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PoM II - Final Exam > 02. Breast Disease > Flashcards

02. Breast Disease Flashcards

1
Q

What hormones cause cyclical breast changes?

A

Estrogen & progesterone

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2
Q

What is an independent factor of breast cancer risk?

A

Breast density (4-6x increase in breast cancer risk)

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3
Q

What is a better imaging modality for women with dense breasts?

A

MRI

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4
Q

What are the drawbacks of using MRI for breast imaging?

A

May lead to more interventions for benign conditions; Tricky get insurance coverage

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5
Q

Whatis the approach for analyzing a breast abnormality?

A

Triple test (triple negative)

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6
Q

What are the components of the triple test?

A

Breast exam; Imaging; Tissue sampling (FNA or Core needle bx)

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7
Q

4 Common Benign Breast Diseases

A

Fibrocystic Changes (FCC) including cysts; Fibroadenomas; Mastitis/Abscess; Nipple d/c

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8
Q

Fibrocystic Changes

A

Breast tissue response to cyclic hormonal changes; Changes are benign but frightening; Cyclic pain, nodularity, nipple d/c, microscopic & gross changes

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9
Q

Breast cysts

A

Painful, fluctuant, mobile masses, W/O REDNESS. Can be exquisitely tender; Confirm with U/S

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10
Q

Breast cyst tx

A

Aspirate with 23-25 gauge needle after injecting 1% lidocaine; send fluid to cytology if not clear

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11
Q

Fibroadenoma

A

MC tumon in women over 25; Firm, round, mobile, NONTENDER mass anywhere in breast. Dx with triple test.

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12
Q

Fibroadenoma tx

A

Remove if growing, >3cm, or bothersome

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13
Q

Breast abscess

A

Common in LACTATING women. PAINFUL, hard RED mass. Usually caused by S. aureus. Often chronic or recurrent, esp. retro alveolar.

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14
Q

Breast abscess dx & tx

A

Aspirate to confirm dx; I & D + bx to r/o CA; ABX if needed. During lactation, mechanically empty breast and temporily d/c nursing in affected breast only

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15
Q

Common etiology of milky nipple d/c

A

Lactation, prolactinoma, post-lactational changes

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16
Q

Common etiology of serous, brown, gray, green nipple d/c

A

Fibrocystic changes

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17
Q

Common etiology of bloody, blood-tinged, or SEROUS nipple d/c

A

Intraductal papilloma; CA

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18
Q

Milky, unlateral nipple d/c tx

A

No tx necessary

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19
Q

Milky, bilateral nipple d/c tx

A

If greater than 2 yr since lactation, check plasma prolactin

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20
Q

Bloody nipple d/c tx

A

Excisional bx of draining duct

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21
Q

Paget’s disease of the nipple

A

Rare form of breast CA that begins in the MILK DUCTS and spreads to the skin of the NIPPLE & AREOLA. Accounts for 1% of breast cancer. Breast skin may appear CRUSTED, RED, OR OOZING. Prognosis may be better if NIPPLE CHANGES ARE ONLY SIGN OF BREAST DISEASE and no lump is felt.

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22
Q

Fat necrosis presentation

A

Firm to hard palpable mass that feels like CA and can look like CA on mammogram. Caused by trauma or post-surgical. Usually doesn’t resolve or change. Bx proves non-malignant. Ask pt if she suffered any chest wall trauma. Common in elective reductions.

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23
Q

Mammary Duct Etasia

A

Dilation of the mammary ducts causing unilateral or bilateral d/c (green, black, brown & thick); Benign

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24
Q

Galactocele

A

“milk” tumor or cyst. Tx with fluid aspiration

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25
Q

Cancer in pregnancy

A

Hormone responsive tumors grow rapidly

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26
Q

Mastodynia/Mastalgia

A

Extremely common complaint. 7-10% of breast CA presents with this as only sx. R/O trauma, costochondritis; breast mass; CA; AMI. Left breast pain may be a sign of AMI.

27
Q

Tx of mastalgia

A

Analgesics; warm showers/compresses; supportive bra; evening primrose oil

28
Q

Gynecomastia

A

Do a testicular exam; may be a testicular tumor causing hormonal imbalance leading to breast development, esp. in older men. May also be d/t meds or liver disease.

29
Q

Male Breast CA

A

Ask about breast pain, swelling, mass, family hx of breast and ovarian CA, esp. hx of male breast CA.

30
Q

Risk factors for Male Breast CA

A

Family hx; Klinefelter’s syndrome (XXY); radiation exposure; liver dz; estrogen tx

31
Q

Signs of early breast cancer on mammogram

A

Microcalcifications +/- nonpalpable mass

32
Q

Clinical signs of breast cancer

A

Lump or thickening of breast or axillary LN; Change in breast size/shape; Nipple d/c, inversion, or axis change; Redness of skin, lymphedema

33
Q

Lifetime risk of developing breast cancer

A

1 in 8 by age 85

34
Q

What is the most common way of finding breast cancer?

A

Breast self examination (70%).

35
Q

Bx method for diagnosing breast abnormalities

A

Core biopsy is accepted method

36
Q

DCIS

A

Ductal carcinoma in situ; Bx result that is tx like a cancer. MOST COMMON type of non-invastive breast CA. CONFINED TO DUCTS OF BREASTS. Detected as microcalcifications on mammography. 30% total lifetime risk of developing invasive carcinoma w/o tx.

37
Q

LCIS

A

Lobular carcinoma in situ; Bx result that is NOT TX like a cancer. HIGH RISK MARKER! Sharp increase in # of cells within the milk glands (lobules) of the breast. Carries 30% lifetime risk of invasive carcinoma, but can develop anywhere in breast.

38
Q

IDC

A

Infiltrating Ductal Carcinoma; AKA Invasive ductal carcinoma. Bx result showing ductal cancer. MOST COMMON invasive breast cancer. Begins in milk ducts of breast and penetrates wall of the duct, invading fatty tissue.

39
Q

ILC

A

Infiltrating Lobular Carcinoma; Bx results confirming lobular cancer

40
Q

In what tissue does breast cancer most commonly present?

A

Ductal tissue

41
Q

HER2 Receptors

A

Breast cancer tumor marker that helps ID meds that will work on the tumor, SPECIFICALLY Herceptin (trastuzumab) & predicts response to anthracyline based adjuvant or metastatic tx

42
Q

Single greatest predictor of breast cancer survival

A

The presence or absence of axillary lymph node metastasis.

43
Q

ALND

A

Axillary lymp node dissection - Remove LNs from level 1 & 2 of axilla & look for signs of metastatic disease.

44
Q

ALND adverse effects

A

Significant lymphedema, parathesia, and limited arm mobility; no venipuncture of arm

45
Q

When is ALND required?

A

Inflammatory breast CA & tumors >5cm

46
Q

SLNB

A

Sentinel Lymph Node Biopsy - Sample the one node that drains the breast; much less risk of lymphedema.

47
Q

SLNB indications

A

Small tumors (

48
Q

Most common sites of breast cancer metastases

A

Brain, bone, liver & lung

49
Q

Visceral mets

A

Worse prognosis;

50
Q

Stage IIIA (T3, N1, M0) workup

A

Bone scan, Abdominal pelvis CT, U/S, or MRI; Chest imaging; Head imaging if brain met suspected

51
Q

Who should be referred to genetic counseling? Why?

A

High risk pts. - Risk reduction strategies & tx

52
Q

Breast cancer tx options (general)

A

Local (surgery; radiation) & Systemic (chemo; hormonal therapy)

53
Q

Use of neoadjuvant chemo

A

Before surgery to shrink large tumors to make them operable or to make small tumors eligible for lumpectomy

54
Q

Use of polychemotherapy

A

Infiltrating breast cancer; Usually a 3-4 drug regimen. Never just 1 drug. Improved outcomes in 15 yr recurrence & death rates.

55
Q

Which women see more benefits from polychemotherapy?

A

Younger women benefit more than older women.

56
Q

What is the overall purpose of chemotherapy?

A

Eradicated clinically occult metastases.

57
Q

When is hormonal tx standard adjunct therapy?

A

In all patients with hormone receptor positive breast cancer; prevents breast cells from receiving endogenous estrogen stimulation

58
Q

What SERM is approved for all stages of hormone responsive breast cancer?

A

Tamoxifen

59
Q

What drug can be used for prevention of hormone responsive breast cancer in high risk patients?

A

Tamoxifen

60
Q

What is the standard treatment regimen for Tamoxifen?

A

20 mg/day for 5 yrs after completion of chemo & radiation tx

61
Q

What are side effects of tamoxifen?

A

Hot flashes & increased risk of thromboembolic events & endometrial cancer. Avoid use in smokers and post-menopausal women.

62
Q

Aromatase inhibitors MoA and Use

A

Prevent conversion of androgens to estrogen in postmenopausal women; AIs are recommend adjuvant tx for post-menopausal breast cancer

63
Q

When is radiation therapy indicated?

A

DCIS + lumpectomy + whole breast radiation; Invasive breast cancer + whole breast radiation following chemo; BCT & post-mastectomy indications

64
Q

Most commonly used breast cancer treatment guidelines

A

National Comprehensive Cancer Network (NCCN)

PoM II - Final Exam (12 decks)

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