Breast Disorders
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| what are 5 stages of breat dev | 1.prepubertal breast 2.breast budding, 1st dign of puberty 3.enlargment and areola 4.nipple/areola form 2nd mound on br tissue 5.more enlargement
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| where is breast found | bn 2nd and 6th ribs over pectoralis muscle. Tail of Spence goes into axilla(more cancer) Cooper's ligaments support on chest wall Inframmatory fold - crease at bottom, fat
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| Each breast contains how many lobes | 12-20 cone shaped, made up of lobules/ducts where milk is produced
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| how often should have breast exam | at risk should have q3yrs til 40, then q yr.
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| what are breast quadrants | upper inner/outer; lower inner/outer; Tail of Spence
UOQ and Tail of Spence - more cancer
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| what is gynecomastia | enlargement of glandular tissue beneath and surrounding areola of male
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| when is BSE(breast self exam) performed best | 5-7 days after menses
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| what are abnormal signs in BSE | dimpling/retraction/incr venous prominence/nipple inversion/peau d'Orange(edema), mastitis/ Paget's disease (erythema of nipple/areola/thickening/scaling
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| what are three patterns for BSE | circular, clockwise/wedge/vertical strip
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| what are risk factors for breast cancer | fam hx(1st line hx mother), age(60-65), hormones, obesity, high fat diet
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| what are two genetic mutations and factors for these | BRCA1 & BRCA2 (blood test)
1st degree relative wtih early onset, breast/ovarian Ca, male
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| what are diagnostic testings for Breast disorders | MRI, Biopsies: percutaneous: FNA-fine needle aspiration(draw cells), core, surgical: stereotactic/ultrasound biopsy, mammography, galactography
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| what is only sure way to know if it's cancer | biopsy
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| what do benign fibrocystic cycts feel like | palpable, moveable, round
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| what is good diet for fibro cysts | low Na, caffeine, chocolate
Need vit E, Danocrine, diuretics, antiestrogen Rx
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| what could nipple discharge mean | intraductal papilloma: 40-60age, wart-like, bloody discharge
Ductal ectasia: peri/post men., multi-colored discharge, burning, itching, retracting nipple, abscess
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| What kind of breast infection is mastitis | inflam or infection of brest tissue, mostly in breastfeeding, red, fever
Tx: antibiotics, cold compresses
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| what is usually cause of mastitis | S. aureus
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| what is mastalgia | breast pain, cyclic, noncyclic
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| what are cysts in breasts | fluid filled sacs dev as breast ducts dilate, estrogen factor, not increase risk of breast cancer
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| what is fibroadenoma | movable, painless lump, (hard masses not good), Af. Am 15-25 age
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| what are two common diagnoses of benign proliferative breast disease | atypical hyperplasia: abnormal incr in ductal/lobular cells in breast. Incr risk of br. Ca 4-5x
Lobular Carcinoma in Situ: cells in lobules, marker for incr risk
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| what are three types of radiation for breast Ca | primary radiation: shrink tumor to surgically take out
brachytherapy: internal
palliative therapy: decr tumor sites, s/s
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| what is most effective therapy against breast Ca | chemotherapy
other therapies: hormonal, biologic and targeted
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| Breast cancer lesions are more like | nontender, fixed not mobile, hard wtih irregular borders
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| what is cryoablation | cold gas injected to freeze tumor
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| what are surgical mgmt for breast Ca | conservation tx, total mastectomy: not anymore, modified radical
Goal: gain local control of disease
mast, sentinel node biopsy, axillary lymph node dissection, reconstruction
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| what is SLNB, sentinel node biopsy and ALND axillary lymph node dissection | take first node that receives drainage from tumor, test for cancer. If find cancer(positive), take more nodes...means past Stage 1
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| what is potential complication after ALND | lymphedema of arm: fluid build up, pain, heavy, impair motor fx, numbness, can be chronic
hematoma/seroma: fluid collection
infection
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| what are precautions for mastectomy pts | no BP, injections, blood drawn, excercises 3x/day
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| what are two more important factors for breast Ca prognosis | tumor size and if spread to lymph nodes under arm
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| what is modified radial mastectomy | remove entire breast tissue, nipple/areola, portion of axillary lymph nodes(ALND)
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| what is radical mastectomy | remove muscles as well
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| what is total mastectomy | remove breast/nipple/areola, NOT ALND
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| what is mammoplasty | breast augmentation: silicone envelopes
breast reduction(mammoplasty)
breast lift(matopexy)
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| Nonsurgical Tx for breast Ca | radiation therapy, chemotherapy, hormonal therapy
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| what are absolute contradicitons to tx | 1st/2nd trimester of preg
multicentric disease in breast
prior radiation to breast
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| What is most common radiation tx | external beam begins 6 wks after surgery
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| what is brachytherapy | partial breast radiation of lumpectomy site
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| what is adjuvant chemotherapy | chemo along with other tx
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| what is mainstay tx for hormonal agents | SERM for premenopausal
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| what are aromatase inhibitors | block estrogen for hormone therapy
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| what is new standard therapy for breast Ca | target therapy, target HER2/neu protein. For pt with tumor >1cm in size
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| what is a tissue xfer procedure after breast Ca surgery | transverse rectus abdominis myocutaneous(TRAM) flap
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