nipple. May have subareolar redness and swelling. Ducts are palpable as rubbery, twisted tubules under aerola. May have palpable mass, soft or firm, poorly delineated. Not malignant, but needs biopsy.

Front 81

Define intraductal papilloma

Back 81

Serous or serousangiuneous discharge, which is spontaneous, unilateral, or from a single duct. Lesion consists of tiny tumors, 2 to 3 cm. Often there is a palpable nodule in the underlying duct. Papillomas affect women 40 to 60 y/o, most are benign. Refer any bloody discharge to for careful evaluation, including biopsy, to r/o Ca.

Front 82

Define carcinoma

Back 82

Bloody nipple discharge that is unilater and from a single duct requires further investigation.

Front 83

Define Paget's Disease (early)

Back 83

Early lesion has unilateral, clear, yellow discharge and dry, scaling crusts, friable at nipple apex. Spreads outward to areola with erythematous halo on areola and crused, exzematous, retracted nipple.

Front 84

Define Paget's Disease (later)

Back 84

Later lesion shows nipple reddened, excoriated, ulcerated, with bloody discharge when surface is eroded, and an erythematous plaque surrounding the nipple. Symptoms include, tingling, burning, itching. Except for redness and occasional cracking from initial breastfeeding, any dermatitis of the nipple area must be carefully explored and referred immediately.

Front 85

Define a plugged duct

Back 85

A fairly common and not serious condition. One milk duct is clogged. One section of the breast is tender; may be reddedned. No infection. It is important to keep breast as empty as possible and milk flowing. The women should nurse her baby frequently, on affected side first to ensure complete emptying, and manually express any remaining milk. A plugged duct usually resolves in less than 1 week.

Front 86

Define Mastitis

Back 86

This in uncommon; an inflammatory moss before abscess formation. Usually occurs in a single quadrant. Area is red, swollen, tender, very hot, hard. Also womean has a HA, malise, fever, chills and sweating, increased pulse, flu like symptoms. May occur during first 4 months of lactation from infrection or from stasis from plugged duct. Treat w/ rest, local heat to area, ABT's, and frequent nursing to keep breast as empty as possible. Most not wean now or the breast will become engorged and the pain will increase. Mother's ATB's not harmful to infants. Usually resolves in 2 to 3 days.

Front 87

Define breast abcess

Back 87

A rare complication of generalized infection if untreated. A pocket of pus accumulates in one local area. Must temporarily d/c nusring on affected breast; manually express milk and discard. Continue to nurse on unaffected side. Treat with ABT's surgical I&D.