Advanced Clinical Assessment: Breast/Lymphatics

What is physiologic (normal) nipple discharge?

physiologic hypersecretion is seen in pregnancy, lactation, chest wall stimulation, sleep, and stress

What is pathologic (abnormal) nipple discharge?

when discharge is blood or serous, unilateral, spontaneous, associated with a mass, and occurring in women ages > 40 yo

What is monilial intertrigo?

• occurs in the folds of the breasts

• type of dermatitis

• inflammatory skin condition

• itchiness, tenderness

• occurs with large, pendulous breasts

• tx: shower and change bra after exercising

What is mastitis?

• firm erythematous in lighter skin

• darker area on darker skin

• tender, swollen area

• occurs in breastfeeding

• caused by engorgement and obstruction of milk drainage of a lactating person

• presents with flu-like symptoms associated

Tx for mastitis

Abx, warm compress, encouragement of further breastfeeding

What is fibroadenomas?

• Age 15-25

• Usually puberty and young adulthood, but up to age 55

• Usually single, may be multiple

• Round, disc-like, or lobular

• May be soft, usually firm

• Well delineated

• Very mobile***

• Usually nontender

• no retraction signs

What is fibrocystic breast disease?

• age 30-50

  • regress after menopause except with estrogen therapy

  • may fluctuate with menstrual cycle

• single or multiple

• round

• soft to firm, usually elastic

• well-delineated

• mobile

• often tender

• no retraction of the nipple

What is breast cancer?

• age 30-90, most common over 50

• usually single, although may coexist with other nodules

• irregular or stellate

• firm or hard

• not clearly delineated from surrounding tissues

• may be fixed to skin or underlying tissues

• usually non-tender

• retraction signs possible

• changes in contour of the breast

What are non-modifiable risk factors of breast cancer?

• female gender > 50

• personal hx of breast cancer

• mutation BRCA1/BRCA2

• first-degree relative with breast cancer

• previous breast irradiation

• menarche < 12; menopause > 50

What are lifestyle related risk factors for breast cancer?

• nulliparity or first child after 30

• long-term use combined HRT

• alcohol intake of 2-5 drinks daily

• obesity and high-fat diet

• physical inactivity

• not breast-feeding

What are retraction signs?

• sign of breast cancer

• as breast cancer advances, it causes fibrosis (scar tissue)

• shortening of this tissue produces dimpling, changes in contour, and retraction or deviation of the nipple

• other causes of retraction include fat necrosis and mammary duct ectasia

Nipple retraction and deviation

• nipple is flattened or pulled inward

• nipple may be broadened and feel thickened

• when involvement is radially asymmetric, the nipple may deviate or point in a different direction

  • typically points toward underlying cancer

What is edema (Peau d'orange)?

• edema of the skin is produced by lymphatic blockade

• appears as thickened skin with enlarged pores "orange peel"

• often seen first in the lower portion of the breast or areola

What are signs of cancer?

• skin dimpling

• edema

• retraction

• abnormal contours

• nipple retraction and deviation

What is intraductal papilloma?

• small, noncancerous (benign) tumor that grows in a milk duct of the breast

• occurs most often in women ages 35-55

• causes/risk factors are unknown

What may spontaneous unilateral blood discharge indicate?

• intraductal papilloma

• ductal carcinoma in situ

• Paget disease

What is Paget's disease?

• uncommon form of breast cancer usually starts as a scaly, eczema-like lesion on the nipple that may weep, crust, or erode

• breast mass may be present

• suspect if there is persisting dermatitis of the nipple and area

• often presents with an underlying in situ or invasive ductal or lobular carcinoma

What are signs of cancer in the lymph system?

nodes that are large ( >1 or 2 cm) and firm or hard, matted together or fixed to the skin or underlying tissues suggest malignancy

What are breast cancers in AMAB?

occur under the nipple most commonly

What is mammogram?

- low-powered x-ray technique that captures a picture of the internal structure of the breast

- may help in the dx of breast problems, including cancer

- recommended a woman have a baseline mammogram at age 40, followed by every couple of years until age 50, then annually

What is needle biopsy?

- performed under local anesthesia

- attempt to draw fluid from lumps that are thought to be cysts

- withdrawn fluid and tissue is further evaluated to determine if there are cancerous cells present