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66 Cards in this Set
- Front
- Back
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Anatomy of Breasts |
Landmarks 4 Quadrants Nipple |
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Landmarks of breast |
Nipple Areola Montgomery's glands (sebacceous) |
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4 Quadrants of breast |
Upper outer quadrant: includes tail of spence Upper inner quadrant Lower inner quadrant Lower outer quadrant |
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Upper outer quadrant |
Tail of Spence: most common site of malignancy 50% incidence of breast cancer |
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Tail of Spence |
Part of breast tissue extending into axillae Most common site of malignancy |
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Upper inner quadrant |
15% incidence of breast cancer |
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Lower inner quadrant |
6% of incidence of breast cancer |
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Lower outer quadrant |
11% incidence of breast cancer |
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Nipple |
18% incidence of breast cancer in this region |
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Breast tissue |
Determined by age, nutritional status, pregnancy, lactation, genetics Adipose Glandular Suspensory ligaments |
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Adipose tissue |
Most of breast tissue |
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Glandular tissue |
Secretes milk |
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Suspensory ligaments |
Cooper's ligaments Fibrous bands that attach breast tissue to chest wall muscles Cancer may cause the ligaments to contract causing pits or dimples in overlying skin |
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Lymph system of breast |
Pectoral Subscapular Lateral Cenntral axillary |
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Pectoral Nodes |
Behind anterior axillary fold Drains anterior chest wall and breast |
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Subscapular Nodes |
Located along lateral edge of scapula just inside posterior axillary fold Drains posterior chest wall and arm |
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Lateral Nodes |
Along the humerus inside the upper arm Drains the arm |
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Central Axillary nodes |
High middle axillae Receives drainage from all axillary nodes 75% of drainage will go infraclavicular/supraclavicular nodes on same side 25% of drainage will go infraclavicular/supraclavicular nodes on opposite breast, abd, deep into breast Problem with metastatic disease, increases spread to the other side |
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Newborn developmental Considerations |
Estrogen causes white nipple fluid in either sex Resolves in a few days to few weeks |
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Adolescent developmental concerns |
Estrogen stimulates breast development Breast development 8-13 yrs, average 10-11 Occurs over 3 yrs Breasts may normally be asymmetric: teens may need reassurance |
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Precocious puberty |
Before 8 yrs Hormonal imbalance Needs endocrine evaluation |
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Delayed puberty |
After 13.5 yrs Hormonal imbalance Needs endocrine evaluation |
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Pregnant female |
Nipples enlarge, darken, become more erect Increased venous pattern, superficial vessels Note elevated Montgomery glands Colostrum forms in the 4th month |
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Colostrum |
Forms in 4th month Precursor to milk Thick, yellow fluid |
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Lactation |
Colostrum changes to milk 3 days postpartum Frequent nursing relieves sensation of tenderness and engorgement |
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Mastitis |
Inflammation or infection of breast tissue after childbirth Red, swollen, hot, painful breasts |
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Aging Female |
Menopause: decrease breast size, glandular tissue atrophy Decreased elasticity: decreased adipose, pendulous, flattened, sagging breasts Axillary hair decreases |
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Male breast |
Lifetime risk of breast cancer 1:1000 Gynecomastia: nub of breast tissue under areola, feels like a large grape |
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Gynecomastia: adolescence |
May normally have enlargement in adolescence Usually unilateral and temporary Excess testosterone is converted to estrogen |
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Gynecomastia: Aging male |
May occur in aging male Unilateral or bilateral Occurs when testosterone levels drop and estrogen becomes unopposed May also be r/t medication effects or pituitary tumor Meds: Cimetadine |
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Breast pain |
Breast cancer often begins with pain Localized or generalized Character: burning, pulling, discomfort Cyclic pain: common with OCs and fibrocystic changes Treat with Vitamin E 400-800 mg Associated factors: underwire bras, exercise |
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Lumps |
Fibrocystic/non cancerous lumps Associated skin changes: redness (mastitis), warmth, dimpling, swelling History of trauma: lumps as a result |
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Fibrocystic lumps |
May enlarge and become more tender prior to menstrual period Caffeine intake may incease size and tenderness of cystic lumps |
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Breast cancer lumps |
May cause dimpling and swelling Only become larger, do not fluctuate in size |
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Nipple discharge |
Needs evaluation, prolactin levels (pituitary tumor) |
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Clear discharge |
May be r/t meds OCs, phenothiazides (thorazine), diuretics, digitalis, steroids, tricyclic antidepressants (amitriptyline), reserpine, aldomet May be r/t pituitary tumor |
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Galactorrhea |
Milk discharge Associated with pituitary tumor |
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Bloody discharge or thick yellow with blood |
Always significant, especially when associated with a lump May indicate ductal cancer |
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Rash on breast |
Paget's disease: advanced ductal cancer Starts as a small crust on the nipple with surrounding erythema |
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Mammogram screening |
ACS: yearly starting at age 40 USPSTF: Biennial between ages 50-74 |
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Clinical breast exam |
ACS: - 20 - 39 yrs: Every 3 yrs - > 40 yrs: Every year USPSTF: not supported |
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Breast self exam |
ACS: - Optional USPSTF: - Recommend against teaching BSE |
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Breast augmentation |
May still receive mammograms Men may also receive mammograms |
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Mammogram failure rate |
10% failure to detect irregular mass when present |
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Young women and mammograms |
High density breast tissue Poor visualization in mammogram |
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Self breast exam |
Perform 5-7 days after onset of menses Decreased nodularity Increased nodularity midcycle to last 1-2 days of cycle |
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Breast Cancer |
Second major cause of cancer death in women - Lung cancer is leading cause of cancer death in women 1 in 8 will develop breast CA before age 45 - Incidence increases with age 80% of breast cancer after age 40 Need to identify early and treat early |
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Risk Factors per ACS |
Female: 100x more common Age Breast cancer in one breast increase risk 3-4x in opposite breast Abnormal breast cells on previous biopsy Family history: 1st degree relative before age 50 - 20-30% of women will have family hx, 70% don't BRACA1 or BRACA2: these gene mutations are also risks for men Radiation to chest: esp prior to 30, ie. treatment for Hodgkin's Current use of OCP First child after age 30-35 Never having a child or breast feeding Menses before 12 yrs Menopause after 55 yrs HRT (hormone replacement therapy): estrogen and progesterone Caucasian Mammogram showing dense tissue, more grandular, less adipose Overweight/Obese Physical inactivity ETOH: more than 1 drink/day, increased risk 1-1.5 x DES exposure |
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Inspect breasts |
Expose both breasts for comparison Note size and shape: often slightly asymmetrical Left breast usually larger than right |
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Inspect breast skin |
Normal: smooth and even color Note any localized areas of redness, bulging, dimpling, edema |
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Redness of breast, heat |
Inflammation Mastitis |
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Peau d' orange |
Orange peel skin Caused by blocked lymph ducts Common with cancer Edema may exaggerate hair follicles causing bumpy texture and large pores |
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Inspect and Palpate Axillae |
Arms relaxed at side Examine while sitting Support client's arm Palpate: high into axilla, anterior axilla, posterior axilla, down chest wall, supraclavicular and infraclavicular areas |
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Inspect nipples |
Normally symmetric on same plane May be everted, flat, inverted Note dry scaling, fissures, ulceration, bleeding Supernumerary nipple |
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Deviated nipples |
May indicate cancer |
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Inverted nipples |
Suspect malignancy if it is a recent change or unilateral Change is what is significant |
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Supernumerary nipple |
2 nipples along the mammary ridge at MCL Occurs in 1% of men and women Appear like a nevus |
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Retraction maneuvers |
Observe changes in contour, symmetry, retraction, dimpling associated with cancer Hands at sides Lift arms overhead Push hands on hips Palms together Lean forward: look at underside of large breasts |
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Palpate breasts: sitting |
Bimanual technique Especially in women with larger breasts |
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Palpate breasts: lying |
Pillow or towel roll under shoulder Pt place hand behind head Palpate vertically using pads of 3 fingers Never raise fingers, only glide Premenstraually: breasts engorged r/t estrogen, feel fuller and more nodular |
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Strip method |
Palpate in strips from MAL to sternal border Include Tail of Spence |
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S/P mastectomy, augmentation |
Use the same technique to palpate breasts lying down |
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Palpate thenipple |
Assess for lumps and discharge Note color, consistency of discharge |
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Characteristics of Breast Lumps |
Palpate both breasts for comparision - Location: quadrant, cm from nipple, clock - Size: length, width, depth - Shape: round, oval, indistinct - Consistency: soft, hard, firm - Tenderness - Borders: defined, irregular - Retraction/dimpling: present or absent - Mobility: fibrocystic, cancer |
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Cancer lump characteristics |
Painless lump Ulceration Retraction Nipple discharge |
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Educate re: SBE |
During or after completing the exam Examine 5-7 days after first day of menses Postmenopausal: examine at the same time each month Emphasize importance of early detection Watch her demonstrate |
