Causes of Breast Cancer
List of causes of Breast Cancer
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Breast Cancer)
that could possibly cause Breast Cancer includes:
- The cancer can return at the original site. This is called a local recurrence
- The cancer can recur nearby, such as in the chest. This is called a regional recurrence
- The cancer can spread to a distant location in the body, such as lymph nodes, bone marrow, or lungs. This is called a distant recurrence, or a metastasis
More causes:
see full list of causes for Breast cancer
Breast Cancer Causes: Book Excerpts
Breast Cancer as a complication of other conditions:
Other conditions that might have
Breast Cancer as a complication may,
potentially, be an underlying cause of Breast Cancer.
Our database lists the following as having
Breast Cancer as a complication of that condition:
Breast Cancer as a symptom:
Conditions listing Breast Cancer
as a symptom may also be potential underlying causes of Breast Cancer.
Our database lists the following as having
Breast Cancer as a symptom of that condition:
Medications or substances causing Breast Cancer:
The following drugs, medications, substances or toxins are some of the possible
causes of Breast Cancer as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
Read more about medication causes of Breast Cancer
Drug interactions causing Breast Cancer:
When combined, certain drugs, medications, substances or toxins may react
causing Breast Cancer as a symptom.
The list below is incomplete and various other drugs or substances may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Alcohol and Oral contraceptive interaction
- Alcohol and Hormone Replacement Therapy
- Synthetic Conjugated Estrogen and Progestin interaction
- Cenestin and Progestin interaction
- C.E.S and Progestin interaction
- more interactions...»
See full list of 48
drug interactions causing Breast Cancer
Medical news summaries relating to Breast Cancer:
The following medical news items are relevant to causes of Breast Cancer:
Related information on causes of Breast Cancer:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Breast Cancer may be found in:
Causes of Breast Cancer: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Breast Cancer.
Breast Pain & Discharge:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Breast pain
-
Fibrocystic change
–Most common benign breast condition
–Clinically present in 50% and histologically
in 90% of women
-
Mastitis
–Associated with lactation
-
Extramammary causes of pain (e.g., cervical radiculitis, costochondritis, herpes zoster, angina)
-
Breast cancer
–Occurs in 1/9 women (lifetime risk)
-
Cyst
-
Breast abscess
-
Unilateral or bilateral gynecomastia
-
Phylloides tumor
-
Intraductal papilloma
-
Fat necrosis
-
Trauma
-
Fibroadenoma
-
Lipoma
-
Pregnancy
Breast discharge
-
Duct ectasia
-
Galactorrhea
-
Mondor's disease
-
Chronic nipple stimulation
-
Pregnancy
-
Hypothyroidism
-
Sarcoidosis
-
Systemic lupus erythematosus
-
Cirrhosis or other hepatic disease
-
Breast cancer
–Occurs in 1/9 women (lifetime risk)
-
Intraductal papilloma
-
Fibrocystic change
-
Medications (e.g., phenothiazines, metoclopramide, tricyclic antidepressants, reserpine, opiates, cimetidine, androgens)
-
Hypothalamic and pituitary abnormalities (e.g., prolactinoma, acromegaly, empty sella syndrome)
-
Pseudocyesis
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Nipple discharge:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Breast abscess
Breast abscess, most common in breast-feeding women, may produce a thick, purulent discharge from a cracked nipple or infected duct. Associated findings include an abrupt onset of a high fever with chills; breast pain, tenderness, and erythema; a palpable soft nodule or generalized induration; and possibly, nipple retraction.
Breast cancer
Breast cancer may cause bloody, watery, or purulent discharge from a normal-appearing nipple. Characteristic findings include a hard, irregular, fixed lump; erythema; dimpling; peau d’orange; changes in contour; nipple deviation, flattening, or retraction; axillary lymphadenopathy; and, possibly, breast pain.
Choriocarcinoma
Galactorrhea (a white or grayish milky discharge) may result from this highly malignant neoplasm, which can follow pregnancy. Other characteristics include persistent uterine bleeding and bogginess after delivery or curettage and vaginal masses.
Intraductal papilloma
Intraductal papilloma is the primary cause of nipple discharge in the nonpregnant, non–breast-feeding woman. Unilateral serous, serosanguineous, or bloody nipple discharge — usually from only one duct — is its predominant sign. Discharge may be intermittent or profuse and constant and can usually be stimulated by gentle pressure around the areola. Subareolar nodules, breast pain, and tenderness may occur.
Mammary duct ectasia
A thick, sticky, grayish discharge from multiple ducts may be the first sign of mammary duct ectasia. The discharge may be bilateral and is usually spontaneous. Other findings include a rubbery, poorly delineated lump beneath the areola, with a blue-green discoloration of the overlying skin; nipple retraction; and redness, swelling, tenderness, and burning pain in the areola and nipple.
Paget’s disease
With Paget’s disease, serous or bloody discharge emits from denuded skin on the nipple, which is red, intensely itchy and, possibly, eroded or excoriated. The discharge is usually unilateral.
Prolactin-secreting pituitary tumor
Bilateral galactorrhea may occur with prolactin-secreting pituitary tumor. Other findings include amenorrhea, infertility, decreased libido and vaginal secretions, headaches, and blindness.
Proliferative (fibrocystic) breast disease
Proliferative breast disease is a benign disorder that occasionally causes a bilateral clear, milky, or straw-colored discharge, which is rarely purulent or bloody. Multiple round, soft, tender nodules are usually palpable in both breasts, although they may occur singly. Usually, nodules are mobile and are located in the upper outer quadrant. Nodule size, tenderness, and discharge increase during the luteal phase of the menstrual cycle. Symptoms then regress after menses.
Other causes
Drugs
Galactorrhea can be caused by psychotropic agents, particularly phenothiazines and tricyclic antidepressants; some antihypertensives (reserpine and methyldopa); hormonal contraceptives; cimetidine; metoclopramide; and verapamil.
Surgery
Chest wall surgery may stimulate the thoracic nerves, causing intermittent bilateral galactorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Nipple retraction:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Breast abscess
Breast abscess, most common in breast-feeding women, occasionally produces unilateral nipple retraction. More common findings include a high fever with chills; breast pain, erythema, and tenderness; breast induration or a soft mass; and cracked, sore nipples, possibly with a purulent discharge.
Breast cancer
Unilateral nipple retraction is commonly accompanied by a hard, fixed, nontender nodule beneath the areola as well as other breast nodules. Other nipple changes include itching, burning, erosion, and watery or bloody discharge. Breast changes commonly include dimpling, altered contour, peau d’orange, ulceration, tenderness (possibly pain), redness, and warmth. Axillary lymph nodes may be enlarged.
Mammary duct ectasia
Nipple retraction commonly occurs along with a poorly defined, rubbery nodule beneath the areola, with a blue-green skin discoloration; areolar burning, itching, swelling, tenderness, and erythema; and nipple pain with a thick, sticky, grayish, multiductal discharge.
Mastitis
Nipple retraction, deviation, cracking, or flattening may occur in mastitis with a firm and indurated or tender, flocculent, discrete breast nodule; warmth; erythema; tenderness; and edema. Fatigue, high fevers, and chills may also be present.
Other causes
Surgery
Previous breast surgery may cause underlying scarring and retraction.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Peau d'orange:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Breast abscess
Usually affecting lactating women with milk stasis, breast abscess causes peau d’orange, malaise, breast tenderness and erythema, and a sudden fever that may be accompanied by shaking chills. A cracked nipple may produce a purulent discharge, and an indurated or palpable soft mass may be present.
Breast cancer
Advanced breast cancer is the most likely cause of peau d’orange, which usually begins in the dependent part of the breast or the areola. Palpation typically reveals a firm, immobile mass that adheres to the skin above the area of peau d’orange. Inspection of the breasts may reveal changes in contour, size, or symmetry. Inspection of the nipples may reveal deviation, erosion, retraction, and a thin and watery, bloody, or purulent discharge. The patient may report a burning and itching sensation in the nipples as well as a sensation of warmth or heat in the breast. Breast pain may occur, but it isn’t a reliable indicator of cancer.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Breast nodule [Breast lump]:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Adenofibroma. The extremely mobile or “slippery” feel of this benign neoplasm helps distinguish it from other breast nodules. The nodule usually occurs singly and characteristically feels firm, elastic, and round or lobular, with well-defined margins. It doesn't cause pain or tenderness, can vary from pinhead size to very large, commonly grows rapidly, and usually lies around the nipple or on the lateral side of the upper outer quadrant.
❑ Areolar gland abscess. Areolar gland abscess is a tender, palpable mass on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever may also be pres-ent.
❑ Breast abscess. A localized, hot, tender, fluctuant mass with erythema and peau d'orange typifies an acute abscess. Associated signs and symptoms include fever, chills, malaise, and generalized discomfort. With a chronic abscess, the nodule is nontender, irregular, and firm and may feel like a thick wall of fibrous tissue. It's commonly accompanied by skin dimpling, peau d'orange, nipple retraction and, sometimes, axillary lymphadenopathy.
❑ Breast cancer. A hard, poorly delineated nodule that's fixed to the skin or underlying tissue suggests breast cancer. Malignant nodules typically cause breast dimpling, nipple deviation or retraction, or flattening of the nipple or breast contour. Between 40% and 50% of malignant nodules occur in the upper outer quadrant.
Nodules usually occur singly, although satellite nodules may surround the main one. They're usually nontender. Nipple discharge may be serous or bloody. (A bloody nipple discharge in the presence of a nodule is a classic sign of breast cancer.) Additional findings include edema (peau d'orange) of the skin overlying the mass, erythema, tenderness, and axillary lymphadenopathy. A breast ulcer may occur as a late sign. Breast pain, an unreliable symptom, may be present.
❑ Fibrocystic breast disease. The most common cause of breast nodules, this fibrocystic condition produces smooth, round, slightly elastic nodules, which increase in size and tenderness just before menstruation. The nodules may occur in fine, granular clusters in both breasts or as widespread, well-defined lumps of varying sizes. A thickening of adjacent tissue may be palpable. Cystic nodules are mobile, which helps differentiate them from malignant ones. Because cystic nodules aren't fixed to underlying breast tissue, they don't pro- duce retraction signs, such as nipple deviation or dimpling. Signs and symptoms of premenstrual syndrome — including headache, irritability, bloating, nausea, vomiting, and abdominal cramping — may also be present.
❑ Mammary duct ectasia. The rubbery breast nodule in mammary duct ectasia, a menopausal or postmenopausal disorder, usually lies under the areola. It's commonly accompanied by transient pain, itching, tenderness, and erythema of the areola; thick, sticky, multicolored nipple discharge from multiple ducts; and nipple retraction. The skin overlying the mass may be bluish green or exhibit peau d'orange. Axillary lymphadenopathy is possible.
❑ Mastitis. With mastitis, breast nodules feel firm and indurated or tender, flocculent, and discrete. Gentle palpation defines the area of maximum purulent accumulation. Skin dimpling and nipple deviation, retraction, or flattening may be present, and the nipple may show a crack or abrasion. Accompanying signs and symptoms include breast warmth, erythema, tenderness, and peau d'orange as well as a high fever, chills, malaise, and fatigue.
❑ Paget's disease. Paget's disease is a slow-growing intraductal carcinoma that begins as a scaling, eczematoid unilateral nipple lesion. The nipple later becomes reddened and excoriated and may eventually be completely destroyed. The process extends along the skin as well as in the ducts, usually progressing to a deep-seated mass.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Introduction: Malignant Neoplasms:
What causes cancer?
(Professional Guide to Diseases (Eighth Edition))
Researchers have found that cancer develops from mutations within the genes of cells. Thus, cancer is a genetic disease. Cancer susceptibility genes are of two types. Some are oncogenes, which activate cell division and influence embryonic development, and some are tumor suppressor genes, which halt cell division.
These genes are typically found in normal human cells, but certain kinds of mutations may transform the normal cells. Inherited defects may cause a genetic mutation, whereas exposure to a carcinogen may cause an acquired mutation. Current evidence indicates that carcinogenesis results from a complex interaction of carcinogens and accumulated mutations in several genes.
In animal studies of the ability of viruses to transform cells, some human viruses exhibit carcinogenic potential. For example, the Epstein-Barr virus, the cause of infectious mononucleosis, has been linked to Burkitt's lymphoma and nasopharyngeal cancer.
High-frequency radiation, such as ultraviolet and ionizing radiation, damages the genetic material known as deoxyribonucleic acid (DNA), possibly inducing genetically transferable abnormalities. Other factors, such as a person's tissue type and hormonal status, interact to potentiate radiation's carcinogenic effect. Examples of substances that may damage DNA and induce carcinogenesis include:
❑alkylating agents — leukemia
❑aromatic hydrocarbons and benzopyrene (from polluted air) — lung cancer
❑asbestos — mesothelioma of the lung
❑tobacco — cancer of the lung, oral cavity and upper airways, esophagus, pancreas, kidneys, and bladder
❑vinyl chloride — angiosarcoma of the liver.
Diet has also been implicated, especially in the development of GI cancer as a result of a high animal fat diet. Additives composed of nitrates and certain methods of food preparation — particularly charbroiling — are also recognized factors.
The role of hormones in carcinogenesis is still controversial, but it seems that excessive use of some hormones, especially estrogen, produces cancer in animals. Also, the synthetic estrogen diethylstilbestrol causes vaginal cancer in some daughters of women who were treated with it. It's unclear, however, whether changes in human hormonal balance retard or stimulate cancer development.
Some forms of cancer and precancerous lesions result from genetic predisposition either directly (as in Wilms' tumor and retinoblastoma) or indirectly (in association with inherited conditions such as Down syndrome or immunodeficiency diseases). Expressed as autosomal recessive, X-linked, or autosomal dominant disorders, their common characteristics include:
❑early onset of malignant disease
❑increased incidence of bilateral cancer in paired organs (breasts, adrenal glands, kidneys, and eighth cranial nerve [acoustic neuroma])
❑increased incidence of multiple primary malignancies in nonpaired organs
❑abnormal chromosome complement in tumor cells.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Breast cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The cause of breast cancer isn't known, but its high incidence in women implicates estrogen.
Certain predisposing factors are clear; women at high risk include those who have a family history of breast cancer, particularly first-degree relatives (mother, sister, and maternal aunt).
Other women at high risk include those who:
❑have long menstrual cycles or began menses early (before age 12) or menopause late (after age 55)
❑have taken hormonal contraceptives
❑used hormone replacement therapy for more than 5 years
❑who took diethylstilbestrol to prevent miscarriage
❑have never been pregnant
❑were first pregnant after age 30
❑have had unilateral breast cancer
❑have had ovarian cancer — particularly at a young age
❑were exposed to low-level ionizing radiation.
Recently, scientists have discovered the BRCA1 and BRCA2 genes. Mutations in these genes are thought to be responsible for less than 10% of breast cancers. However, these discoveries have made genetic predisposition testing an option for women at high risk for breast cancer.
Women at lower risk include those who:
❑were pregnant before age 20
❑have had multiple pregnancies
❑are Native American or Asian.
Most breast cancer deaths occur in women age 50 and older (84% of cases), and 77% of new breast cancer cases occur in this age-group. However, it may develop any time after puberty. It occurs in men, but rarely; male cases of breast cancer account for less than 1% of all cases.
The 5-year survival rate for localized breast cancer has improved because of earlier diagnosis and the variety of treatments now available. According to the most recent data, mortality rates continue to decline in White women and, for the first time, are also declining in younger Black women. Lymph node involvement is the most valuable prognostic predictor. With adjuvant therapy, 70% to 75% of women with negative nodes will survive 10 years or more compared with 20% to 25% of women with positive nodes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Primary tumors of the spinal cord may be extramedullary (occurring outside the spinal cord) or intramedullary (occurring within the cord itself). Extramedullary tumors may be intradural (meningiomas and schwannomas), which account for 60% of all primary malignant spinal cord neoplasms, or extradural (metastatic tumors from breasts, lungs, prostate, leukemia, or lymphomas), which account for 25% of these malignant neoplasms.
Intramedullary tumors, or gliomas (astrocytomas or ependymomas), are comparatively rare, accounting for only about 10%. In children, they're low-grade astrocytomas.
Spinal cord tumors are rare compared with intracranial tumors (ratio of 1:4). They occur equally in men and women, with the exception of meningiomas, which occur mostly in women. Spinal cord tumors can occur anywhere along the length of the cord or its roots.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Mastitis and breast engorgement:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Mastitis develops when a pathogen that typically originates in the nursing infant’s nose or pharynx invades breast tissue through a fissured or cracked nipple and disrupts normal lactation. The most common pathogen of this type is Staphylococcus aureus; less frequently, it’s S. epidermidis or beta-hemolytic streptococci. Rarely, mastitis may result from disseminated tuberculosis or the mumps virus. Predisposing factors include a fissure or abrasion on the nipple; blocked milk ducts; and an incomplete let-down reflex, usually due to emotional trauma. Blocked milk ducts can result from a tight bra or prolonged intervals between breast-feedings. Causes of breast engorgement include venous and lymphatic stasis, and alveolar milk accumulation. (See Physiology of lactation, page 982.)
Mastitis occurs postpartum in about 1% of pregnant women, mainly in primiparas who are breast-feeding. It occurs occasionally in nonlactating females and rarely in males. All breast-feeding mothers develop some degree of engorgement, which isn’t an infectious process.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Nipple discharge:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Breast abscess
This disorder, most common in breast-feeding women, may produce a thick, purulent discharge from a cracked nipple or infected duct. Associated findings include abrupt onset of high fever with chills; breast pain, tenderness, and erythema; a palpable soft nodule or generalized induration; and possibly, nipple retraction.
Breast cancer
This may cause bloody, watery, or purulent discharge from a normal-appearing nipple. Characteristic findings include a hard, irregular, fixed lump; erythema; dimpling; peau d’orange; changes in contour; nipple deviation, flattening, or retraction; axillary lymphadenopathy; and possibly, breast pain.
Choriocarcinoma
Galactorrhea (a white or grayish milky discharge) may result from this highly malignant neoplasm, which can follow pregnancy. Other characteristics include persistent uterine bleeding and bogginess after delivery or curettage, and vaginal masses.
Herpes zoster
This virus can stimulate the thoracic nerves, causing bilateral, spontaneous, intermittent galactorrhea. Other characteristics include shooting or burning pain, eruption of small red nodules or vesicles on the thorax and possibly the arms and legs, pruritus and paresthesia or hyperesthesia in affected areas, headache, and fever and malaise.
Hypothyroidism
This disorder occasionally causes galactorrhea. Related findings include bradycardia; weight gain despite anorexia; decreased mentation; periorbital edema; menorrhagia; constipation; puffy face, hands, and feet; brittle, sparse hair; and dry, doughy, pale, cool skin.
Intraductal papilloma
This disorder is the primary cause of nipple discharge in the nonpregnant, non–breast-feeding woman. Unilateral serous, serosanguineous, or bloody nipple discharge—usually from only one duct—is its predominant sign. Discharge may be intermittent or profuse and constant, and can often be stimulated by gentle pressure around the areola. Subareolar nodules, breast pain, and tenderness may occur.
Mammary duct ectasia
A thick, sticky, grayish discharge from multiple ducts may be the first sign of this disorder. The discharge may be bilateral and is usually spontaneous. Other findings include a rubbery, poorly delineated lump beneath the areola, with a blue-green discoloration of the overlying skin; nipple retraction; and redness, swelling, tenderness, and burning pain in the areola and nipple.
Paget’s disease
With this disorder, serous or bloody discharge emits from denuded skin on the nipple, which is red, intensely itchy and, possibly, eroded or excoriated. The discharge is usually unilateral.
Prolactin-secreting pituitary tumor
Bilateral galactorrhea may occur with this tumor. Other findings include amenorrhea, infertility, decreased libido and vaginal secretions, headaches, and blindness.
Proliferative (fibrocystic) breast disease
This benign disorder occasionally causes a bilateral clear, milky, or straw-colored discharge, which is rarely purulent or bloody. Multiple round, soft, tender nodules are usually palpable in both breasts, although they may occur singly. Usually, nodules are mobile and are located in the upper outer quadrant. Nodule size, tenderness, and discharge increase during the luteal phase of the menstrual cycle. Symptoms then regress after menses.
Trauma
Bilateral galactorrhea can result from trauma to the breasts.
Other causes
Drugs
Galactorrhea can be caused by psychotropic agents, particularly phenothiazines and tricyclic antidepressants; some antihypertensives (reserpine and methyldopa); hormonal contraceptives; cimetidine; metoclopramide; and verapamil.
Surgery
Chest wall surgery may stimulate the thoracic nerves, causing intermittent bilateral galactorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nipple retraction:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Breast abscess
This disorder, most common in breast-feeding women, occasionally produces unilateral nipple retraction. More common findings include high fever with chills; breast pain, erythema, and tenderness; breast induration or soft mass; and cracked, sore nipples, possibly with purulent discharge.
Breast cancer
Unilateral nipple retraction is commonly accompanied by a hard, fixed, nontender nodule beneath the areola, as well as other breast nodules. Other nipple changes include itching, burning, erosion, and watery or bloody discharge. Breast changes commonly include dimpling, altered contour, peau d’orange, ulceration, tenderness (possibly pain), redness, and warmth. Axillary lymph nodes may be enlarged.
Mammary duct ectasia
Nipple retraction commonly occurs along with a poorly defined, rubbery nodule beneath the areola, with a blue-green skin discoloration; areolar burning, itching, swelling, tenderness, and erythema; and nipple pain with a thick, sticky, grayish, multiductal discharge.
Mastitis
Nipple retraction, deviation, cracking, or flattening may occur in this disorder with a firm and indurated or tender, flocculent, discrete breast nodule, warmth, erythema, tenderness, and edema. Fatigue, high fevers, and chills may also be present.
Other causes
Surgery
Previous breast surgery may cause underlying scarring and retraction.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Peau d'orange:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Breast abscess
Usually affecting lactating women with milk stasis, this infectious disorder causes peau d’orange, malaise, breast tenderness and erythema, and a sudden fever that may be accompanied by shaking chills. A cracked nipple may produce a purulent discharge, and an indurated or palpable soft mass may be present.
Breast cancer
Advanced breast cancer is the most likely cause of peau d’orange, which usually begins in the dependent part of the breast or the areola. Palpation typically reveals a firm, immobile mass that adheres to the skin above the area of peau d’orange. Inspection of the breasts may reveal changes in contour, size, or symmetry. Inspection of the nipples may reveal deviation, erosion, retraction, and a thin and watery, bloody, or purulent discharge. The patient may report a burning and itching sensation in the nipples as well as a sensation of warmth or heat in the breast. Breast pain may occur, but it isn’t a reliable indicator of cancer.
Erysipelas
This streptococcal infection causes a well-demarcated erythematous elevated area, typically with a peau d’orange texture. Pain, warmth, and generalized signs and symptoms, such as fever and fatigue, also occur.
Graves’ disease
Patients with this thyroid disorder may exhibit raised, thickened, hyperpigmented, peau d’orange-like areas that tend to coalesce. Other common signs and symptoms of hyperthyroidism include weight loss, palpitations, anxiety, heat intolerance, tremor, and amenorrhea.
Tuberculosis of the axillary lymph nodes
Peau d’orange occasionally occurs as one or more axillary lymph nodes enlarge.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Breast nodule [Breast lump]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Adenofibroma
The extremely mobile or “slippery” feel of an adenofibroma—a benign neoplasm—helps distinguish it from other breast nodules. The nodule usually occurs singly and characteristically feels firm, elastic, and round or lobular, with well-defined margins. It doesn’t cause pain or tenderness, can vary from pinhead size to very large, often grows rapidly, and usually is located around the nipple or on the lateral side of the upper outer quadrant.
Areolar gland abscess
A tender, palpable abscess on the periphery of the areola caused by an infection and inflammation of Montgomery’s glands. Fever may also be present.
Breast abscess
A localized, hot, tender, fluctuant mass with erythema and peau d’orange typifies an acute abscess. Associated signs and symptoms include fever, chills, malaise, and generalized discomfort. In a chronic abscess, the nodule is nontender, irregular, and firm and may feel like a thick wall of fibrous tissue. It’s commonly accompanied by skin dimpling, peau d’orange, and nipple retraction and sometimes by axillary lymphadenopathy.
Breast cancer
A hard, poorly delineated nodule that’s fixed to the skin or underlying tissue suggests breast cancer. Malignant nodules commonly cause breast dimpling, nipple deviation or retraction, or flattening of the nipple or breast contour. Between 40% and 50% of malignant nodules occur in the upper outer quadrant of the breast.
Malignant nodules are usually nontender and occur singly, although satellite nodules may surround the main one. Nipple discharge may be serous or bloody. (A bloody nipple discharge in the presence of a nodule is a classic sign of breast cancer.) Additional findings may include edema and dimpling (peau d’orange) of the skin overlying the mass, erythema, accentuated veins, and axillary lymphadenopathy. A breast ulcer may occur as a late sign. Breast pain, an unreliable symptom, may be present.
Fibrocystic breast disease
The most common cause of breast nodules, this condition produces smooth, round, slightly elastic nodules that increase in size and tenderness just before menstruation. The nodules may occur in fine, granular clusters in both breasts or as widespread, well-defined lumps of varying sizes. A thickening of adjacent tissue may be palpable. Cystic nodules are mobile, which helps differentiate them from malignant ones. Because cystic nodules aren’t fixed to underlying breast tissue, they don’t produce retraction signs, such as nipple deviation or dimpling. A clear, watery (serous), or sticky nipple discharge may appear in one or both breasts. Signs and symptoms of premenstrual syndrome—including headache, irritability, bloating, nausea, vomiting, and abdominal cramping—may also be present.
Intraductal papilloma
Intraductal papilloma is a small, benign nodule that grows in the lactiferous ducts. A single larger nodule can sometimes be palpated, but multiple diffuse nodules usually resist palpation. Soft and poorly delineated papillomas usually lie in the subareolar margin. The primary sign of this disorder is a serous or bloody nipple discharge, typically from only one duct. Breast pain and tenderness may also occur.
Mammary duct ectasia
This disorder, which affects menopausal or postmenopausal women, produces a rubbery breast nodule that usually lies under the areola. It’s commonly accompanied by transient pain, itching, tenderness, and erythema of the areola; a thick, sticky, multicolored nipple discharge from multiple ducts; nipple retraction; and a bluish green discoloration or peau d’orange on the skin overlying the mass. Axillary lymphadenopathy may also occur.
Mastitis
In mastitis, breast nodules feel firm and indurated or tender, flocculent, and discrete. Gentle palpation defines the area of maximum purulent accumulation. Skin dimpling and nipple deviation, retraction, or flattening may be present, and the nipple may show a crack or abrasion. Accompanying signs and symptoms include breast warmth, erythema, tenderness, and peau d’orange as well as high fever, chills, malaise, and fatigue.
Nipple adenoma
Although similar in symptoms to Paget’s disease, adenomas rarely produce a deep-seated mass.
Paget’s disease
Paget’s disease is a slow-growing intraductal carcinoma that begins as a scaling, eczematoid nipple lesion on one side. The nipple later becomes reddened and excoriated and may eventually be completely destroyed. The process extends along the skin as well as in the ducts, usually progressing to a deep-seated mass.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Breast Mass/Discharge:
Differential Overview
(Field Guide to Bedside Diagnosis)
Breast Mass
❑ Fibrocystic disease
❑ Fibroadenoma
❑ Breast cancer
❑ Intraductal papilloma
❑ Mastitis
❑ Hematoma
❑ Thrombophlebitis
❑ Galactocele
Breast Discharge
❑ Drugs
❑ Postpartum lactation
❑ Prolactin-secreting pituitary adenoma
❑ Intraductal papilloma
❑ Fibrocystic disease
❑ Breast cancer
❑ Mammary duct ectasia
❑ Repeated nipple stimulation
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Breast cancer:
Causes
(Handbook of Diseases)
The cause of breast cancer is unknown, but its high incidence in women implicates estrogen. Certain predisposing factors are clear; women at high risk include those who:
❑ have a family history of breast cancer
❑ have long menses; began menses early or menopause late
❑ have never been pregnant
❑ were first pregnant after age 31
❑ have had unilateral breast cancer
❑ have had endometrial or ovarian cancer
❑ have been exposed to low-level ionizing radiation.
Many other predisposing factors have been investigated, including estrogen therapy, antihypertensives, high-fat diet, obesity, and fibrocystic disease of the breasts.
Women at lower risk include those who:
❑ were pregnant before age 20
❑ have had multiple pregnancies
❑ are Indian or Asian.
Pathophysiology
Breast cancer is more common in the left breast than in the right and more common in the upper outer quadrant. Growth rates vary. Theoretically, slow-growing breast cancer may take up to 8 years to become palpable at 1 cm in size. It spreads by way of the lymphatic system and the bloodstream, through the right side of the heart to the lungs and, eventually, to the other breast, the chest wall, liver, bone, and brain.
Many refer to the estimated growth rate of breast cancer as doubling time, or the time it takes the malignant cells to double in number. Survival time for breast cancer is based on tumor size and spread; the number of involved nodes is the single most important factor in predicting survival time.
Classified by histologic appearance and location of the lesion, breast cancer may be:
❑ adenocarcinoma — arising from the epithelium
❑ intraductal — developing within the ducts (includes Paget’s disease)
❑ infiltrating — occurring in parenchymatous tissue of the breast
❑ inflammatory (rare) — reflecting rapid tumor growth, in which the overlying skin becomes edematous, inflamed, and indurated
❑ lobular carcinoma in situ — reflecting tumor growth involving lobes of glandular tissue
❑ medullary or circumscribed — a large tumor with a rapid growth rate.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Nipple discharge:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Breast abscess
A breast abscess, most common in breast-feeding women, may produce a thick, purulent discharge from a cracked nipple or an infected duct. Associated findings include abrupt onset of high fever with chills; breast pain, tenderness, and erythema; a palpable soft nodule or generalized induration; and, possibly, nipple retraction.
Breast cancer
Breast cancer may cause bloody, watery, or purulent discharge from a normal-appearing nipple. Characteristic findings include a hard, irregular, fixed lump; erythema; dimpling; peau d’orange; changes in contour; nipple deviation, flattening, or retraction; axillary lymphadenopathy; and, possibly, breast pain.
Choriocarcinoma
Galactorrhea (a white or grayish milky discharge) may result from choriocarcinoma, a highly malignant neoplasm that can follow pregnancy. Other characteristics of choriocarcinoma include persistent uterine bleeding and bogginess after delivery or curettage, and vaginal masses.
Herpes zoster
Herpes zoster can stimulate the thoracic nerves, causing bilateral, spontaneous, intermittent galactorrhea. Other characteristics include shooting or burning pain, eruption of small red nodules or vesicles on the thorax and possibly the arms and legs, pruritus and paresthesia or hyperesthesia in affected areas, headache, and fever and malaise.
Intraductal papilloma
Intraductal papilloma is the primary cause of nipple discharge in the nonpregnant, non-breast-feeding woman. Unilateral serous, serosanguineous, or bloody nipple discharge — usually from only one duct — is its predominant sign. Discharge may be intermittent or profuse and constant, and can usually be stimulated by gentle pressure around the areola. Subareolar nodules, breast pain, and tenderness may occur.
Mammary duct ectasia
A thick, sticky, grayish discharge from multiple ducts may be the first sign of mammary duct ectasia. The discharge may be bilateral and is usually spontaneous. Other findings include a rubbery, poorly delineated lump beneath the areola, with a blue-green discoloration of the overlying skin; nipple retraction; and redness, swelling, tenderness, and burning pain in the areola and nipple.
Paget’s disease
With Paget’s disease, serous or bloody discharge emits from denuded skin on the nipple, which is red, intensely itchy and, possibly, eroded or excoriated. The discharge is usually unilateral.
Prolactin-secreting pituitary tumor
Bilateral galactorrhea may occur with this tumor. Other findings include amenorrhea, infertility, decreased libido and vaginal secretions, headaches, and blindness.
Proliferative (fibrocystic) breast disease
Proliferative (fibrocystic) breast disease is a benign disorder that occasionally causes a bilateral clear, milky, or straw-colored discharge, which is rarely purulent or bloody. Multiple round, soft, tender nodules are usually palpable in both breasts, although they may occur singly. Usually, nodules are mobile and are located in the upper outer quadrant. Nodule size, tenderness, and discharge increase during the luteal phase of the menstrual cycle. Symptoms then regress after menses.
Trauma
Bilateral galactorrhea can result from trauma to the breasts. Depending on the cause and severity of the chest trauma, the patient may also have chest pain, dyspnea, bruising, flail chest, cardiac tamponade, pulmonary artery tears, ventricular rupture, shock, and bronchial, tracheal, or esophageal tears or rupture.
Other causes
Drugs
Galactorrhea can be caused by psychotropic agents, particularly phenothiazines and tricyclic antidepressants; some antihypertensives (reserpine and methyldopa); hormonal contraceptives; cimetidine; metoclopramide; and verapamil.
Surgery
Chest wall surgery may stimulate the thoracic nerves, causing intermittent bilateral galactorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nipple retraction:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Breast abscess
A breast abscess, most common in breast-feeding women, occasionally produces unilateral nipple retraction. More common findings include high fever with chills; breast pain, erythema, and tenderness; breast induration or soft mass; and cracked, sore nipples, possibly with purulent discharge.
Breast cancer
With breast cancer, unilateral nipple retraction is commonly accompanied by a hard, fixed, nontender nodule beneath the areola, as well as other breast nodules. Other nipple changes include itching, burning, erosion, and watery or bloody discharge. Breast changes commonly include dimpling, altered contour, peau d’orange, ulceration, tenderness (possibly pain), redness, and warmth. Axillary lymph nodes may be enlarged.
Mammary duct ectasia
Nipple retraction commonly occurs in mammary duct ectasia, along with a poorly defined, rubbery nodule beneath the areola, with a blue-green skin discoloration; areolar burning, itching, swelling, tenderness, and erythema; and nipple pain with a thick, sticky, grayish, multiductal discharge.
Mastitis
Nipple retraction, deviation, cracking, or flattening may occur in mastitis, along with a firm and indurated or tender, flocculent, discrete breast nodule; warmth; erythema; tenderness; and edema. Fatigue, high fever, and chills may also be present.
Other causes
Surgery
Previous breast surgery may cause underlying scarring and retraction.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Peau d'orange:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Breast abscess
Usually affecting lactating women with milk stasis, breast abscess is an infectious disorder that causes peau d’orange, malaise, breast tenderness and erythema, and a sudden fever that may be accompanied by shaking chills. A cracked nipple may produce a purulent discharge, and an indurated or palpable soft mass may be present.
Breast cancer
Advanced breast cancer is the most likely cause of peau d’orange, which usually begins in the dependent part of the breast or the areola. Palpation typically reveals a firm, immobile mass that adheres to the skin above the area of peau d’orange. Inspection of the breasts may reveal changes in contour, size, or symmetry. Inspection of the nipples may reveal deviation, erosion, retraction, and a thin and watery, bloody, or purulent discharge. The patient may report a burning and itching sensation in the nipples as well as a sensation of warmth or heat in the breast. Breast pain may occur, but it isn’t a reliable indicator of cancer.
Erysipelas
Erysipelas, a streptococcal infection, causes a well-demarcated, erythematous, elevated area, typically with a peau d’orange texture. Pain, warmth, and generalized signs and symptoms, such as fever and fatigue, also occur.
Graves’ disease
Patients with Graves’ disease (a thyroid disorder) may exhibit raised, thickened, hyperpigmented, peau d’orange–like areas that tend to coalesce. Other common signs and symptoms of hyperthyroidism include weight loss, palpitations, anxiety, heat intolerance, tremor, and amenorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Breast nodule:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Adenofibroma
The extremely mobile or “slippery” feel of an adenofibroma (a benign neoplasm) helps distinguish it from other breast nodules. The nodule usually occurs singly and characteristically feels firm, elastic, and round or lobular, with well-defined margins. It doesn’t cause pain or tenderness, can vary from pinhead size to very large, typically grows rapidly, and usually lies around the nipple or on the lateral side of the upper outer quadrant.
Areolar gland abscess
An areolar gland abscess is characterized by a tender, palpable abscess on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever, local swelling, and drainage may also be present, and the patient may complain of malaise.
Breast abscess
A localized, hot, tender, fluctuant mass with erythema and peau d’orange typifies an acute breast abscess. Associated signs and symptoms include fever, chills, malaise, and generalized discomfort. With a chronic abscess, the nodule is nontender, irregular, and firm and may feel like a thick wall of fibrous tissue. It’s commonly accompanied by skin dimpling, peau d’orange, and nipple retraction and sometimes by axillary lymphadenopathy.
Breast cancer
A hard, poorly delineated nodule that’s fixed to the skin or underlying tissue suggests breast cancer. Malignant nodules commonly cause breast dimpling, nipple deviation or retraction, or flattening of the nipple or breast contour. Between 40% and 50% of malignant nodules occur in the upper outer quadrant.
Nodules usually occur singly, although satellite nodules may surround the main one. They’re usually nontender. Nipple discharge may be serous or bloody. (A bloody nipple discharge in the presence of a nodule is a classic sign of breast cancer.) Additional findings include edema (peau d’orange) of the skin overlying the mass, erythema, tenderness, and axillary lymphadenopathy. A breast ulcer may occur as a late sign. Breast pain, an unreliable symptom, may be present.
Fibrocystic breast disease
The most common cause of breast nodules, fibrocystic breast disease produces smooth, round, slightly elastic nodules, which increase in size and tenderness just before menstruation. The nodules may occur in fine, granular clusters in both breasts or as widespread, well-defined lumps of varying sizes. A thickening of adjacent tissue may be palpable. Cystic nodules are mobile, which helps differentiate them from malignant ones. Because cystic nodules aren’t fixed to underlying breast tissue, they don’t produce retraction signs, such as nipple deviation or dimpling. A clear, watery (serous), or sticky nipple discharge may appear in one or both breasts. Signs and symptoms of premenstrual syndrome — including headache, irritability, bloating, nausea, vomiting, and abdominal cramping — may also be present.
Intraductal papilloma
The tiny nodules of intraductal papilloma (a benign lesion) usually resist palpation. Nodules large enough to be palpated usually occur singly, but they may be multiple and diffuse. Soft and poorly delineated, the nodules usually lie in the subareolar margin. The primary sign of this disorder is serous or bloody nipple discharge, typically from only one duct. Breast pain and tenderness may occur.
Mammary duct ectasia
The rubbery breast nodule in mammary duct ectasia — a menopausal or postmenopausal disorder — usually lies under the areola. It’s commonly accompanied by transient pain, itching, tenderness, and erythema of the areola; thick, sticky, multicolored nipple discharge from multiple ducts; and nipple retraction. The skin overlying the mass may be bluish green or exhibit peau d’orange. Axillary lymphadenopathy is possible.
Mastitis
With mastitis, breast nodules feel firm and indurated or tender, flocculent, and discrete. Gentle palpation defines the area of maximum purulent accumulation. Skin dimpling and nipple deviation, retraction, or flattening may be present, and the nipple may show a crack or abrasion. Accompanying signs and symptoms include breast warmth, erythema, tenderness, and peau d’orange, plus high fever, chills, malaise, and fatigue.
Paget’s disease
In Paget’s disease, the slow-growing intraductal carcinoma begins as a scaling, eczematoid unilateral nipple lesion. The nipple later becomes reddened and excoriated and may eventually be completely destroyed. The process extends along the skin as well as in the ducts, usually progressing to a deep-seated mass.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nipple discharge:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Breast abscess.Breast abscess may produce a thick, purulent discharge from a cracked nipple or infected duct. Associated findings include an abrupt onset of a high fever with chills; breast pain, tenderness, and erythema; a palpable soft nodule or generalized induration; and possibly, nipple retraction.
Breast cancer.Breast cancer may cause bloody, watery, or purulent discharge from a normal-appearing nipple. Characteristic findings include a hard, irregular, fixed lump; erythema; dimpling; peau d'orange; changes in contour; nipple deviation, flattening, or retraction; axillary lymphadenopathy; and, possibly, breast pain.
Choriocarcinoma.Galactorrhea (a white or grayish milky discharge) may result from this highly malignant neoplasm, which can follow pregnancy. Other characteristics include persistent uterine bleeding and bogginess after delivery or curettage and vaginal masses.
Intraductal papilloma.Intraductal papilloma is the primary cause of nipple discharge in the nonpregnant, non–breast-feeding woman. Unilateral serous, serosanguineous, or bloody nipple discharge—usually from only one duct—is its predominant sign. Discharge may be intermittent or profuse and constant and can usually be stimulated by gentle pressure around the areola. Subareolar nodules, breast pain, and tenderness may occur.
Mammary duct ectasia.A thick, sticky, grayish discharge from multiple ducts may be the first sign of mammary duct ectasia. The discharge may be bilateral and is usually spontaneous. Other findings include a rubbery, poorly delineated lump beneath the areola, with a blue-green discoloration of the overlying skin; nipple retraction; and redness, swelling, tenderness, and burning pain in the areola and nipple.
Paget's disease.With Paget's disease, serous or bloody discharge emits from denuded skin on the nipple, which is red, intensely itchy and, possibly, eroded or excoriated. The discharge is usually unilateral.
Prolactin-secreting pituitary tumor.Bilateral galactorrhea may occur with prolactin-secreting pituitary tumor. Other findings include amenorrhea, infertility, decreased libido and vaginal secretions, headaches, and blindness.
Proliferative (fibrocystic) breast disease.Proliferative breast disease occasionally causes a bilateral clear, milky, or straw-colored discharge, which is rarely purulent or bloody. Multiple round, soft, tender nodules are usually palpable in both breasts, although they may occur singly. Usually, nodules are mobile and are located in the upper outer quadrant. Nodule size, tenderness, and discharge increase during the luteal phase of the menstrual cycle. Symptoms then regress after menses.
Other causes
Drugs.Galactorrhea can be caused by psychotropic agents, particularly phenothiazines and tricyclic antidepressants; some antihypertensives (such as reserpine and methyldopa); hormonal contraceptives; cimetidine; metoclopramide; and verapamil.
Surgery.Chest wall surgery may stimulate the thoracic nerves, causing intermittent bilateral galactorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Nipple retraction:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Breast abscess.Breast abscess occasionally produces unilateral nipple retraction. More common findings include a high fever with chills; breast pain, erythema, and tenderness; breast induration or a soft mass; and cracked, sore nipples, possibly with a purulent discharge.
Breast cancer.With breast cancer, unilateral nipple retraction is commonly accompanied by a hard, fixed, nontender nodule beneath the areola as well as other breast nodules. Other nipple changes include itching, burning, erosion, and watery or bloody discharge. Breast changes commonly include dimpling, altered contour, peau d'orange, ulceration, tenderness (possibly pain), redness, and warmth. Axillary lymph nodes may be enlarged.
Mammary duct ectasia.Nipple retraction commonly occurs along with a poorly defined, rubbery nodule beneath the areola, with a blue-green skin discoloration; areolar burning, itching, swelling, tenderness, and erythema; and nipple pain with a thick, sticky, grayish, multiductal discharge.
Mastitis.Nipple retraction, deviation, cracking, or flattening may occur in mastitis with a firm and indurated or tender, flocculent, discrete breast nodule; warmth; erythema; tenderness; and edema. Fatigue, high fevers, and chills may also be present.
Other causes
Surgery.Previous breast surgery may cause underlying scarring and retraction.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Peau d'orange:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Breast abscess.Breast abscess causes peau d'orange, malaise, breast tenderness and erythema, and a sudden fever that may be accompanied by shaking chills. A cracked nipple may produce a purulent discharge, and an indurated or palpable soft mass may be present.
Breast cancer.Advanced breast cancer is the most likely cause of peau d'orange, which usually begins in the dependent part of the breast or the areola. Palpation typically reveals a firm, immobile mass that adheres to the skin above the area of peau d'orange. Inspection of the breasts may reveal changes in contour, size, or symmetry. Inspection of the nipples may reveal deviation, erosion, retraction, and a thin and watery, bloody, or purulent discharge. The patient may report a burning and itching sensation in the nipples as well as a sensation of warmth or heat in the breast. Breast pain may occur, but it isn't a reliable indicator of cancer.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Breast nodule [Breast lump]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Adenofibroma.The extremely mobile or “slippery” feel of this benign neoplasm helps distinguish it from other breast nodules. The nodule usually occurs singly and characteristically feels firm, elastic, and round or lobular, with well-defined margins. It doesn't cause pain or tenderness, can vary from pinhead size to very large, commonly grows rapidly, and usually lies around the nipple or on the lateral side of the upper outer quadrant.
Areolar gland abscess.Areolar gland abscess is a tender, palpable mass on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever may also be present.
Breast abscess.A localized, hot, tender, fluctuant mass with erythema and peau d'orange typifies an acute abscess. Associated signs and symptoms include fever, chills, malaise, and generalized discomfort. With a chronic abscess, the nodule is nontender, irregular, and firm and may feel like a thick wall of fibrous tissue. It's commonly accompanied by skin dimpling, peau d'orange, nipple retraction and, sometimes, axillary lymphadenopathy.
Breast cancer.A hard, poorly delineated nodule that's fixed to the skin orunderlying tissue suggests breast cancer. Malignant nodules typically cause breast dimpling, nipple deviation or retraction, or flattening of the nipple or breast contour. Between 40% and 50% of malignant nodules occur in the upper outer quadrant.
Nodules usually occur singly, although satellite nodules may surround the main one. They're usually nontender. Nipple discharge may be serous or bloody. (A bloody nipple discharge in the presence of a nodule is a classic sign of breast cancer.) Additional findings include edema (peau d'orange) of the skin overlying the mass, erythema, tenderness, and axillary lymphadenopathy. A breast ulcer may occur as a late sign. Breast pain, an unreliable symptom, may be present.
Fibrocystic breast disease.The most common cause of breast nodules, this fibrocystic condition produces smooth, round, slightly elastic nodules, which increase in size and tenderness just before menstruation. The nodules may occur in fine, granular clusters in both breasts or as widespread, well-defined lumps of varying sizes. A thickening of adjacent tissue may be palpable. Cystic nodules are mobile, which helps differentiate them from malignant ones. Because cystic nodules aren't fixed to underlying breast tissue, they don't produce retraction signs, such as nipple deviation or dimpling. Signs and symptoms of premenstrual syndrome—including headache, irritability, bloating, nausea, vomiting, and abdominal cramping—may also be present.
Mammary duct ectasia.The rubbery breast nodule in mammary duct ectasia, a menopausal or postmenopausal disorder, usually lies under the areola. It's commonly accompanied by transient pain, itching, tenderness, and erythema of the areola; thick, sticky, multicolored nipple discharge from multiple ducts; and nipple retraction. The skin overlying the mass may be bluish green or exhibit peau d'orange. Axillary lymphadenopathy is possible.
Mastitis.With mastitis, breast nodules feel firm and indurated or tender, flocculent, and discrete. Gentle palpation defines the area of maximum purulent accumulation. Skin dimpling and nipple deviation, retraction, or flattening may be present, and the nipple may show a crack or abrasion. Accompanying signs and symptoms include breast warmth, erythema, tenderness, and peau d'orange as well as a high fever, chills, malaise, and fatigue.
Paget's disease.Paget's disease is a slow-growing intraductal carcinoma that begins as a scaling, eczematoid unilateral nipple lesion. The nipple later becomes reddened and excoriated and may eventually be completely destroyed. The process extends along the skin as well as in the ducts, usually progressing to a deep-seated mass.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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