{"id":178,"date":"2020-08-13T16:02:50","date_gmt":"2020-08-13T16:02:50","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=178"},"modified":"2023-09-30T11:06:21","modified_gmt":"2023-09-30T11:06:21","slug":"40-disorders-of-the-breast","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/40-disorders-of-the-breast\/","title":{"rendered":"40. Disorders of the Breast"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/IPyZJMFcLXo\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 7:07<\/p>\n<input type='hidden' bg_collapse_expand='69e9eec2f30868000406587' value='69e9eec2f30868000406587'><input type='hidden' id='bg-show-more-text-69e9eec2f30868000406587' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9eec2f30868000406587' value='Hide Transcript'><button id='bg-showmore-action-69e9eec2f30868000406587' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9eec2f30868000406587' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 40<br \/>\n00:02<br \/>\ndisorders of the breast breast diseases<br \/>\n00:04<br \/>\nencompass a broad spectrum of pathology<br \/>\n00:06<br \/>\nfrom benign breast disease to breast<br \/>\n00:08<br \/>\ncancer breast care often involves a<br \/>\n00:11<br \/>\nmultidisciplinary approach obstetrician<br \/>\n00:13<br \/>\ngynecologists are often the first person<br \/>\n00:15<br \/>\nthat a woman consults for breast related<br \/>\n00:17<br \/>\nsigns and symptoms the objectives of<br \/>\n00:19<br \/>\nthis video are to list factors that<br \/>\n00:21<br \/>\nplace individuals at risk for breast<br \/>\n00:23<br \/>\ndisorders to describe symptoms and<br \/>\n00:25<br \/>\nphysical exam findings of benign or<br \/>\n00:26<br \/>\nmalignant conditions of the breast to<br \/>\n00:29<br \/>\ndemonstrate the performance of a<br \/>\n00:30<br \/>\nclinical breast examination discuss the<br \/>\n00:32<br \/>\nsteps in the evaluation of common breast<br \/>\n00:34<br \/>\ncomplaints of nostalgia mass nipple<br \/>\n00:37<br \/>\ndischarge and discuss initial management<br \/>\n00:38<br \/>\noptions for benign and malignant<br \/>\n00:40<br \/>\nconditions of the breast let&#8217;s start<br \/>\n00:42<br \/>\nwith a review of breast anatomy here is<br \/>\n00:44<br \/>\nthe breast and it is organized into 12<br \/>\n00:46<br \/>\nto 20 lobes with glandular or lobular<br \/>\n00:49<br \/>\ntissues the lobules have clusters with<br \/>\n00:51<br \/>\nsecretory cells arranged in alveolar<br \/>\n00:53<br \/>\npattern and are surrounded by<br \/>\n00:54<br \/>\nmyoepithelial cells the glands drain<br \/>\n00:57<br \/>\ninto milk ducts with about five to ten<br \/>\n00:59<br \/>\ncollecting ducts that lead to or drain<br \/>\n01:01<br \/>\ninto the nipple typically breast cancer<br \/>\n01:03<br \/>\narises in the glandular or lobular unit<br \/>\n01:06<br \/>\nof the breast and there is a<br \/>\n01:07<br \/>\ndisproportionate amount of glandular<br \/>\n01:08<br \/>\ntissue in the upper outer quadrant of<br \/>\n01:10<br \/>\neach breast<br \/>\n01:11<br \/>\nthis is why breast cancer most commonly<br \/>\n01:13<br \/>\narises in the upper outer quadrant in<br \/>\n01:15<br \/>\nyoung women the breast consists<br \/>\n01:17<br \/>\npredominantly of glandular tissue with<br \/>\n01:19<br \/>\nage the glands involute and are replaced<br \/>\n01:21<br \/>\nby fat and this process is accelerated<br \/>\n01:23<br \/>\nby menopause the two most common<br \/>\n01:25<br \/>\ncomplaints related to breasts are one<br \/>\n01:27<br \/>\npain and two concern about a mass it is<br \/>\n01:30<br \/>\nimportant to take a careful history<br \/>\n01:32<br \/>\nlet&#8217;s review some risk factors for<br \/>\n01:34<br \/>\nbreast cancer age is the strongest risk<br \/>\n01:37<br \/>\nfactor a personal history of breast<br \/>\n01:40<br \/>\ncancer an inherited genetic mutation<br \/>\n01:43<br \/>\nsuch as brca1 or brca2 high breast<br \/>\n01:47<br \/>\ntissue density a first-degree relative<br \/>\n01:49<br \/>\nwith breast or ovarian cancer diagnosed<br \/>\n01:52<br \/>\nat an early age early menarchy late<br \/>\n01:55<br \/>\nmenopause no term pregnancies first<br \/>\n01:59<br \/>\npregnancy after the age of 30 and never<br \/>\n02:01<br \/>\nhaving breast fed a complete breast<br \/>\n02:04<br \/>\nexamination should evaluate both breasts<br \/>\n02:06<br \/>\nin a systematic fashion<br \/>\n02:07<br \/>\nboth axilla and the entire chest wall<br \/>\n02:09<br \/>\nvarious techniques have been described<br \/>\n02:11<br \/>\nfor the palpation of breast tissue<br \/>\n02:13<br \/>\nincluding circles wedges and line<br \/>\n02:15<br \/>\npatterns of examination the best time to<br \/>\n02:18<br \/>\nperform a breast examination is ideally<br \/>\n02:20<br \/>\nin the follicular phase of the menstrual<br \/>\n02:21<br \/>\ncycle let&#8217;s now discuss diagnostic<br \/>\n02:24<br \/>\ntesting mammography is an x-ray<br \/>\n02:26<br \/>\ntechnique that is first line imaging for<br \/>\n02:28<br \/>\nwomen older than 40 it is able to detect<br \/>\n02:30<br \/>\nlesions approximately two years before<br \/>\n02:32<br \/>\nthey become palpable mammography can be<br \/>\n02:35<br \/>\nscreening or it can be a diagnostic test<br \/>\n02:37<br \/>\nwhich involves additional views<br \/>\n02:39<br \/>\nultrasound is especially helpful for<br \/>\n02:41<br \/>\nwomen younger than 40 and it is useful<br \/>\n02:43<br \/>\nin evaluating inconclusive mammographic<br \/>\n02:45<br \/>\nfindings MRI is useful for women who are<br \/>\n02:49<br \/>\nat extremely high risk of developing<br \/>\n02:50<br \/>\nbreast cancer for example BRCA carriers<br \/>\n02:53<br \/>\nwe will now discuss some common breast<br \/>\n02:55<br \/>\ncomplaints starting with nostalgia or<br \/>\n02:57<br \/>\nbreast pain nostalgia can be cyclic or<br \/>\n03:00<br \/>\nnon cyclic the cyclic pain often<br \/>\n03:02<br \/>\ninvolves the luteal phase of the<br \/>\n03:04<br \/>\nmenstrual cycle and the pain is often in<br \/>\n03:06<br \/>\nthe outer quadrants of the breasts<br \/>\n03:08<br \/>\nnon-cyclic nostalgia is not associated<br \/>\n03:10<br \/>\nwith the menstrual cycle and it can be<br \/>\n03:12<br \/>\nassociated with medications including<br \/>\n03:13<br \/>\nantidepressants antihypertensive drugs<br \/>\n03:15<br \/>\nand hormones it can also be associated<br \/>\n03:17<br \/>\nwith tumors mastitis cysts history of<br \/>\n03:21<br \/>\nbreast surgery or it can be idiopathic<br \/>\n03:23<br \/>\nextra memory pain is pain that does not<br \/>\n03:26<br \/>\narise from the breast tissues and it can<br \/>\n03:27<br \/>\narise from chest wall trauma rib<br \/>\n03:29<br \/>\nfractures shingles or fibromyalgia the<br \/>\n03:32<br \/>\nnon pharmacologic treatments for mast<br \/>\n03:34<br \/>\nalgae include a tight-fitting bra or<br \/>\n03:37<br \/>\nsports bra weight reduction and regular<br \/>\n03:39<br \/>\nexercise the only fda-approved<br \/>\n03:42<br \/>\nmedication for nostalgia is Dan Issel<br \/>\n03:44<br \/>\nbut this medication has significant side<br \/>\n03:46<br \/>\neffects moving now to nipple discharge<br \/>\n03:49<br \/>\nit is important to ask the patient if<br \/>\n03:52<br \/>\nthe discharge is spontaneous or<br \/>\n03:53<br \/>\nexpressed if it&#8217;s bilateral or<br \/>\n03:55<br \/>\nunilateral Yoona ductile or multi<br \/>\n03:58<br \/>\nductile and the color whether it&#8217;s white<br \/>\n04:00<br \/>\ngreen yellow clear or bloody and is<br \/>\n04:03<br \/>\nthere a mass present or not benign<br \/>\n04:06<br \/>\nprocesses cause non spontaneous non<br \/>\n04:09<br \/>\nbloody green yellow or brown discharge<br \/>\n04:11<br \/>\nthat can be bilateral bloody unilateral<br \/>\n04:15<br \/>\nnipple discharge would be more<br \/>\n04:16<br \/>\nconcerning for cancer and the next step<br \/>\n04:18<br \/>\nwould be a breast duct ography let&#8217;s now<br \/>\n04:21<br \/>\ndiscuss the breast mass characteristics<br \/>\n04:24<br \/>\nof the mass that suggest malignancy or<br \/>\n04:26<br \/>\nsize<br \/>\n04:27<br \/>\ngreater than two centimeters in mobility<br \/>\n04:28<br \/>\nhaving poorly defined margins firmness<br \/>\n04:31<br \/>\nhaving skin dimpling or color changes<br \/>\n04:34<br \/>\nretraction or changes in the nipple<br \/>\n04:36<br \/>\nbloody nipple discharge and EPSA lateral<br \/>\n04:39<br \/>\nlymph adenopathy if the mass appears<br \/>\n04:41<br \/>\nsuspicious then the next step will be a<br \/>\n04:43<br \/>\nbiopsy and this is usually a core needle<br \/>\n04:45<br \/>\nbiopsy there are three histological<br \/>\n04:47<br \/>\ncategories of benign breast masses the<br \/>\n04:49<br \/>\nclassifications are based on the degree<br \/>\n04:51<br \/>\nof cellular proliferation and a tibia<br \/>\n04:54<br \/>\nnon proliferated masses have a relative<br \/>\n04:57<br \/>\nrisk of developing breast cancer of one<br \/>\n04:59<br \/>\nthese are fibrocystic changes<br \/>\n05:01<br \/>\nfibroadenomas cysts fibrosis and AD<br \/>\n05:04<br \/>\nenosis the masses that are found to be<br \/>\n05:06<br \/>\nproliferative without atypia have a<br \/>\n05:08<br \/>\nrelative risk of developing breast<br \/>\n05:10<br \/>\ncancer of 1.5 to 2 these include<br \/>\n05:12<br \/>\nepithelial hyperplasia sclerosing at<br \/>\n05:15<br \/>\nenosis complex sclerosing lesions and<br \/>\n05:18<br \/>\npapillomas the third category is<br \/>\n05:20<br \/>\nproliferative with atypia<br \/>\n05:22<br \/>\nif the cells have atypical hyperplasia<br \/>\n05:24<br \/>\nthe relative risk of developing breast<br \/>\n05:26<br \/>\ncancer is 3.7 to 5.3 there is atypical<br \/>\n05:30<br \/>\nductal hyperplasia or ADH and atypical<br \/>\n05:33<br \/>\nlobular hyperplasia or a LH lobular<br \/>\n05:36<br \/>\ncarcinoma in situ is sometimes<br \/>\n05:38<br \/>\nclassified in the proliferative with<br \/>\n05:40<br \/>\natypia category it is a non invasive<br \/>\n05:42<br \/>\nlesion that carries a risk of breast<br \/>\n05:44<br \/>\ncancer in the ipsilateral or the<br \/>\n05:46<br \/>\ncontralateral breast with a relative<br \/>\n05:48<br \/>\nrisk of two moving now to management if<br \/>\n05:51<br \/>\nthe core needle biopsy demonstrates<br \/>\n05:53<br \/>\natypical ductal hyperplasia atypical<br \/>\n05:55<br \/>\nlobular hyperplasia or lobular carcinoma<br \/>\n05:58<br \/>\nin situ then a surgical excision is<br \/>\n06:00<br \/>\nneeded to avoid underestimation of the<br \/>\n06:02<br \/>\ndiagnosis if the diagnoses are confirmed<br \/>\n06:05<br \/>\nthe next steps will be close<br \/>\n06:07<br \/>\nsurveillance lifestyle and diet changes<br \/>\n06:08<br \/>\nand chemo prevention is an option with a<br \/>\n06:11<br \/>\nselective estrogen receptor modulator we<br \/>\n06:14<br \/>\nwill conclude by discussing breast<br \/>\n06:15<br \/>\ncancer it is the second most common<br \/>\n06:17<br \/>\nmalignancy and women and is the second<br \/>\n06:19<br \/>\nleading cause of cancer-related death in<br \/>\n06:21<br \/>\nwomen there are three histological cell<br \/>\n06:24<br \/>\ntypes of breast cancer ductal lobular<br \/>\n06:26<br \/>\nand nipple and 70 to 80 percent of<br \/>\n06:29<br \/>\ncancers are ductal in origin treatment<br \/>\n06:32<br \/>\nof breast cancer often involves both<br \/>\n06:34<br \/>\nsurgical and medical therapies surgical<br \/>\n06:37<br \/>\ntherapy options include lumpectomy and<br \/>\n06:39<br \/>\nradiation or mess<br \/>\n06:40<br \/>\nto me and medical therapy options<br \/>\n06:42<br \/>\ninclude chemotherapy and hormonal<br \/>\n06:44<br \/>\ntherapies this concludes the aapko video<br \/>\n06:47<br \/>\non breast disorders we have discussed<br \/>\n06:49<br \/>\nimportant risk factors symptoms and<br \/>\n06:51<br \/>\nphysical exam findings of benign and<br \/>\n06:53<br \/>\nmalignant conditions of the breast<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 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