Breast disorders

fibroadenoma

• solid, slowly enlarging benign mass
• round, firm, easily moveable
• nontender
• clearly delineated from surrounding tissue

fibrocystic changes of the breast that include a range of changes involving lobules, ducts, and stromal tissues of the breast

• premenoupausal women between 20 and 50 years of age
• Imbalance in normal estrogen-to-progesterone ratio
• at least 1/2 of all women
• pain, tender lumps, upper outer quadrant
• symptoms increase week prior to menstruation and then fade

• Symptomatic management
• Hormonal manipulation -oral contraceptives
• Drug therapy—vitamins C, E, and B complex
• Diuretics
• Avoidance of caffeine
• Reduction of dietary fat
• Mild analgesics -Tylenol, Ibuprofen
• Limited salt intake before menses
• Well-padded supportive bra
• Local application of heat or ice for pain relief

• benign breast problem of women approaching menopause
• caused by dilation and thickening of collecting ducts in the subareolar area

• mass that is hard with irregular borders and tender
• greenish brown nipple discharge
• enlarged axillary nodes
• edema over site of mass
• doesn't effect breast cancer risk but it is hard to distinguish between cancer and ductal ectasia

• benign process in the epithelial lining of the duct, forming an outgrowth of tissue
• trauma and erosion within the duct, resulting in bloody/serous nipple discharge
• occurs most often in women 40-55 years old
• Dx to rule out breast cancer - microscopic exam of discharge

• benign condition of breast enlargement in men
• can be result of primary cancer such as lung cancer

• drugs - estrogen for prostate cancer
• aging
• obesity
• underlying disease causing estrogen excess
• androgen deficiency

Breast cancer

• non-invasive = remains in duct; 20% of cases
• invasive = penetrates tissue surrounding the duct; 80% of cases

Skin dimpling with advanced disease

into surrounding tissues in irregular patterns

• invasion of lymph channels causing skin edema
• metastasis to lymph nodes
• bones, lungs, brain and liver - metastasis sites
• ulceration of overlying skin
• nipple retraction
• Peau d'orange

• Caused by blocked lymphatics
• causes skin edema, redness, warmth, orange peel appearance
• in inflammatory breast cancer - most malignant - into blood through lymphatic channels

• 1% of men
• hard, painless, subareolar mass
• widely spread disease because it's usually detected at a later state than in women

• female
• age > 65
• BRCA1 and BRCA2 genetic mutations
• family history - 2 or more 1st degree relatives
• Hx of previous breast cancer
• dense breasts

• family history - one 1st degree relative
• biopsy confirmed atypical hyperplasia
• ionizing radiation
• high postmenopausal bone density

• never had kids or had first kid after 30
• early menarche/late menopause or both
• oral contraceptives
• Hormone Replacement Therapy
• postmenopausal obesity
• 2 alcoholic drinks per day
• high socioeconomic status
• Jews

baseline screening yearly beginning at 40

• cost
• pain
• embarrassment
• access

• early detection reduces mortality rate
• teach BSE to all women

• clinical breast exam
• cancer surveillance
• prophylactic mastectomy
• chemoprevention - removing ovaries

• in late stage they may use nonsurgical treatment
• tumor removed with local anesthetic
• hormone therapy
• chemotherapy
• radiation
• if surgery is the main treatment follow-up with radiation, chemo, hormone or targeted therapy

• for staging
• also sometimes just inject dye into the nodes to detect presence of cancer cells in them

• don't use affected arm for blood pressure, injections or drawing blood
• monitor VS
• elevate HOB with affected arm on pillow
• care of drainage tubes
• comfort measures
• mobility and diet
• breast reconstruction possible
• adjuvant therapy

• squeezing rubber ball
• ROM in arm
• pulley exercises
• rope turning
• radiation, chemo, hormone, stem cell transplants, targeted therapy