STUDY - Technical - New Dacian's Medicine
breast
nodule (Classical / Allopathic Medicine)
A frequently
reported gynecologic sign, a breast nodule has two chief
causes: benign breast disease and cancer. Benign breast
disease, the leading cause of nodules, can stem from cyst
formation in obstructed and dilated lactiferous ducts,
hypertrophy or tumor formation in the ductal system,
inflammation, or infection.
Although fewer
than 20% of breast nodules are malignant, the signs and
symptoms of breast cancer aren't easily distinguished from
those of benign breast disease. Breast cancer is a leading
cause of death among women but also occasionally occurs in
men, with signs and symptoms mimicking those found in women.
Thus, breast nodules in both sexes should always be evaluated.
A woman who
performs monthly breast self-examinations can detect a nodule
5 mm or less in size, considerably smaller than the 1-cm
nodule that's readily detectable by an experienced examiner.
However, a woman may fail to report a nodule because of fear
of breast cancer.
HISTORY:
Ask the patient how and when the breast nodule was discovered.
Ask the patient if the lump varies in size and tenderness with her menstrual cycle.
Ask the patient to describe pain or tenderness associated with the lump. Is the pain in one breast only? Has she sustained recent trauma to the breast?
Ask the patient if the lump has changed since she first noticed it. Is there any change in breast shape, size, or contour? Does she have nipple discharge?
Ask the patient if she's lactating.
Ask the patient about fever, chills, fatigue, and other flulike signs and symptoms.
Review the patient's medical history for factors that increase her risk of breast cancer. Also, ask the patient for a family history.
Ask the patient how and when the breast nodule was discovered.
Ask the patient if the lump varies in size and tenderness with her menstrual cycle.
Ask the patient to describe pain or tenderness associated with the lump. Is the pain in one breast only? Has she sustained recent trauma to the breast?
Ask the patient if the lump has changed since she first noticed it. Is there any change in breast shape, size, or contour? Does she have nipple discharge?
Ask the patient if she's lactating.
Ask the patient about fever, chills, fatigue, and other flulike signs and symptoms.
Review the patient's medical history for factors that increase her risk of breast cancer. Also, ask the patient for a family history.
PHYSICAL
ASSESSMENT:
Carefully palpate a suspected breast nodule, noting its location, shape, size, consistency, mobility, and delineation. Note whether you feel one nodule or several small ones.
Inspect and palpate the skin over the nodule for warmth, redness, and edema.
Palpate the lymph nodes of the breast and axilla for enlargement.
Observe the contour of the breasts, looking for asymmetry and irregularities. Be alert for signs of retraction, such as skin dimpling and nipple deviation, retraction, or flattening.
Be alert for a nipple discharge that's spontaneous, unilateral, and nonmilky (serous, bloody, or purulent). Be careful not to confuse it with the grayish discharge that can commonly be elicited from the nipples of a woman who has been pregnant.
Carefully palpate a suspected breast nodule, noting its location, shape, size, consistency, mobility, and delineation. Note whether you feel one nodule or several small ones.
Inspect and palpate the skin over the nodule for warmth, redness, and edema.
Palpate the lymph nodes of the breast and axilla for enlargement.
Observe the contour of the breasts, looking for asymmetry and irregularities. Be alert for signs of retraction, such as skin dimpling and nipple deviation, retraction, or flattening.
Be alert for a nipple discharge that's spontaneous, unilateral, and nonmilky (serous, bloody, or purulent). Be careful not to confuse it with the grayish discharge that can commonly be elicited from the nipples of a woman who has been pregnant.
SPECIAL
CONSIDERATIONS:
Postpone teaching the patient how to perform breast self-examination until she overcomes her initial anxiety over discovering a nodule.
Postpone teaching the patient how to perform breast self-examination until she overcomes her initial anxiety over discovering a nodule.
PEDIATRIC
POINTERS:
Most nodules in children and adolescents reflect the normal response of breast tissue to hormonal fluctuations. For instance, the breasts of young teenage girls may normally contain cordlike nodules that become tender just before menstruation.
Most nodules in children and adolescents reflect the normal response of breast tissue to hormonal fluctuations. For instance, the breasts of young teenage girls may normally contain cordlike nodules that become tender just before menstruation.
A transient breast
nodule in young boys (as well as women between ages 20 and 30)
may result from juvenile mastitis, which usually affects one
breast. Signs of inflammation are present in a firm mass
beneath the nipple.
AGING ISSUES:
In women age 70 and older, three-quarters of all breast lumps are malignant.
In women age 70 and older, three-quarters of all breast lumps are malignant.
PATIENT
COUNSELING:
If the patient is lactating and has mastitis, advise her to pump her breasts to prevent further milk stasis, to discard the milk, and to substitute formula until the infection responds to an antibiotic. When teaching a patient how to perform breast self-examination, advise her to do the examination 5 to 7 days after the first day of her last menstrual period.
If the patient is lactating and has mastitis, advise her to pump her breasts to prevent further milk stasis, to discard the milk, and to substitute formula until the infection responds to an antibiotic. When teaching a patient how to perform breast self-examination, advise her to do the examination 5 to 7 days after the first day of her last menstrual period.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)