Chapter 6/ Breast Disorder

Fibrocystic Breast Assessment

- Lumpy tender breasts bilaterally occurring primarily during week before menses - Dull, aching fullness - Possible clear to yellow nipple discharge - Fibrosis or thickening early on; cyst formation in later stages; cysts usually mobile and tender without skin retraction - Mammography and ultrasound

Breast Cancer

Invasive Ductal Carcinoma Invasive Lobular Carcinoma

What are the therapeutic managements of Breast Cancer?

Surgical options and adjunction therapy

What is Mastitis and how many types are there?

infection of connective tissue primarily in lactating or engorged women. Two types lactational or nonlactational

mammography

involves taking x-ray pictures of a bare breast while it is compressed between two plastic plates. This can identify and characterize a breast mass and detect an early malignancy. It remains the gold standard screening method for women at average risk for breast cancer.

carcinoma

is a malignant tumor that occurs in epithelial tissue; it tends to infiltrate and give rise to metastases. The incidence of this cancer peaks in the sixth decade of life. It spreads rapidly to axillary and other lymph nodes, even while small.

Surgical options

- Breast conserving surgery -mastectomy: simple, modified radical

Fibrocystic Breast management

- Education about condition - Self-care tips - Monthly breast self-examination after menses for changes

Adjuction therapy

-radiation therapy -chemotherapy - endocrine - immunotherapy

Is the following statement true or false? Early breast cancer has no symptoms. T or F?

. True Early breast cancer has no symptoms. The earliest sign of breast cancer is often an abnormality seen on a screening mammogram before the woman or health care professional feels it.

What is fibrocystic breast changes ?

A response of breast tissue to monthly estrogen and progesterone levels. Rare in postmenopausal women!!

Duct ectasia

By far the most common breast cancer is invasive ductal carcinoma, which represents 80% of all cases histologic forms—well differentiated and slow-growing, poorly differentiated and infiltrating, or highly malignant and undifferentiated with numerous metastases. This common type of breast cancer starts in the ducts, breaks through the duct wall, and invades the fatty breast tissue

What is a fibroadenomas?

Fibroadenomas, also classified as proliferative lesions without atypia (cell abnormalities), are common slow-growing, benign solid breast tumors that occur in about 25% of all women and account for up to half of all breast biopsies

What are the benign disorders?

Fibrocystic breast changes Fibroadenomas Mastitis

Magnetic Resonance Mammography - (MRM)

MRM) of the breast uses a powerful magnetic field, radio waves, and a computer to produce detailed pictures of the breast structures. It allows for earlier detection because it can detect smaller lesions and provide finer detail. MRM is a highly accurate (higher than 90% sensitivity for invasive carcinoma) but costly tool. Contrast infusion is used to evaluate the rate at which the dye initially enters the breast tissue.

fibrocystic breast changes

ND: + or - Site: Bilateral:upper outer quadrant Characteristics/Age : Round, smooth, several lesions, cyclic, palpable / Age 30-50yrs old Tenderness: positive D: aspiration and biopsy T:Limit caffeine Ibuprofen supportive bra

Fibroadenomas

ND: - Site: Unilateral; nipple area or upper outer quadrant Characteristics/ Age: Round, firm, movable,palpable, rubbery, well delineated, single lesion, well-circumscribed freely mobile nodules with or without tenderness/ Age 15-30 yrs old Tenderness: negative D : mammograms " watchful waiting" aspiration and biopsyy T: surgical excision, reevaluation in 6 months, monthly breast self-examination, and annual clinical breast examination

Mastitis

ND: negative Site: unilateral; outer quadrant Characteristics/ Age: wedge-shaped warmth, redness, swelling,nipple cracked, breast engorged Tenderness: positive D: ? T: oral antibiotics, acetaminophen, warm shower, supportive bra, if breast feeding; increase fluids and continue emptying of breast.hand wash

Is the following statement true or false? Fibrocystic breast changes are most common in postmenopausal women. T or F?

b. False Fibrocystic breast changes are most common in women between the ages of 20 and 50 and are rare in postmenopausal women.

Which woman would be at greatest risk for developing breast cancer? . One who had her first child at age 25 b. One with a family history of colon cancer c. One who had her first period at age 10 d. One who is negative for BRCA-1 and BRCA-2 genes

c. One who had her first period at age 10 A woman who experiences an early menarche such as before the age of 12 is at higher risk for developing breast cancer. Women who have children after age 30, have a personal history of colon cancer, or test positive for the BRCA-1 and BRCA-2 genes are also at risk for breast cancer.

benign

non-cancerous breast abnormality.

How do you prep for a screening mammogram?

• Schedule the procedure just after menses when breasts are less tender. • Do not use deodorant or powder on the day of the procedure, because they can appear on the x-ray film as calcium spots. • Acetaminophen (Tylenol) or acetylsalicylic acid (aspirin) can relieve any discomfort after the procedure. • Remove all jewelry from around the neck because the metal can cause distortions on the film image. • Select a facility that is accredited by the American College of Radiology to ensure appropriate credentialed staff.