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Surgery final (Sabiston) > 34 - Disease of the breast > Flashcards

34 - Disease of the breast Flashcards

1
Q

What are the 3 types of tissues the breast is made of?

A

glandular epithelium
fibrotic stroma
fatty tissue

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2
Q

What kind of tumors can develop from the following tissues?

  1. fibrotic stroma- ___
  2. fatty tissue- ___
A

fibroadenoma

liposarcoma

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3
Q

Which arteries supply the breast?
Internal ___ artery, and thoraco- ____ artery are the main ones.
Other arteries include the sub___, inter___, lateral ___and others

A 
thoracic 
acromial
scapular
costal
thoracic
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4
Q

Where does the blood drain from in the breast?

A

axillary vein

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5
Q

__% of the lymphatic drainage of the breast is through the __ LN, __% through the ___ LN.

A

75
axillary
25
parasternal

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6
Q

What are the borders of the breast?
___ to the__ arch
the sides- ___ till the mid ___ line

A

clavicle
ribs
sternum
axillary

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7
Q

The axillary LN are classified into 3 levels in relation to the ___ ___ muscle. The higher the level is the ___ the prognosis is.

A

pectoralis minor

worse

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8
Q

Axillary LN levels:

  1. Low- ___ to the muscle
  2. ___ the muscle
  3. High- ___ to the muscle
A

lateral
behind (deep)
medial

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9
Q

When finding a mass in the breast of a woman <30, it is most likely ___

A

fibroadenoma

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10
Q

When finding a mass in the breast of a woman 35-menopause, it is most likely ___ or ___

A

cystic

carcinoma

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11
Q

When finding a mass in the breast of a post menopausal woman, it is most likely ___

A

carcinoma

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12
Q

Prolonged breast feeding has a ___ effect against breast cancer

A

protective

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13
Q

Progesterone and estrogen ___ the risk for breast cancer

A

increase

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14
Q

___ age at menarche and ___ age at menopause together with ___ are all risk factors for breast cancer

A

early
late
nulliparity

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15
Q

The best time for breast physical examination is - days after the last ___. It should be done when the patient is __ and __

A

menstruation
sitting
lying

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16
Q

If the mass in the breast is __, non-___, __, with ___ borders- highly suspected

A

hard
mobile
singular
irregular

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17
Q

The preferred method for breast biopsy is ___ ___ biopsy, which allows to see the architecture, determine the grade and the receptors status

A

core needle

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18
Q

Core needle biopsy is made under ___ (__/__/__)

A

imaging
US
mammograph
MRI

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19
Q

If breast mass is benign- __ screening, if malignant- __ or __

A

routine
surgery
neoadjuvant

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20
Q

FNA is used for ___ breast cancer, or to assess ___

A

multifocal

LN

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21
Q

If the core needle biopsy is unclear (__%)- continue to ____ biopsy. It is important to mark it with __ or ___ seed under US or mammographic study

A

10
excisional
wire
radioactive

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22
Q

Mammographic test is suboptimal for __ and __ women.

A

young

pregnant

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23
Q

US test is useful to differentiate between ___ or __ masses, and is better for __ patients. It is suboptimal for ___ diagnosis

A

solid
cystic
younger
calcifications

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24
Q

MRI has __% FP

A

50

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25
Q

Mammographic test should be performed every - years in women >__ years.

A

1-2

50

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26
Q

Breast MRI is recommended for women >__ years with past breast malignancy/family history/ high risk.

A

30

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27
Q

BI-RADS 1= ___

A

negative- annual screening

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28
Q

BI-RADS 2= ___

A

benign- annual screening

29
Q

BI-RADS 3= ___

A

<2% malignant- short interval follow up (6-months for 2 years)

30
Q

BI-RADS 4= ___

A

2%-95% malignant- biopsy should be performed

31
Q

BI-RADS 5= ___

A

> 95% malignant

32
Q

BI-RADS 6= ___

A

known biopsy- proven malignancy

33
Q

BI- RADS 0= ___

A

incomplete assessment- additional imaging

34
Q

BI-RADS=___

A

Breast Imaging-Reporting and Data System

35
Q

High risk patients are patients with 5 years calculated risk > __%

A

1.7

36
Q

The options for high risk breast cancer patients are one of 3:
___ surveillance
___prevention
prophylactic ___

A

close
chemo
mastectomy

37
Q

Close surveillance in high risk breast cancer patients involves:

  • self ___ examination once a month from the age of 18
  • __ examination by a breast surgeon twice a year, from the age of __
  • ___/___ test once per year form the age of ___
A 
manual
manual
25
MRI/mammographic 
25
38
Q

Prophylactic mastectomy reduces the risk for breast cancer by __%. Recommended for women with ___

A

90

BRCA

39
Q

The most common reason for bloody secretions from the breast is intraductal ___

A

papilloma

40
Q 
Name the benign breast findings:
simple breast \_\_\_
simple \_\_
\_\_ & \_\_
breast infection (\_\_\_)
Fat \_\_\_
\_\_
A 
cyst
fibroadenoma
hamartoma & adenomas
mastitis
necrosis
papilloma
41
Q

The median age for breast cancer diagnosis is ___

A

63

42
Q

How do we classify breast cancer?

  1. non invasive (-)
  2. ___ (most of the cases at diagnosis)
  3. ___ (axillary and supraclavicular LN)
  4. ___
A

in-situ
local
regional
metastatic

43
Q

What are the two types of non invasive breast cance?

A

LCIS (lobular carcinoma in situ)

DCIS (ductal carcinoma in situ)

44
Q

LCIS requires ___, beside in the case of ___.

A

follow up

pleomorphic

45
Q

DCIS is consider as ___ malignant finding. __ and __ are more ___ morphologies, while __ and __ more malignant.

A 
pre
cribriform
papillary
comedo
solid
46
Q

Ductal membrane tends to go through ___ ending in ___.

A

central necrosis

calcifications

47
Q 
The 4 ways dealing DCIS are:
\_\_\_
\_\_\_
\_\_\_
\_\_\_
A
  • mastectomy
  • breast conserving surgery + adjuvant radiation
  • breast conserving surgery + w/o radiation
  • hormonal adjuvant therapy (tamoxifen)
48
Q

Mastectomy in the case of DCIS is recommended when we cannot achieve ___ borders, poor ___ results, C/I for ___

A

clean
cosmetic
radiation

49
Q

BCS + adjuvant radiation is recommended when the resection achieves clean borders (- cm).

A

2-3

50
Q

What are the 3 types of invasive breast cancer?

A

IDC (infiltrating ductal carcinoma)
ILC (infiltrating lobular carcinoma)
mixed ductal/lobular carcinoma

51
Q

IDC is the most common invasive breast cancer (__-__%)

A

50-70

52
Q

ILC is less common than IDC (__%), tends to penetrate in a __ __ nature

A

10

single file

53
Q

Phyllodes are tumors classified with proliferation of __ and __. In excisional biopsy we see ___ like cells.

A

stroma
epithelium
leaf

54
Q

Phyllodes tumors can be ___ or ___. The treatment will be ___ or ___ respectively

A

benign
malignant
local excision
local excision/mastectomy +adjuvant therapy

55
Q

In breast cancer staging __-__ are considered as ___ advanced disease

A

IIB-IIIB

locally

56
Q

T1< __ cm
T2= - cm
T3 >__
T4=___

A

2
2-5
5
extension to the skin/chest wall

57
Q

N0=__
N1=-
N2=-
N3>__

A

no LN
1-3
4-9
9

58
Q

Stage I= ___
Stage II= ___
Stage III= ___
Stage VI= ___

A

T1 N0 M0
T0-3 N0-1 M0
T1-4 N0-3 M0
T1-4 N1-3 M1

59
Q

The most important prognostic factor is the __ __ involvement, tumor > __ cm, __, __/__ receptors, positive __.

A 
axillary LN
2
grade
estrogen/progesterone
HER2
60
Q

The common areas for metastatic tumors in breast cancer are the __, __, and __

A

liver
lungs
bones

61
Q

The risk for breast cancer in BRCA is -%

A

50-70%

62
Q

The risk for ovarian cancer in BRCA 1 is _%, BRCA 2 is -%

A

45%

20-30%

63
Q

LCIS will usually require __/__/__

A

follow-up/local excision/tamoxifen

64
Q

DCIS will usually require __+__/__ + __

A

lumpectomy + radiation

mastectomy + SLND

65
Q

Phyllodes will require- if benign- ___ with clean borders of __ cm.
If malignant- __ with clean borders of __ cm / __ + __

A 
local excision
1
local excision
1
mastectomy
adjuvant radiation
66
Q

Stage I-II:

  1. __ + __ /__
  2. ___
  3. ___/___ adjuvant therapy
  4. ___ adjuvant therapy for patients in high risk/positive LN
A

lumpectomy + radiation / mastectomy
SLND
biological / hormone
chemo

67
Q

Stage III:

  1. ___ chemotherapy
  2. __ + __ /__
  3. ___
  4. adjuvant ___ (also after mastectomy)
  5. ___/___ adjuvant therapy
  6. ___ adjuvant therapy for patients in high risk/positive LN
A 
neoadjuvant
lumpectomy + radiation / mastectomy
ALND
adjuvant radiation
biological / hormone
chemo
68
Q

Stage IV: ___

A

systemic therapy

Surgery final (Sabiston) (54 decks)

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