Women's Health: Estrogen Concepts and Breast Conditions
Terms in this set (70)
What is the most powerful form of estrogen?
They may occur with or without.
Do fibrocystic Breast come with mastalgia? (Breast pain)
During the reproductive years
When is Fibrocystic Breast changes most likely to occur?
Fibrocystic Breast Changes
What is the most common benign condition of the breast?
Focal Tissue Senstivity (Breast too sensitive to hormones)
Altered estrogen and progesterone balance
Altered muscle tone causing congestion
Posture/Lifestyle habits (Poor posture can cause congestion in breast tissues)
Give as many causes as you can of Fibrocystic Breast Changes.
Breast Lump (which changes with the menstrual cycle)
Frequently in the upper outer quadrant
Pain and lumps are typically bilateral
Swelling of the breast
What are the signs/symptoms of Fibrocystic Breast Changes?
Tenderness - May be cyclically tender
Skin Texture - no changes or slightly infammed
Delineation of the borders - Relatively clearly delineated
Symptoms will wax and wane (UNLIKE BREAST CANCER).
What will we find in a breast exam in a women with fibrocystic breast changes?
Mammography (Diagnose fibrocystic changes from breast cancer)
Tissue Biopsy - DDX FBC from BP
MRI - breast implants elaborates imaging features (may result in false positives)
What can we use to definitively diagnose breast cancer?
Good breast support
How can we manage fibrocystic breast changes?
Avoid Hormonally treated foods
What three things can we do with our diet for Fibrocystic Breast Changes?
Upper Thoracic and mid-thoracic spines
What spinal segments do we adjust for breast innervation?
Parasympathetic - None known
Sympathetic - Thoracolumbar Spine
What spinal segments do we adjust for Ovarian Innervation?
Carotid and Varnous plexus from superior cervical ganglia is what innervates.
Therefore, C2 and C3
What spinal manipulation can we do for vasomotor supply to the hypothalamic regions?
What nutritional supplementation can we recommend for Fibrocystic breast changes?
Chaste Berry Extract
Evening Primrose Oil
What 3 supplements can we recommend for cyclic mastalgia?
Primary breast feeding women.
If non-breast feeding women get the condition it could indicate cancer.
Who gets Mastitis?
Improper drainage of milk duct leading to inflammation and bacteria enter through crack in the nipple
What two things can cause mastitis?
Triangular flush under breast
Increased temp and pulse
What are the signs/symptoms of mastitis?
Benign tumors seen in younger women. They are composed of fibrous and glandular tissue.
What are Fibroadenomas? Who gets them?
Increased focal sensitivity to estrogen
Diet high in proccessed fats
What causes Fibroadenomas?
Clearly defined borders
What are the signs/symptoms of Fibroadenomas?
Signs and symptoms, needle biopsy, mammography, and ultrasound.
How can we definitively diagnose fibroadenomas?
What is the risk of fibroadenomas becoming malignant?
How many excised fibroadenomas recur within 5 years?
In pregnancy yes
Do Fibroadenomas grow?
Ultrasound-guided vacuum-assisted biopsy (<3cm in diameters)
Cryoablation - Cryoprobe inserted into core of lesion. Necrotic tissue resolves and shrinks over 12 months
MRI guided focused ultrasound - high temperatures ablate the tissue. Resolves lump in 75% of cases
How do we treat Fibroadenomas?
Caused by a direct blow to the breast. If no trauma has occurred, we need to assume that it is cancer.
Will be a hardened area of necrosis which mimics the feel of breast cancer.
What causes fat necrosis? What does it feel like?
We excise the lump
How do we treat fatty necrosis?
Approximately 1 in 8 women in the U.S.
How common is breast cancer?
BRCA 1 or BRCA 2
Mutations of what genes increase your risk of breast cancer?
Orange peel skin
Depression/Bulge in skin
Change in nipple direction
Non-healing sore on breast or nipple
What are the signs/symptoms of breast cancer?
Histopathology and Location (Ductal Carcinoma which occurs in epithelial cell slining ducts. Lobular carcinoma which occurs in the milk secreting glands.)
Receptor Cells (ER Positive)
Human Epidermal Growth Factor 2 -positive (HER2+)
Triple Negative (Frequenty associated with genetic factors)
Genetics (BRCA1 and BRCA)
What are the 5 classification systems of breast cancers?
What form of breast cancer is the most common?
What form of breast cancer has the highest cure rate?
75%. It means they have increased growth rate in response to estrogen.
How many breast cancers are ER Positive? What are the implications of this?
65%. It means they have increased grwoth rate in response to progesterone.
Of the ER Positive cancers, how many are PR postive? What does this mean?
Which factor when positive indicates an aggressive cancer?
10% of cancers. They lack estrogen and progesterone receptors and do not express the HER2 Protein
What are triple negative breast cancers?
How do we diagnose breast cancer?
Lymph Node Resection
How do we manage breast cancer?
"Lump" and surrounding tissue removed under local anesthesia.
What is a lumpectomy?
: Most common. Done daily for five days up to 6 weeks.
: Less common, less effective. radioactive pellets are inserted.
Compare and contrast external and internal beam radiation for breast cancer.
Purported to strengthen boney matrices and perhaps limit fracture risk.
What are bisphosphonates used for?
Subcutaneous injection for osteoporosis
What is Denosumab used for?
: Breast removal
: Breast, nipple, aerola
: Breast, nipple, areola, and axillary dissection to remove lymph nodes.
: Breast and major muscles of chest wall.
Define these types of masectomys
Hormone therapy. used for up to five years after initial treatment. Modulates estrogen receptors. Competitive inhibition of estrogen.
What is Tamoxifen used for?
Inhibits estrogen synthesis. Used only in postmenopausal women.
NOT utilized for pre-menopausal.
What is Aromatase Inhibitors?
Used for women with HER2-positive breast cancer. Reduces risk of recurrence.
This is a standard treatment along with adjuvant (after-surgery) chemotherapy.
What is Herceptin used for?
Typically no nausea and no hair loss.
Side effects do include heart injury and lung injury though.
What are the benefits of herceptin over chemotherapy?
Given for metastatic cancer if herceptin fails
What is Tykerb?
Maintain recommended body weight
Exercising for a minimum of 30 minutes most days of the week
Having children before 30
Avoid endocrine disruptors
Reduce alcohol consumption
Consume diet rich in cruciferous vegetables and other sources of Indole-3 carbinol (I3C)
Consume sources of lycopene
Drink green tea
Reduce exposure to exogenous estrogens and xenoestrogens
What are the "self care" and "Wellness" things we can do for breast cancer.
Omega 3 Fatty acids
Cruciferous Vegetables (I3C)
List as many things as you can that modulates estrogen metabolism
Poor prognosis compared to other breast cancers.
Responds well to adjuvant chemotherapy.
Triple Negative Breast Cancer has what prognosis? What does it respond well to?
Combining what with conventional therapy doubles response rate to stage IV cancer patients and doubled survival at one year?
Protects hematopoietic precursors from toxic effects of chemo drugs.
It also tends to be impaired in breast cancer patients.
Why does melatonin double the 1 year survival rate of stage IV cancer patients?
Suprresses PGE2 synthesis and tumor growth. Also reduces some infections during chemo and enhances selectivity of chemotherapy.
What are the co-management benefits of glutamine?
Reduced cancer rates at multiple sites.
Low vit D is associated with increased cancer incidence and mortality.
What are the co-management benefits of vitamin D?
What supplement can we give to reduce fatigue and anemia during radiation therapy?
What supplement protects cancer patients from chemotherapy-associated liver toxicity?
They increase it
What are the effects of Grapefruit on breast cancer risk?
Benign overgrowth of the lining of the duct system.
Though benign, COULD be precancerous.
What is Intraductal Papilloma?
Bloody discharge from nipple
Discolored Discharge from old blood
May have lump or thickening in breast
What are the signs/symptoms of intraductal papilloma?
: Mammogram which will show a ball-like lesion in duct
: Wait and see with careful follow up. We could remove it surgically.
How do we diagnose and treat intraductal papilloma?
Milk duct lining breaks down. Stagnant duct contents irritate duct walls. Fibrotic response around irritated tissue.
Ducts leak and an inflammatory repsonse occurs.
What is Mammary Duct Ectasia?
Mimics breast cancer
What are the signs/symptoms of mammary duct ectasia?
Biopsy to diagnose, removal of lump to treat.
What is the diagnostic method and treatment for mammary duct ectasia?
Abnormal section of breast milk
What is Galactorrhea?
Thin, milky-white, watery discharge
Present for a short time or years
Menstrual period is often disturbed.
What are signs and symptoms of galactorrhea?
Abnormal hormone levels
Prescription drugs like antidepressants or tranquilizers
Pituitary gland tumors
What are the diagnostic methods for galactorrhea?
Women over 20 perform monthly SBE
Women 20-40 physical breast exam every 3 years
Over 40, breast exam every year
All women baseline mammogram between age 35-40
Women over 50, yearly mammogram.
What are the ACS guidelines?
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