Sandbox:Shadan: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 197: Line 197:
**Presence or absence of galactorrhea
**Presence or absence of galactorrhea
**Presence or absence of blood
**Presence or absence of blood
**Type of discharge such as being clear,viscous,watery or bloody
**Type of discharge such as being clear, viscous, watery or bloody
*Determination of chest wall pain
**Examination of costochondral junction
**Examination of lateral chest wall while the patient is lying down at 90 degrees on her side in order to move the breast away
**Comparison of pain from chest wall and breast tissue
Abdomen
*Abdomen examination of patients with breast lumps is usually normal
Back
*Back examination of patients with breast lumps is usually normal
Genitourinary
*Genitourinary examination of patients with breast lumps is usually normal
Neuromuscular
*Neuromuscular examination of patients with breast lumps is usually normal
Extremities
*Extremities of patients with breast lumps is usually normal


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 21:12, 7 December 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Classification

Classification of breast lumps based on epithelial hyperplasia[1]

  • Approximately 65% of all benign breast disease considered as nonproliferative(NP)with relative cancer risk of 1.2, 1.4 times:
    • Simple cyst
    • Fibrosis
    • Fibroadenoma (simple)
    • Columnar alteration (Simple)
    • Apocrine metaplasia (simple)
    • Mild ductal hyperplasia
  • Approximately 30% of total are classifed as proliferative disease(PD) with relative cancer risk of 1.7, 2.1 times
    • Usual ductal hyperplasia
    • Sclerosing adenosis
    • Columnar hyperplasia
    • papilloma
    • Radical scar
  • Approximately 5% to 8% of the rest regarded to PD with atypia with relative cancer risk more than 4 times
    • Atypical lobar hyperplasia
    • Lobular carcinoma in situ
    • Atypical ductal hyperplasia
  • Unclear risk
    • Mucocele like tumor
    • Apocrine atypia
    • Secretory atypia

Classification of benign breast lesion regarding to histological region:[2]

  • Terminal and lobular ducts
    • Acinar distention
      • Cyst
    • Intralobular connective tissue proliferation
      • Sclerosing adenosis
      • Fibroadenoma
      • Phyllodes tumor
      • Hamartoma
    • Epithelial changes in terminal duct lobaular units (TDLU)
      • Apocrine metaplasia
      • Ductal and lobular hyperplasia, usual and typical
      • Papillomatosis
      • Intracystic papilloma
  • Ductal system
    • Ductal ectasia
    • Intraductal papilloma
  • Lesion of different origin
    • Fatty tissue lesion
      • Lipoma
      • Liponecrosis
    • Fibrous tissue lesions
      • Focal fibrosis
      • Diabetic mastopathy
      • Pseudoangiomatous stromal hyperplasia (PASH)
      • Myofibroblastoma
    • Vascular origin
      • Hemangioma
    • Inflammatory origin
      • Mastitis/abscess
      • Tuberclosis and sarcoidosis
      • Foreign body granuloma and siliconoma
    • Lymph node origin
      • Inflammatory lymoh nodes

Risk factors

Associated risk factors leading to female breast cancer[3]

  • Age: probability of breast cancer from birth to 39 years; 1 in 202, from 40 to 59 years; 1 in 26, from 60 to 69 years; 1 in 28.
  • Personal history of breast cancer
  • Breast pathology: PD with atypia has greater risk of developing to breast cancer in comparison of PD.
  • Family history: greater breast cancer risk in women with first degree relatives with breast cancer under 50 years old.
  • Genetic predisposition
    • High risk
      • BRCA1
      • BRCA2
    • Moderate risk
      • Homozygous ataxia-telangiectasia (ATM)
      • Somatic mutation in CHEK2
      • BRCA1 modifier gene: BRIP1
      • BRCA2 modifier gene: PALB2
    • Low risk
      • These alleles have not designated yet.

Endogenous hormone exposure and reproductive factors:

  • Early menarche;under age of 13 years
  • Parity; nulliparous is associated with incresed risk of breast cancer
  • Age at first full term pregnancy; younger age may decrease risk of breast cancer
  • Breast feeding; decreased risk of breast cancer
  • Testostrone; increased relative risk to 2.86-3.28
  • Age at menopause;older menopausal age associated with greater risk of breast cancer

Exogenous hormone exposure

  • long term exposure> 5 years; increases chances of breast cancer
  • Time of usage;nearly menopausal age associated with development to breast cancer

Lifestyle These factors may increase risk of developing breast cancers

  • Alcohol consumption; even as 5.0 to 9.9 per day, approximately 3 to 6 drinks per week, developed with relative risk 1.15
  • Inactivity
  • Obesity; BMI:25-29.9 and BMI>30 have relative risk about 1.28
  • Previous history of radiation;at the age< 35years old

Screening

The Screening methods of breast lesions[3]:

  • Breast examination
    • Self breast examination
      • Although this is controversial, most clinicians recommend women to perform self examination monthly
    • Clinical breast examination
      • Women with age> 40 years is recommended for clinical breast examination annually
  • Ultrasound
    • whole breast ultrasound detects lesions in dense breast tissue which could not be diagnosed by mammography [4]
  • Mammography
    • Gold standard of screening
    • Early detection of non-palpabale masses
    • Regarding to 2013 NCCN guidelines annual screening in average risk women aged≥ 40 years
    • Regarding to 2013 NCCN guidelines annual screening in high risk women from age of 25 years
    • Sensitivity of 0.33-0.39 and specificity of 0.95
  • Magnetic resonance imaging (MRI)
    • Significant method for detection, assessment and management of breast cancer
    • Sensitivity of 0.77-0.79 and specificity of 0.86-0.89
    • Based on 2013 NCCN guidelines annual MRI for individuals with > 20% risk of developing breast cancer in lifetime starting at age of 25 years
    • Beneficial modality in high risk individuals
    • Valuable in individuals with equivocal results from other screening tests
    • Usable for individuals with ineffective mammography results due to breast augmentation

History and symptoms

History

By clinical history, the cancer risk can be evaluated [3]

  • Age at menarche
  • Menopausal status
  • number of pregnancies
  • Previous history of radiation
  • History of oral contraceptives or hormone replacement therapy
  • Past history of breast cancer and age at time of diagnosis
  • Familial history of breast cancer or ovarian cancer in first-degree relatives
  • Other associated breast disease or possible biopsies

Symptoms Common symptoms of breast lump include:[3][5]

Physical examination

  • Physical examination of patients should perform both in sitting position and supine position to examine breast abnormalities [3]

Appearance of the patient

  • Patients with breast lumps usually appear well

Vital signs

  • Patients with breast lumps usually have normal vital signs

Skin

  • Patients' breast skin may develop with dimpling, redness and peaud'orange particularly in inflammatory breast cancer

HEENT

  • HEENT examination of patient with breast lumps is usually normal

Neck

  • Lymphadenopathy maybe present in cervical and supraclavicular lymph nodes and determination of size, mobility and number are essential

Lungs

  • Pulmonary examination of patients with breast lumps is usually normal

Heart

  • Cardiovascular examination of patients with breast lumps is usually normal

Breast [3] [6]

  • Breast examination must consider 4 quadrant parts of both breast while patients are in sitting position and supine position
  • General inspection of both breast for probable findings of nipple changes, asymmetric changes and notable masses
  • Size, location, shape, mobility, consistency of lesions should be mentioned
  • Axillary lymph nodes must be examined for adenopathy
  • Examination of nipple discharge
    • From one duct or multiple ducts
    • Presence or absence of galactorrhea
    • Presence or absence of blood
    • Type of discharge such as being clear, viscous, watery or bloody
  • Determination of chest wall pain
    • Examination of costochondral junction
    • Examination of lateral chest wall while the patient is lying down at 90 degrees on her side in order to move the breast away
    • Comparison of pain from chest wall and breast tissue

Abdomen

  • Abdomen examination of patients with breast lumps is usually normal

Back

  • Back examination of patients with breast lumps is usually normal

Genitourinary

  • Genitourinary examination of patients with breast lumps is usually normal

Neuromuscular

  • Neuromuscular examination of patients with breast lumps is usually normal

Extremities

  • Extremities of patients with breast lumps is usually normal

References

  1. ↑ Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K; et al. (2005). "Benign breast disease and the risk of breast cancer". N Engl J Med. 353 (3): 229–37. doi:10.1056/NEJMoa044383. PMID 16034008.
  2. ↑ Lanyi, M (2003). Mammography : diagnosis and pathological analysis. Berlin New York: Springer-Verlag. ISBN 9783540441137.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Shah R, Rosso K, Nathanson SD (2014). "Pathogenesis, prevention, diagnosis and treatment of breast cancer". World J Clin Oncol. 5 (3): 283–98. doi:10.5306/wjco.v5.i3.283. PMC 4127601. PMID 25114845.
  4. ↑ Kelly KM, Dean J, Comulada WS, Lee SJ (2010). "Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts". Eur Radiol. 20 (3): 734–42. doi:10.1007/s00330-009-1588-y. PMC 2822222. PMID 19727744.
  5. ↑ Santen RJ. Benign Breast Disease in Women. [Updated 2018 May 25]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278994/
  6. ↑ Santen RJ. Benign Breast Disease in Women. [Updated 2018 May 25]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278994/
Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox:Shadan&oldid=1507502"