Clinical Medicine 216 - Breast Lumps and Nipple Discharge
The breasts, or mammary glands, are present in?
Both males and females
The breast lies on top of the __________ ?
Pectoralis major muscle and serratus anterior muscle
The breast is located between the ________ and extends from the side of the ________.
2nd and 6th ribs; sternum to the midaxillary line
The superior lateral corner of breast tissue is called?
Axillary tail of Spence
The areola contains?
Montgomery's sebaceous glands
Montgomery's sebaceous glands secrete a protective lipid material during ________ .
The breast is composed of __________ ?
Glandular ducts and lobules, connective tissue, and fat
__________ provides the background architecture of the breast.
_________ are attached to both the fascia of the skin and the pectoralis major muscle.
Cooper's ligaments (suspensory ligamants)
Cancer around Cooper's ligaments may cause them to be contracted and can cause ________ of the overlying skin.
The relative proportion of glandular, fibrous, and fatty tissue varies depending on ________ ?
Age, cycle, pregnancy, location, and general nutritional state
Most breast cancers occur in the _________ because that is where most of the tissue is located.
Upper outer quadrant and subareola region
Genetic contribution to breast cancer involves specific BRCA 1 and BRAC 2 locations. Women with these mutations are at increased risk for __________ ?
Breast and ovarian cancer
Almost _________ of all breast cancers occur in the upper outer quadrant.
Approximately _________ of breast cancer occurs in the subareola region.
_________ of breast cancer occurs in the upper inner quadrant.
_________ of breast cancer occurs in the lower outer quadrant.
_________ of breast cancer occurs in the lower inner quadrant.
Nearly half of the glandular tissue is located in the __________ .
Upper outer quadrant
Most breast cancer is thought to originate in the __________ ?
Terminal ductal lobular unit (TDLU)
Terminal ductal lobular unit (TDLU) comprises _________ ?
Lobules with intralobular terminal ducts and extralobular ducts
Each lobe of the breast contains ________ of terminal ductal units, which forms the functional secretory units of the breast.
The _________ drain to the infraclavicular and sometimes to the medial substernal lymph nodes.
Lower inner quadrants
Most of the breast drains into the _________ ?
Lymphatics of the axilla
_________ serve to produce and secrete milk—the primary function of the breast mammary glands.
Lobes, lobules, and acini
During __________ , vertical epidermal ridges or milk-lines are present and curve down from the axilla to the groin bilaterally.
________ are tubular connections between the lobes and nipples to allow milk to exit the breast
Ducts and lactiferous sinuses
Supernumerary nipples occur along the __________ . Supernumerary nipples and/or breasts with inverted nipples are congenital conditions that occur in about 10% of the population.
Supernumerary nipples and/or breasts with inverted nipples are congenital conditions that occur in about _________ of the population.
Supernumerary nipples are sometimes mistaken for _________ .
Skin tags or moles
Neoplasms can still develop in _________ ?
Regardless of breast size, all women have approximately ________ lobules.
15 to 25
_________ major ducts exits the nipple.
6 to 10
The nipple and areola are _________ structures.
_________ are common within normal breasts, with oral contraceptives, and in benign breast (fibrocystic) disease.
__________ occurs with trauma, inflammation, infection, and benign breast disease.
__________ is the secretion of breast milk in men, or in women who are not breastfeeding an infant
What are the 3 most common breast lumps?
Fibroadenomas, fibrocystic breast changes, and breast carcinoma
What is commonly found in young women and is a benign tumour composed of glandular (related to gland) and fibrous (containing fibers) tissues?
Most of the benign and malignant pathologies of the breast arise in the __________?
Duct and lobular network
Most major venous pathways of the breast lead to the _________ (why lung metastases are common) or _________ (skeletal metastases).
Pulmonary capillary network; vertebral vein
Obstruction of the lymphatic system in the dermis of the skin is a serious sign of _________ of the breast. Later-stage presentation will give the skin an _________ ?
Inflammatory carcinoma; orange peel appearance called "peau d'orange"
Carcinoma invasion of __________ will cause dimpling of the skin.
The parenchyma is the __________ elements of a gland or organ.
Essential or functional
The parenchyma of the breast is composed of _________ ?
Ductal and glandular structures
The __________ is the framework of a gland or organ.
On physical examination, the ________ may contribute to feeling granularity under the areola.
________ is a benign condition of the breast, and it is a spectrum of a variety of morphologic changes in the terminal ductal lobular unit (TDLU).
Some fibrocystic changes can result from _________ and can cause palpable masses and/or mammographic lesions.
Cellular proliferation (hyperplasia)
What is a benign proliferation of glandular acini within a lobule?
Adenosis may also be referred to as _________ when acini are deformed by sclerotic reaction.
A subtype of adenosis is called _________ , in which there is dilatation of acini within the TDLU.
Blunt duct adenosis
Blunt duct adenosis can show calcifications within the _________ .
_________ is a change in which the cells of the TDLU resemble those of apocrine sweat glands; it is often associated with cysts of various sizes.
__________ is a dilation of medium to large ducts lined by flattened cells and filled with secretions and amorphous debris, which can include some calcifications ("milk of calcium").
Duct ectasia (smaller) and cysts (larger)
Smaller dilated ducts are often referred to as _________ , particularly when associated with periductal inflammation.
________ is the replacement of the normal fatty stroma by increased fibrous tissue.
_________ is a spectrum of complexity in the proliferation of benign cells lining the TDLU, both quantitatively and qualitatively.
________ contains only a few more cells beyond the normal 2-cell layer, and the cells do not have any significant nuclear changes.
________ contains many more cells than the usual 2-cell layer and is found in 20% of breast biopsies.
Moderate or florid hyperplasia
Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) are 2 forms of ________ that are referred to as "atypical" since they have many, but not all, of the histologic features of carcinoma in situ.
________ is associated with a significant risk for the development of invasive breast cancer.
Atypical ductal hyperplasia (ADH)
Since their risk for developing invasive cancer and histologic appearance are not significantly different, lobular carcinoma in situ and atypical lobular hyperplasia (ALH) are often referred to together as ________.
________ are frond- or finger-like hyperplastic epithelial growths with a fibrovascular core. Small calcifications can occur at the tip of the epithelial fronds. The epithelial hyperplasia may be of varying degrees.
Papillomas can occur in large or small ducts and can be solitary or multiple. When multiple and small, the term ________ is used and is considered to be part of the spectrum of fibrocystic change.
Papillomas may arise from _________ ?
Skin, mucous membranes, or glandular ducts
A _________ is a circumscribed, benign epithelial tumour projecting from the surrounding surface; more precisely, a benign epithelial neoplasm consisting of villous or arborescent outgrowths of fibrovascular stroma covered by neoplastic cells.
Fibroadenoma is a benign breast lesion, but is not part of ________ . Fibroadenoma represents a focal hyperplasia of the stroma and the epithelial component of the terminal ductal lobular unit (TDLU) and creates a distinctive round and well-circumscribed mass on physical exam or mammogram.
The stromal hyperplasia often compresses and stretches the hyperplastic glands, creating the fibroadenoma's characteristic histologic pattern. With age, the stroma will become more sclerotic and may undergo dystrophic calcification, and the epithelial hyperplasia may decrease _________ ?
When a fibroadenoma contains cysts, sclerosing adenosis, epithelial calcifications, or papillary apocrine changes, it is referred to as a ________ , and there is a slightly increased risk in the development of breast cancer.
________ is considered a precursor to invasive breast cancer because it is often noted in and around invasive cancers and because invasive cancer has been noted to develop when these lesions are incompletely excised.
Ductal carcinoma in situ (DCIS)
Histologically, ductal carcinoma in situ (DCIS) is characterized by a proliferation of neoplastic cells, which distend the terminal ductal lobular unit (TDLU) but do not breach the _________ .
Of the ________ that subsequently develop, invasive ductal carcinoma is the most common type. However, it is not a single entity and the risk of progression to invasive carcinoma may vary considerably based on several pathologic features.
________ is usually an incidental finding in breast tissue removed for another indication and is frequently multifocal. This lesion rarely causes clinical findings such as a mass. On palpation it feels more like a platform of dense tissue and may be seen as calcifications on mammography.
Lobular carcinoma in situ (LCIS)
Lobular carcinoma in situ (LCIS) is characterized microscopically by the distention of at least half of the ________ by a very round uniform population of small cells, which may have clear cytoplasm or nuclear vacuoles.
Acini in a lobular unit
________ is characterized histologically by a monotonous population of small cells that frequently contain a cytoplasmic vacuole and that classically infiltrate in a single-file pattern. The stroma is densely sclerotic, giving this tumour a rock-hard feeling on palpation and making the cells difficult to remove by FNA.
Infiltrating lobular carcinoma
Infiltrating ductal carcinomas are the most common type of invasive breast cancer, accounting for _________ of cases, and is sometimes referred to as ductal carcinoma of no special type.
50% to 75%
In general, this form of breast cancer is composed of neoplastic cells that infiltrate the tissue in nests, sheets, cords, tubular structures, or as a combination of these patterns. The stroma is usually sclerotic, and the tumor may invade vascular spaces.
Infiltrating ductal carcinomas
The ________ of metastases in axillary lymph nodes is the most important predictor of disease-free and overall survival in breast cancer, due to it being an indicator of systemic rather than local disease.
Presence or absence
Patients with metastases in ________ lymph nodes have a worse prognosis than those who have fewer involved lymph nodes.
4 or more
This proto-oncogene encodes a transmembrane protein which functions as a cell-surface receptor which is involved with regulation of cell growth and proliferation. When mutated, it promotes neoplastic transformation. Mutations cause over-expression of the gene and is seen in approximately one third of breast cancers.
HER-2-Neu ________ can be used as a predictive marker for a variety of adjuvant therapies
This tumour suppressor gene is located on chromosome 17 and is involved in the maintenance of normal cell growth by suppressing cell replication and possibly inducing apoptosis.
_________ of p53 lead to over-expression with increased accumulation of the mutated gene product, which is detectable in the affected cells by immunocytochemical stains. Approximately one third of breast cancers demonstrate this change, but those that do are associated with high nuclear grade have a considerably worse prognosis.
_________ starts with a small crust on the nipple apex and then spreads to areola.
A lump from an _________ is due to local hematoma or edema and resolves shortly.
Breast cancer occurring _________ menopause in family members increases risk for the patient.
Risk factors for breast cancer that you cannot change:
Female gender, age >50, personal history of breast cancer, mutation of BRCA1 and BRCA2, first-degree relative with breast cancer (mother, sister, daughter), high breast tissue density, biopsy-confirmed atypical hyperplasia, high-dose radiation to chest, early menarche (<12 years) or late menopause (>55 years).
Lifestyle related risk factors for breast cancer:
Nulliparity (never had a child) or first child after age 30 years, recent oral contraceptive use, never breastfed a child, recent and long-term use of estrogen and progestin, alcoholic intake of more then 1 drink a day, obesity (especially after menopause) and high-fat diet, and physically inactive.
Recent nipple __________ signifies acquired disease.
Maneuvers to screen for retraction or dimpling:
Arms raised, hands pressed at the hips, and patient bends forward
Lymph nodes around the breast will enlarge with any _________ ?
Local infection of the breast, arm, or hand; and with breast cancer metastases
Premenstrual engorgement is normal and is due to increasing _________?
During palpation, you may feel a transverse ridge of compressed tissue in the lower quadrant known as ________ , and it is especially noticeable in larger breasts.
Edema of the breast exaggerates the _________ , giving a pigskin or orange peel look (peau d-orange).
_________ is a benign growth of male breast tissue, and feels like a smooth, firm, movable disk, which occurs normally in puberty, and it can be unilateral or bilateral and is temporary. Can also occur with the use of anabolic steroids, some medication, and some disease states.
In women who are not lactating, nipple discharge is most frequently caused by?
Intraductal papilloma, duct ectasia, or cancer
One section of the breast surface in a lactating woman appearing red and tender may indicate _________ ?
A plugged duct
Nipple retraction looks flattened and broader, like an underlying crater. A recent retraction suggests cancer, which causes fibrosis of the whole duct system and pulls in the nipple. But it may also occur with ________ ?
Benign lesions such as ectasia of the ducts
As cancer advances you may see:
Firm or hard irregular axillary nodes; skin dimpling; nipple retraction, elevation, and discharge
_________ is usually a solitary, unilateral, non-tender mass, with a single focus in one area, although it can be interspersed with other nodules. Borders are irregular and poorly delineated, and grows constantly.
A fibroadenoma is a __________ , that is usually a solitary non-tender mass that is solid, firm, rubbery, and elastic. It is round, oval, or lobulated in shape, and clearly demarcated. It is also freely movable, slippery, and usually presents with no axillary lymphadenopathy.
The distension or dilation of a duct, vessel, or hollow viscus
_________ is the term used to describe discharge that contains both blood and a clear yellow liquid known as blood serum.
__________ is a rare complication of generalizes infection (e.g., mastitis) if untreated.
_________ is uncommon, and is the inflammation of breast tissue, which could result in abscess formation. Area is red, swollen, tender, very hot, and hard. Patient may also have a fever and chills.
Breast lumps found _________ in identical quadrants of the breast are more likely to be _________ .
The Canadian Task Force on Preventive Health Care does not recommend _________ for women ages 40 to 74 who do not have a higher risk of breast cancer. Studies show that self-examinations do not save women's lives, and that they can lead to unneeded tests, such as biopsies.
Clinical Breast Exam: A normal finding in palpating axillary lymph nodes is _________ ?
1 or more soft, small (<1cm), non-tender nodes
Clinical Breast Exam: An abnormal finding in palpating axillary lymph nodes is _________ ?
1 or more enlarged (>1cm), hard, tender nodes
Clinical Breast Exam: Normal findings with the patient in the 4 seated positions?
Breast contours remain symmetric throughout movements, nipples point forward
Clinical Breast Exam: Abnormal findings with the patient in the 4 seated positions?
Asymmetry between breasts (possible skin dimpling), deviation of nipple direction
Clinical Breast Exam: Normal findings of inspection of colour, size & symmetry, couture of breasts, characteristic of nipples.
Symmetric and smooth contours of breast, no erythema or nipple erosion
Clinical Breast Exam: An abnormal findings of breast inspection?
Thickening of skin causing prominent pores to be visible
Clinical Breast Exam: _________ of palpation are clavicle superiorly, the mid sternum medially, the mid-axillary line laterally, and the infra-mammary fold inferiorly.
Clinical Breast Exam: Palpation: Feeling for consistency of tissues, tenderness, nodules (location, size, shape, consistency, elimination, tenderness, mobility). ________ charting is used to document location, as well as, charting the distance from the nipple.
Clock-face or 4 quadrant
Clinical Breast Exam: Normal findings of palpation:
Soft/cystic, regular borders, mobile mass
Clinical Breast Exam: Abnormal findings of palpation:
Hard, irregular borders, fixed mass
Clinical Breast Exam: Areolar palpation looks for:
Elasticity of tissues and discharge (colour, quantity, consistency, origin, laterality)
What are the most concerning symptoms with breast changes?
Fever, erythema skin changes, non-milky nipple discharge, increased in mass size over time
Cyclic mastalgia is related to the ________ and is bilateral with diffuse, heavy or sore sensation.
Non-cyclic mastalgia is related to ________ and is often unilateral with a sharp, burning sensation.
Fibroadenoma, cyst, or infection
Mastalgia is often present with cyclical and non-cyclical breast changes. Non-cyclical breast changes are seen with ________ ?
Mastitis, cellulitis, other infections, and trauma
Mastalgia is often present with cyclical and non-cyclical breast changes. Cyclical breast changes are seen with _________ ?
Fibrocystic disease and copper ligament stretching
Unilateral nipple discharge is seen with _______ ?
Papilloma, duct ectasia/abscess/infection, and breast cancer
Bilateral nipple discharge is seen with _______ ?
Medications, lactation, pituitary adenoma, and hypothyroidism
Intraductal papilloma is a benign epithelial tumour, may have a palpable mass in the areolar region with spontaneous, unilateral, bloody nipple discharge. What is the management?
Imaging then excision of affected duct
What is termed as an obstruction of a sub-areolar duct with inspissation (thickening) of normal secretions, which leads to duct dilation, inflammation, and fibrosis? May present with a palpable mass, local pain, possible retraction, and spontaneous, unilateral, gray-green nipple discharge.
Galactorrhea (not associated with childbirth) may present with bilateral, milky discharge. Galactorrhea can also be due to medications and endocrine disruptions (hypothyroidism, pituitary adenoma). What is the management?
Labs (PRL, hCG, TSH) and microscopy of discharge
What is a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast? Presents with marked edema, erythema, dimpling (peau d-orange), and is less painful than mastitis.
Inflammatory breast cancer
What is the management for inflammatory breast cancer?
Imaging and tissue sampling
What is an uncommon disease of the nipple and areola, where malignant cells migrate to the surface of the breast? It is associated with underlying ductal carcinoma.
Paget's disease of the breast
Paget's disease present with?
Scaling, tender to palpation, and erosion of the nipple
A female breast mass can be a non-dominate mass that ________ through the cycle, or a dominant mass that _______ throughout the cycle.
Management of non-dominate breast masses:
Imaging (ultrasound, mammogram)
Management of dominate breast masses:
Imaging and fine needle aspiration (FNA)
BI-RADS stands for:
Breast Imaging Reporting and Data System
________ is the recording of body temperature distribution using the infrared radiation emitted by the surface of that body at wavelengths between 0.8 μm and 1.0 μm. Despite being non-invasive, it has low sensitivity.
Fibrocystic changes is a mammary disease complex with underlying endocrine disturbances resulting in 3 abnormalities ________. it is bilateral, granular to nodular masses, with possible mastalgia.
Cyst formation, fibrosis, and adenosis
________ are bilateral, granular to nodular masses, with possible mastalgia.
Management of fibrocystic breast changes?
Ultrasound (cystic lesion) & fine needle aspiration (FNA) (yields fluid)
Management of fibroadenoma?
Ultrasound (cystic lesion) & fine needle aspiration (FNA)(yields no fluid) are not diagnostic - requires core or excisional biopsy
Fibroadenoma is an overgrowth of ________ within the lobule of the breast. These masses are smooth, rubbery, discrete, non-tender, and are a mobile nodule.
Periductal stromal connective tissue
What is a benign, non-suppurative inflammatory process of adipose tissue (often due to trauma or surgery), which can present as peri- or sub-areolar mass, and possible skin changes (scar)?
Fat necrosis of the breast
What is the management of fat necrosis of the breast tissue?
Mammogram: “oil cysts”, can appear similar to malignancies, ultrasound (variable: hypoechoic mass with well defined borders), and fine needle aspiration (FNA) (milky, emulsified fat)
Invasive breast cancer may be _______.
Ductal, lobular, or other type
Breast cancer subtypes:
ER+, PR+, HER2-Neu +, and tripple negative breast cancer (TNBC)
Malignant carcinoma, also known as breast cancer, is a painless, unilateral, dominant (non-cyclic) mass. It is fixed and hard. It may have associated skin changes like dimpling or nipple retraction in advanced stages. What is the management?
Imaging and fine needle aspiration (FNA) or core-needle biopsy, with possible surgery, chemotherapy, and/or radiation
What is the most common type of in-situ breast carcinoma? It is often non-palpable and found on screening mammogram, and is a precursor to invasive ductal carcinoma.
Ductal carcinoma in-situ (DCIS)
Most common types of breast cancer is ________ (70% - 85%)?
Invasive breast cancer
Invasive ductal carcinoma is the most common type of invasive breast cancer (79%), while _______ is the second (10%).
Invasive lobular carcinoma
T: Tumour size; N: regional lymph Nodes involvement; M: Metastasis has occurred.
TNM staging of solid tumours
BRCA management with hormone therapy (SERM: Tamoxifen, AI: Femara) can causes these common concerns:
Hot flushes and osteoporosis
BRCA management with chemotherapy can causes these common concerns:
Hair loss, nausea, fatigue, and infection
BRCA management with radiation can causes these common concerns:
Fatigue, anemia, lymphedema (arm), skin irritation, pneumonitis, and heart damage
Serious causes of skin alteration and thickening of the breast are ________ ?
Inflammatory breast cancer and breast abscess
__________ can cause benign causes of skin alteration and thickening of the breast.
A serious cause of bloody nipple discharge is seen in ________ ?
Benign causes of bloody nipple discharge is ________ ?
Papilloma and physiologic conditions
Discharge is considered pathological if it is:
Spontaneous, unilateral, bloody, serous, clear, or associated with a mass
With mastitis you must rule out ________ ?
Inflammatory breast cancer usually has a _________ , and often by the time of diagnosis 1/3 of the breast is involved.
Intraductal papilloma are:
Wart like growths in ductules attached by a stalk
The most common cause of an inflamed breast in non-lactating women is _______ ?
Inflammatory breast cancer
Mastitis associated with breastfeeding, a subareolar abscess, and inflammatory breast cancer can present with ________ ?
Ductal ectasia and papillomatosis can produce _________ ?
Greenish or brownish discharge
A bloody nipple discharge can occur with __________ ?
Benign or cancerous conditions
_________ involvement is more suspicious for intraductal papilloma or cancer. Whereas, _________ discharges usually are caused by hyperprolactinemia or duct ectasia.
_________ is usually helpful in differentiating solid from cystic lesions and is often the first step in evaluation of a cyst, or a mass, in the women with firm, dense, breast tissue.
________ involves both breasts, which are enlarged and dense. While ________ usually involves one lobe or a quadrant of a breast.
Engorgement (congestive mastitis); infectious mastitis
Prominent vessels, plus tender cordlike veins suggests _______ ?
Thrombophlebitis of the superficial veins of the breast
Paget's disease begins as a _________ area on the nipple and progresses to a deep ________ behind the nipple well.
Scaling eczematoid; lump
Fluctuation of breast masses are of a ________ .
_________ is used primarily to evaluate abnormal areas that are seen on a mammogram, to assess breast implants for leaks or ruptures, and to assess breast abnormalities not seen on mammography or ultrasound.
Magnetic Resonance imaging
__________ should be suspected when prolactin serum levels are high.
Thyroid function test is used to rule out _________ as a cause of hyperprolactinemia.
_________ vary in size during menstruation, but ________ do not.
Breast abscess can be caused by _________ ?
Staph aureus or streptococcal infections, and can be associated with duct ectasia
_________ is a fatty tumour of the breast, with borders that are smooth and well defined. The mass has a fluctuant consistency and is usually non-tender and mobile.
_________ is an uncommon breast finding, but should be considered, especially in immunocompromised patients. In the early stages, it can appear as a solitary, firm, irregular, non-tender mass.
An acute abscess typically follows _________ . It is exquisitely tender on palpation and very warm to the touch. The breast is erythematous and swollen, usually involves 1/4 of the breast tissue, and the mass has a fluctuant consistency.
Inflammatory breast cancer does not usually present with a _______ , but it is often present with an abscess.
The breast is _________ sensitive tissue, and responsive to the changes of monthly cycling and aging.
After menopause, there is _________ of glandular tissue, and a notable __________ in the number of lobules.
Both the nipple and the areola are supplied with __________ to express milk from the ductal system during breast-feeding.
Smooth muscle that contracts
__________ of the area, including the breast examination, makes the nipple smaller, firmer, and more erect, whereas the areola puckers and wrinkles. These smooth muscle reflexes are normal and should not be mistaken for signs of breast disease.
The adult breast may be soft, but it often feels granular, nodular, or lumpy. This uneven texture is normal and may be termed __________ . It is often bilateral.
The normal 'nodularity' may _________ before menses, a time when breasts often enlarge and become tender or even painful.
The male breast consists chiefly of a __________ . These overlie a thin disc of undeveloped breast tissue consisting primarily of ducts.
Small nipple and areola
Lacking _________ stimulation, the ductal branching and development of lobules of male breasts are minimal.
Estrogen and progesterone
A _________ of breast tissue, 2 cm or more in diameter, has been described in roughly one of three adult men.
Not all the lymphatics of the breast drain into the axilla. Malignant cells from breast cancer may spread directly to the ________ nodes or into the _________ of lymph nodes within the chest.
Infraclavicular; internal mammary chain
Self-examination is best done when estrogen stimulation is lowest, approximately _________ of menses.
5 to 7 days after onset
Physiologic hypersecretion of breast discharge is seen with _________ .
Pregnancy, lactation, chest wall stimulation, sleep, and stress
Common lesions in the female breast at the age of 15 to 25 are _________ ; at the age of 25-50 are _________ ; and over 50 _________ .
Fibroadenoma; cysts, fibrocystic changes, and cancer; caner until proven otherwise
In pregnancy and lactating women, common lesions are:
Lactating adenomas, cysts, mastitis, and cancer
Male breast cancer constitutes 1% of breast cancer cases, peaking in frequency around age ________ .
Risk factors for male breast cancer are:
BRCA2 mutations, obesity, family history of male or female breast cancer, testicular disorders, and work exposure to high temperatures and exhaust emission
To examine the _________ portion of the breast, ask the patient to roll onto the ________ , placing her hand on her ________ but keeping the _________ pressed against the bed or examining table.
Lateral; opposite hip; forehead; shoulders
To examine the ________ portion of the breast, ask the patient to lie with her ________ flat against the bed or examining table, placing her hand at her ________ and lifting up her _________ until it is even with her shoulder.
Medial; shoulders; neck; elbow
Examination of the male breast may be brief but is important. If the breast appears enlarged, distinguish between the _________ enlargement of obesity and the _________ enlargement, called gynecomastia.
Soft fatty; firm disc of glandular
Inspection of the skin axilla should look for rash, infection, and unusual pigmentation. Deeply pigmented, velvety axillary skin suggests _________—one form is associated with internal malignancy.
Mastitis is most common in lactating women, however, it can also occur in nonlactating women as a result of _________ .
Generalized dermatitis occurring from an insect bite, sunburn, or allergic reactions
Cyclic mastalgia occurs _________ and is associated with the menstrual cycle. _________ pain is not cyclic.
Cyclic mastalgia is usually described as _________ , and most likely caused by hormonal changes that affect the breast tissue, resulting in edema and increased nodularity. Noncyclic mastalgia is usually described as _________ .
Heaviness; sharp and burning
Noncyclic mastalgia is commonly ________ to the presence of a fibroadenoma or cyst, and can be relieved by the treatment of the underlying breast lesion.
Gynecomastia can occur as a result of:
Medications (such as corticosteroids), hormonal medications, diazepam, and illicit drugs (such as marijuana).
Pregnancy is the most common cause of generalized breast tenderness in females of reproductive age. Test urine or blood for _________ to rule out pregnancy.
Human chorionic gonadotropin (β-hCG)
What is mastitis?
Inflammation of a mammary gland, usually caused by an infection
What is an adenoma?
A benign epithelial tumour having a glandular origin and structure.
What is fibrosis?
The formation of excessive fibrous tissue, as in a reparative or reactive process
What is adenosis?
A disease of a gland, especially one marked by the abnormal formation or enlargement of glandular tissue