19.8 FEMALE MDT

Question 1

-Painful breast masses, Often multiple and bilateral
-often worsens during premenstrual phase of cycle
-Increased risk in women who drink alcohol
-Absence of enlarged or tender lymphadenopathy
–Mammography OR Ultrasound- Used alone when patient is under 30 years old
-Core needle biopsy, All suspicious lesions should be biopsied by a General Surgeon
-NSAIDS for mild to moderate discomfort
Patient education 1) Avoiding trauma 2) Wear supportive brassiere night and day 3) Decreasing dietary fat intake 4) Consider eliminating caffeine 5) Vitamin E, 400IU daily 6) Monthly BSE just after menstruation
-Risk of not detecting breast cancer is higher

Answer 1

Fibrocystic condition AKA “Fibrocystic Changes

Question 2

-Round or ovoid, Rubbery, Discrete, Relatively movable, Nontender mass 1-5 cm in diameter
-Core needle biopsy often recommended
-All breast masses should be referred to General Surgery for further
evaluation and work up
(b) Once confirmed by biopsy, no treatment is usually necessary
(c) Excision may be necessary for large or rapidly growing fibroadenomas
1) Larger than 3-4 cm
2) Rule out phyllodes tumor
a) A rare malignant fibroadenoma like tumor

Answer 2

Fibroadenoma

Question 3

(1) Lesion of the breast
(a) Produces a mass (often accompanied by skin or nipple retraction)
(2) Usually indistinguishable from carcinoma even with imaging studies
(3) Commonly seen after fat injections to augment breast size or fill defects after
breast surgery
(4) Trauma is presumed to be the cause
(5) Ecchymosis is occasionally present
(6) If untreated, the mass gradually disappears
(7) The safest course is to obtain a biopsy
(a) Core needle biopsy is often adequate
(b) Frequently entire mass must be excised to exclude carcinoma
(8) Common after segmental resection, radiation therapy, or flap reconstruction after mastectomy. Also common after MVA
or assualt.

Answer 3

Fat necrosis

Question 4

• Most significant risk factor IS AGE: Risk rises rapidly until early 60s, peaks in 70s, then declines
• BRCA 1, BRCA 2, and other mutations
• Nulliparous or late first pregnancy (after age 30)
• Early menarche (under age 12)/ Late menopause (after age 55)
• Endometrial cancer
  1)Mammography screening Most reliable means of detecting breast cancer before a mass can be palpate.
  2) Most slow growing cancers can be identified by mammography at least two years before they are palpable.
  3) Recommendations on timing and frequency vary by agency.
  a) Age under 40, Not recommended in average risk women
  b) Age 40-49, Shared decision making with patient
  (2 Women who decide to initiate screening in their 40s, suggest screening every two years.
  c) Age 50-74, Recommended every two years, unless prior screenings indicate otherwise
  1) MRI and ultrasound may be useful to those who are at high risk
  (c) Breast self-examination Has not shown to improve survival

Answer 4

Female breast carcinoma