University:
Texas Lutheran University
Course:
NURS 332 | Fundamental Nursing Concepts & Practice
Academic year:

2020
Views:

255

Pages:

38
Author:

JustCloud

Breast Modified sweat gland. lies within layers of superficial pectoral fascia anterior to deep fascia of pectoralis major Cooper ligament Grande support. It extends from deep fascia to superficial dermal layer Axillary tail & Spence: it’s the extention of breast to axilla it pierces deep fascia & enter axilla Breast boundaries: medial edge lateral edge sternum 6th Rib lateral margin of pectoralis major mid clavicle inferior margin inferius dors Derived from ectoderm: sweat glands supernumerary breast tissue can be found from shoulder to thigh Development: estrogen duct development progesterone lobuloalveolar, maturation of glandular tissue prolactin milk production menopause: estrogen & progesterone cellular atrophy, reduction of lobed tissue with increase of fat tissue Blood Supply: Intercostal artery (iad) Internal thoracic artery Axillary artery lateral thoracic artery thoraco acromial artery Venous drainage: axillary (most imp) internal mammary inter costal Para Vertebral plexus of Baston: Venous drainage that alveus to Spine (valveless plexus) Physiology: It has best size in lutal phase of menstrual cycle (life 16-25) Derived from ectodermal milk streaks (milk line) Is an elongated line from shoulder to thigh where supernumerary breast vesicles & or nipples can be found. Fibrocystic changes 70-80% of women -wide spectrum of clinical & histological findings including cyst formation breast nodularity, stromal proofrafton & Githelial hyperplasia. (fibras & cystic changes) They are affected by hormones Change with monstrual cycle -Signs & symptoms: age 30-40 y MC Cysts او breast pain & swelling, tenderness Bilateral mostly affected by menstrual cycle. -Diagnosis: Hx & examinations uis in Case I suspetion Cove hoopsy les festhekgical evalundion -Treatment: NSAIDS • Stop xanthine (caffeine, tabaco, cola-) +omoprazole OCP, danazole, tamoxifen (to preval AUD) Mondor's Disease superficial Thrombophlebitis of lateral thoracic or thoracoepigastikic Vein mostly Due to local trauma, surgery, infection and repetitive movement of ul *Sign & symptom local pain tender, palpable Cord acute pain in aviva or sup aspeed of lateral breast. *Diagnosis: u/s + Examination of palpalle Cord in the inframmamary feld *Treatment: NSAIDs for pain Premalignant Ductal Carcinoma in situ (DCIS) Inner layer of epithelial cells in major duct. It’s proliferation of ducted cells but without invading basement membrane, considered pre malignant Lobular Carcinoma in situ (LCIS) Cells from terminal duct-lobular unit multifocal proliferation of acinar and terminal ducted cells It’s considered as marker of malignancy Post menopause Premenopause 5% male Cancer Never in male palpable mass sometime, but usually asymptomatic No sign and symptom, Discovered accidentally microcalcifications in mammogram and multicentric <1% LN invasion not found in mammo, Discovered by biopsy No LN invasion Increase Risk of breast Cancer in ipsilateral bread & usually same quadrant Increase Risk of breast Cancer in Both breasts. most commonly most commonly infiltrated ducted carcinoma (multicentric) worst type/ prognosis Comedo infiltrated ducted carcinoma (multicentric) 30% develop invasive cancer. Treatment: other types Papillary, Cribiform If small <2cm lumpectomy + follow up ± Radiation Tamoxifen lower Risk of Cancer No treatment-Close observation If large >2 cm lumpectomy with 1 cm margin + Radiation Very high Risk No need for LN dissection totally involved me Simple mastectomy + sentinel LN biopsy if difficultly involved margins Bilateral mastectomy ± hormonal Therapy No axillary LN Dissection + hormonal Therapy failed to obtain clear margins (near nerve). If totally involved me Simple mastectomy + sentinel LN biopsy if difficultly involved margins failed to obtain clear margins (near nerve). No axillary LN Dissection + hormonal Therapy No need for LEMON hormonal Therapy Malignant Tumors Pathological subtypes Infiltrating Ductal Carcinoma (invasive) MC invasion breast Cancer (80%) Perimenopausal and post menopausal women. Ductal cells invade basement membrane Mets to: axilla, bone, lung, liver, brain Invaded Ductal cells invade stroma in various histologic forms: scirrhous-medullary-comedo-Colloid-papillary-tubular mostly present as palpable mass and mammogram abnormality. Infiltrating Lobular Carcinoma (invasive) 2nd most common (10%) originate from terminal duct cells high likelihood of being bilateral (Mor) Present as ill defined thickness of the breast, palpable mass No microcalcification often multicentric Paget Disease of nipple usually associated with underlying LCIS or DCIS extending within epithelium of main excretory ducts to skin of nipple and areola Present as Tender itchy nipple, bloody discharge + subareolar palpable mass Initially erythema and mild eczematous changes that became erosion & ulcer Diagnosed by biopsy Treated with modified radical mastectomy. (Not with staging) Inflammatory Carcinoma 2-3% axillary lymphadenopathy almost always present most lethal breast Cancer Due to blockage of efferent lymphatic duct causing Edema Present as erythema, Peau d'orange, nipple retraction Diagnosed by skin biopsy (Show lymphatic invasion) Clinical + imaging Treated bys chemo then surgery & Radiation as Stage MRM + chest wall Diagnostic options and approach history Investigations Bilateral mammo within Pathology mammography: 2 View Cranio caudal Medio lateral oblique Always Bilateral mammo ↑ fatty replacement Sensitive and specificity varies with breast density (Better for 35 y and above) if cancer is first detected by mammo 80% has negative L-N (Vs 45% if detected clinical) Suspicious finding imp to know How to read mammo Stellate Spiculated (MC) Microcalcifications distortion of architecture asymmetrical localized fibrosis increased vascularity altered subareolar duct pattern unclear borders Radial scars spiculated mass Breast imaging reporting data system & BIRADS: with central lucency: 0: assessment incomplete 1: negative normal 2: benign findings follow up after 1 y (annually) 3: Probably benign findings Repeat in 6m + biopsy Suspicious of Cancer. Do biopsy 5: highly →Do biopsy 6: known biopsy- Proven Cancer, treatment pending. ultrasonography useful for distinguishing between cyst & solid mass effective for lesions larger than 0.5 cm in diameter. helpful in evaluating young women with dense breast FNA Can't Diagnose Cancer or invasion. for palpable solid mass effective Core needle biopsy most commonly used if didn't work Do excisional biopsy MRI With implant To assess presence of nedales Genetic screening BRCA 1/2: Pt diagnosed with breast + ovary Cancer Strong FH of Breast/ovarian Cancer FH of male breast Cancer Young <35 y Recurrent bilateral breast Cancer < 50 bilateral breast Cancer < 50 Open biopsy for breast cyst Second cyst recurrence Bloody fluid in the cyst Pulpable mass after aspiration (Stereotactic Biopsy HSSL false for recurrent disease-chemical Show breast cancer ed, uls or mammo guided, walling-Second cyst recurrence Pulpable mass after aspiration Reading mammogram View CC MLO Skin thickness edema nipple Retracted Retro areolar mass breast tissue speculated mass with pleomorphic calcification tissue distraction increased vascularity calcified vessel microcalcification Pectoralis tail (seen in mediolateral oblique view) any opacities → BI-RADS Score

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