BREAST: LEARN ABOUT THE MAMMARY GLAND HERE

Medical Licentiate Emerson

1. 11: BREAST

2. Breast lump Hx taking Demographic Hx PC Hx of PC of a lump/ ulcer When it was 1 st noticed? What brought it to the patients‘ notice? What symptoms does it cause e.g. pain, nipple discharge? Has it changed? How much has it changed since it was 1st noticed? Has it ever disappeared or healed? Does the patient have any other lumps/ulcers? What does the patient think caused it?

3. (d) Medical Hx Hx breast ca Hx ca colon Hx ca ovary Hx radiation exposure Metastatic symptoms Back pain (bone metastasis esp. to lumbar spine) Dyspnea (lung metastasis) Jaundice or Abdominal distension (liver metastasis) Hard nodules on skin (MSS metastasis) Swelling of arm (s) (axillary lymphadenopathy)

4. PREDISPOSING FACTORS/RISK FACTORS Age of the patient Parity Did she breast feed all children for long When was the last time to breast feed At what age did she have her 1st pregnancy or 1st child Age at menarche? Early? Pre or post menopause- late menopause If premenopausal- what is the menstrual pattern ( regularity, duration, quantity What breast symptoms after the menstrual cycle Medication i.e. HRT (Hormonal replacement therapy), Radiation, Combined oral contraceptive Hx of alcohol or smoking Family Hx Diet obesity

5. Examination of the breast Inspection Symmetry Site -position of lump Skin -color discoloration Puckering Peau de orange Ulceration Nipple discharge and appearance Edgar -Montgomery tubercle Calor Oedema

6. Nipple (7 D‘s) Depression Discharge Discoloration Duplication Destroyed Deviated Displacement

7. Ask patient to hold the waist Gross lumps Phyllodes Distended veins Ask pt. to raise hands Look for skin tethering and nipple retraction

8. PALPATION Flat of finger Begin with normal side Palpate for Tenderness AND Temperature If there is a lump or mass; check Site Size Shape Consistence Is it fixed or free mobile Palpate axillary lymph nodes and or supraclavicular

9. Ask if they have a lump anywhere also ……… G/E -Arms for swelling P/A – -Hepatomegaly -Ascites -Nodules in pouch of Douglas Lumbar spine- hit back for tenderness and restricted movement. Findings that suggest cancer breast Hard, non-tender, irregular lump in LOQ Tethering/fixation of the lump Palpable axillary LN‘s

10. Presentation of breast disease Painless lump Carcinoma Cyst o Fat necrosis Fibroadenoma An area of Fibroadenosis Lipoma of breast (intra-ductal papilloma) Phylloides tumor (Brodie tumor)

11. Painful lump An area of Fibroadenosiso Cyst Periductal mastitis Abscess (usually postpartum or Lactational) Carcinoma (sometimes)

12. Pain and tenderness but no lump Cyclic breast pain Non-cyclical breast pain Carcinoma (very rare) Nipple discharge Duct ectasia Intraductal papilloma Ductal cis Associated with a cyst

13. Changes in the nipple and/or areolar Ductal ectasia Carcinoma Paget‘s disease Eczema Changes in breast size and shape Pregnancy Carcinoma Benign hypertrophy Rare large tumours