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Benign and malignant breast disease - Coggle Diagram

- - - - Telorrhea
        
        It is defined as the exit of liquid secretion through the nipples and is classified as physiological and pathological. In the nipple, the milk ducts converge in which the cells of the mammary glandular tissue drain. Within the anamnesis, it is important to differentiate whether telorrhea is spontaneous or occurs due to expression of the nipple, whether it is persistent or not, and whether it is related to a mass or inversion of the nipple.
        
        Whitish telorrhea:
        
        If the discharge is non-spontaneous (to the expression of the nipple),
        considered physiological. In the case of being spontaneous, it can be caused by pregnancy, hyperprolactinema, hypothyroidism and by some medications that stimulate lactotropes or that inhibit dopamine, including phenothiazines, benzodiazepines, haloperidol, metoclopramide, opiates, some oral contraceptives, among others.
        
        Spontaneous or non-spontaneous yellowish, greenish, brown telorrhea
        
        Ductal ectasia is a benign pathology consisting of dilation of the terminal ducts from 0.5 to 5mm. They are usually 3 or 4 ectatic ducts.
        
        There are four mechanisms described for the development of ectatic ducts: 1. The hormonal effect by producing a relaxation of the myoepithelial elements of the duct wall. 2. Obstruction of the ducts by squamous epithelial cells. 3. Inflammation of bacterial and autoimmune origin which produces destruction of the elastic wall of the duct. 4. Lymphatic blockage that causes failure in the absorption of ductal secretions. 5. Another major cause of ductal ectasia is smoking.
        
        Suspicious telorrhea: hyaline, hematic, serohematic, serous unilateral, spontaneous, or persistent
        
        This type of telorrhea is related to papillary tumors, which can range from a benign lesion such as intraductal papilloma, to cancer in the case of papillary carcinoma. Therefore, patients with telorrhea of these characteristics should always be referred to breast surgery regardless of the result of the paraclinical examinations.
      - Skin changes
        
        Among the skin changes are eczema, local infection, edema and ulceration of the skin.
        
        Mastalgia
        
        Breast pain (mastalgia or mastodynia) is the symptom related to the breast most frequently referred to in the primary care consultation. It has been estimated that 50% to 70% of women experience breast pain at some point in their life. The clinical importance of breast pain is not only related to the intensity of the pain but it can generate great anxiety in the patient due to the fear of hidden breast cancer. However, breast pain as an isolated symptom of breast cancer is very rare, seen in less than 5% of cases.
        
        Non-cyclical mastalgia
        
        Non-cyclical breast pain is not related to the menstrual cycle. It affects both pre and postmenopausal women. Pain can be constant or intermittent, unilateral or bilateral, and can be localized anywhere in the breast
        
        Cyclical mastalgia
        
        The normal breast undergoes cyclical physiological changes during the menstrual cycle. Three to seven days before each menstruation, the woman experiences a feeling of heaviness, discomfort and fullness in the breasts, along with areas of nodularity.
        painful. These symptoms usually improve with the arrival of menstruation. Pain can affect only one or both breasts.
        
        Treatment
        
        A well-fitting, supportive breast bra is an effective measure that achieves a 75% to 85% improvement in breast pain.
        
        Non-steroidal anti-inflammatory drugs (NSAIDs) are useful for the management of cyclic mastalgia, specifically those of higher potency such as diclofenac and piroxicam. Given the fewer side effects, topical presentations are preferred over systemic presentations.
        
        Flaxseed in the diet, evaluated in a study in patients with high intensity cyclic mastalgia, showed better results than placebo, which is why it can be considered in the management of this type of mastalgia.
        
        There is insufficient evidence to recommend the use of night spring oil.
        
        Tamoxifen at a dose of 10mg a day and danazol at a dose of 200mg a day have been shown to be effective in cyclic mastalgia, but they have very important side effects.
        
        Local infection
        
        the clinical picture is characterized by erythema, local heat, and pain in part or all of the mammary gland. It can present as cellulitis or abscess. Treatment should be done with antibiotics for 10 days, and in the case of abscess, its drainage (percutaneous or surgical). If there is no improvement of the inflammatory changes locally
        after finishing the antibiotic, she should be referred to breast surgery.
        
        Eczema
        
        Areolar eczema is usually caused by dermatological processes that can compromise both the areola and the nipple or only the areola, and with the appropriate treatment they should disappear in a short time (15 days).
        
        Treatment of areolar eczema includes: Topical corticosteroid treatment for 10 days. Change the type of soap that is used. Manual washing of the bra with toilet soap without mixing it with other garments. Use of cotton bra. If no improvement after 15 days, the patient should be referred to breast surgery for biopsy to rule out Paget's disease.
  - - - Screening is the application of a test to asymptomatic individuals who are more likely to acquire a disease. The target population must be specifically defined and a test with adequate sensitivity and specificity must be used.
      - Se pueden establecer programas de detección temprana sin tamización basados en la educación oportuna y apropiada de la población y de los profesionales de la salud, con el fin de identificar signos y síntomas de alerta que permitan diagnosticar la enfermedad en sus primeras etapas.
      - Early detection is the appropriate response by doctors or health professionals to the symptoms reported by the patient, or to the clinical signs identified in the clinical examination of the breast.
      - Risk factors for breast cancer
        
        BRCA1 or BRCA2 mutation 2. Family history of cancer (No known mutation) 3. One first-degree relative 4. Two first-degree relatives 5. Three or more first-degree relatives 6. One second-degree relative 7. Radiation Chest therapy at an age under 30 years 8. Hormonal Factors
        
        Late parity (age over 30 years) or nulliparity
        
        Early menarche (age under 12 years) or late menopause (age over 55 years) 11. Combination hormone replacement therapy (for 10 years or more) 12. Postmenopausal obesity 13. Alcohol consumption (2 drinks a day compared to non-drinkers) 14. Smoking before the first live birth 15. Sedentary lifestyle 16. Race white 17. Breast density (very dense versus mostly fat) 18. Atypical ductal or lobular hyperplasia, or carcinoma in situ on previous biopsy
      - Diagnostic and screening tests
        
        Clinical breast examination
        
        It should be performed once a year as part of the general clinical examination to all asymptomatic or symptomatic women over 40 years of age and to all patients who consult for breast symptoms regardless of age.
        
        Fine needle aspiration
        
        It is a simple biopsy that is used for the diagnosis of complex cysts without a solid mass and for palpable solid masses highly suggestive of being benign.
        
        Trucut needle biopsy
        
        It is a type of biopsy with low morbidity that is used for the
        diagnosis of palpable or non-palpable solid lesions.
        
        Breast magnetic resonance imaging
        
        It is an imaging modality indicated in the screening of high-risk women (BRCA 1 and 2 mutations). It is also useful in the evaluation of patients with breast implants to rule out intracapsular rupture of the same; in patients with palpable masses who have reported mammography Birads 0 for dense breasts and normal ultrasound; finally, in patients with breast cancer in whom it is desired to assess the extent of the disease
        
        Stereotactic, suros, or mammotome biopsy
        
        Estos tipos de biopsia se realizan con aguja trucut utilizando como guía la imagen mamográfica, ya que está indicada en lesiones sospechosas que se ven únicamente en mamografía.
        
        Breast ultrasound
        
        Its main utility lies in differentiating between solid and cystic, palpable and non-palpable lesions, since mammography cannot do this.
        
        Indications:
        
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        Self-examination
        
        Stand in front of a mirror, observe and check both breasts for dimples, nipple deviations, or peeling skin, especially on the areola. 2. Staring into the mirror, place your hands behind your head and keeping it steady, press your elbows forward, watching for any dents in the skin, nipple, or lumps. 3. To the same end, place your hands on your hips and press down firmly, leaning slightly toward the mirror, pushing your elbows and shoulders forward. 4. Raise your left arm behind your head with your elbow raised and examine your left breast with your right hand. Inspect carefully by sliding the three middle fingers of the hand in a circular motion around the breast, starting at the upper left periphery all the way to the nipple. Take special care in the area of the breast between the nipple and armpit. 5. It is important that the woman is attentive to her breasts and if she observes an alarm sign such as spontaneous yellowish or bloody discharge, not induced; go immediately to the specialist.
        
        Doctors also recommend performing step 4 lying on your back with a pillow or towel folded under your shoulder. Raise your arm and place it over your head.