Dimpling
shallow dimple (skin tether) is a sign of skin retraction. Cancer causes fibrosis, which contracts suspensory ligaments. May be apparent at rest, with compression or w/lifting arms. Disortion of areola pulls nipple toward retraction
Nipple retraction
looks flatter and broader, like an underlying crater; recent retraction suggests cancer or benign lesions such as ectasia of ducts; DO NOT confuse retraction w/normal long standing type of nipple invers, which has not broadening and is not fixed
Edema (Peau d'Orange)
lymphatic obstruction produces edema. Thickens skin and exaggerates hair follicles, giving pigskin or orange-peel look; condition suggests cancer; Edema usually begins i skin around and beneath areola; can have nipple infiltration
Fixation
Asymmetry, distortion, or decreased mobility with the elevated arm maneuver; as cancer becomes invasive, fibrosis fixes breast to underlying pectoral muscles
Deviation of Nipple Pointing
An underlying cancer causes fibrosis in mammary ducts, which pulls nipple angle toward it
Benign Breast Disease (formerly fibrocytic breast disease)
multiple tender masses; 6 physical finding - 1) swelling and tenderness, 2) masalgia, 3) nodularity, 4) dominant lumps, 5) nipple discharge, 6) infections and inflammations; Nodularity occurs BILATERALLY;
What does Benign Breast Disease Feel Like?
regular, firm nodules that are mobile, well demarcated, and feel rubbery, like small water balloons; Pain may be dull, heavy, cyclic or just before menses as nodules enlarge; cysts are discrete fluid filled sacks; Dominant lumps and nipple discharge must
Cancer
solitary, UNILATERAL; nontender mass; solid, hard dense and fixed to underlying tissues or skin as cancer becomes invasive; borders are irregular and poorl delineated; grows constantly; often painless; Most common in upper outer quad; usually found in wom
Fibroadenoma
benign tumors, most commonly present as self-detected in late adolescence; solitary nontender mass that is solid, firm, rubbery, and elastic; Round, oval or lobulated; 1-5 cm; Freely moveable, slippery, fingers slide easily through tissue; Diagnosed by pa
Differentiating Breast Lumps - Likely Age
Fibroadenoma: 15-30, can occur up to 55; Benign Breast Disease (BBD): 30-55, decreases after menopause; Cancer: 30-80, risk increases after 50
Differentiating Breast Lumps - Shape
Fibroadenoma: Round, lobular; BBD: round, lobular; Cancer: irregular, star-shaped
Differentiating Breast Lumps - Consistency
Fibroadenoma: usually firm, rubbery; BBD: firm to soft, rubbery; Cancer: firm to stony hard
Differentiating Breast Lumps - Demarcation
Fibroadenoma: well demarcated, clear margins; BBD: well demarcated; Cancer: poorly defined
Differentiating Breast Lumps - Number
Fibroadenoma: usually single; BBD: usually multiple, may be single; Cancer: single
Differentiating Breast Lumps - Mobility
Fibroadenoma: very mobile, slippery; BBD: mobile; Cancer: fixed
Differentiating Breast Lumps - Tenderness
Fibroadenoma: usually none; BBD: tender, usually increases before menses, may be noncyclic; Cancer: usually none, can be tender
Differentiating Breast Lumps - Skin Reaction
Fibroadenoma: none; BBD: none; Cancer: usually
Differentiating Breast Lumps - Pattern of Growth
Fibroadenoma: grows quickly and constantly; BBD: size may increase or decrease rapidly; Cancer: grows constantly
Differentiating Breast Lumps - Risk to Health
Fibroadenoma: none, they are benign - diagnosed by ultrasound and biopsy; BBD: benign, although general lumpiness may mask other cancerous lump; Cancer: serious, needs early treatment
Mammary Duct Ectasia
pastelike matter in subareola ducts produces sticky, purulent discharge that may be white, gray brown, green,or bloody; Caused by stagnation of cellular debris and secretions into duct, leading to obstruction, inflammation, and infection; Occurs in women
Intraductal Papilloma
Serous or serosanguineous discharge, which is spontaneous, unilateral, or from a single duct. Lesions consist of tiny tumors, 2-3 mm; often a palpable nodule in underlying duct; affect women 40-60 yo; most are benign;
Carcinoma
bloody nipple discharge that is unilateral and from a single duct requires further investigation; may or may not have palpable lumb but could be revealed on mammography
Paget's Disease (Intraductal Carcinoma)
early lesion has unilateral, clear, yellow discharge and dry, scaling crusts, friable at nipple apex; spreads outward to areola with erythematous halo on areola and crusted, eczematous, retracted nipple; later lesion shows nipple reddened, excoriated, ulc
Plugged Duct
fairly common and not serious condition; one milk duct is clogged; one section of breast is tender, may be reddened; no infection; important to keep breast as empty as possible and milk flowing; nurse frequently on affected side first to ensure complete e
Mastitis
uncommon; an inflammatory mass before abscess formation; usually occurs in single quad; area is red, swollen, tender, ery hot, and hard; female has headache, malaise, fever, chills and sweating, increased pulse, flu-like symptoms; may occur during 1st 4 m
Breast Abscess
a rare complication of generalized infection (eg-mastitis) if untreated; pocket of pus accumulates in one local area; must temporarily discontinue nursing on affected breast; manually express milk and discard; treat w/antibiotics, surgical incision, and d
Gynecomastia
benign enlargement of male breast that occurs when peripheral tissues convert androgen hormones to etrogens; is a mobile disk of tissue located centrally under nipple-areola; at puberty, is usually mild and transient; in older men, bilateral, tender, firm
Male Breast Cancer
1% of breast cancer occurs in men, no standard screening mamogram and is detected by clinical symptoms; usually presents as a painless palpable mass; hard, irregular, nontender, fixed to the area, may have nipple retraction; nipple discharge, with or w/o