34 - Disease of the breast Flashcards by Guy Schachter

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

glandular epithelium
fibrotic stroma
fatty tissue

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What kind of tumors can develop from the following tissues?

fibrotic stroma- ___
fatty tissue- ___

fibroadenoma

liposarcoma

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

thoracic 
acromial
scapular
costal
thoracic

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Where does the blood drain from in the breast?

axillary vein

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

75
axillary
25
parasternal

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

clavicle
ribs
sternum
axillary

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

pectoralis minor

worse

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Axillary LN levels:

Low- ___ to the muscle
___ the muscle
High- ___ to the muscle

lateral
behind (deep)
medial

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

fibroadenoma

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

cystic

carcinoma

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

carcinoma

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Prolonged breast feeding has a ___ effect against breast cancer

protective

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Progesterone and estrogen ___ the risk for breast cancer

increase

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

early
late
nulliparity

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

menstruation
sitting
lying

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

hard
mobile
singular
irregular

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

core needle

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

imaging
US
mammograph
MRI

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

routine
surgery
neoadjuvant

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

multifocal

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

10
excisional
wire
radioactive

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Mammographic test is suboptimal for __ and __ women.

young

pregnant

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

solid
cystic
younger
calcifications

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MRI has __% FP

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

1-2 | 50

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

BI-RADS 1= ___

negative- annual screening

BI-RADS 2= ___

benign- annual screening

BI-RADS 3= ___

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

BI-RADS 4= ___

2%-95% malignant- biopsy should be performed

BI-RADS 5= ___

>95% malignant

BI-RADS 6= ___

known biopsy- proven malignancy

BI- RADS 0= ___

incomplete assessment- additional imaging

BI-RADS=___

Breast Imaging-Reporting and Data System

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

1.7

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

close chemo mastectomy

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 ___

``` manual manual 25 MRI/mammographic 25 ```

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

90 | BRCA

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

papilloma

``` Name the benign breast findings: simple breast ___ simple __ __ & __ breast infection (___) Fat ___ __ ```

``` cyst fibroadenoma hamartoma & adenomas mastitis necrosis papilloma ```

The median age for breast cancer diagnosis is ___

How do we classify breast cancer? 1. non invasive (_-_) 2. ___ (most of the cases at diagnosis) 3. ___ (axillary and supraclavicular LN) 4. ___

in-situ local regional metastatic

What are the two types of non invasive breast cance?

LCIS (lobular carcinoma in situ) | DCIS (ductal carcinoma in situ)

LCIS requires ___, beside in the case of ___.

follow up | pleomorphic

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

``` pre cribriform papillary comedo solid ```

Ductal membrane tends to go through ___ ending in ___.

central necrosis | calcifications

``` The 4 ways dealing DCIS are: ___ ___ ___ ___ ```

* mastectomy * breast conserving surgery + adjuvant radiation * breast conserving surgery + w/o radiation * hormonal adjuvant therapy (tamoxifen)

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

clean cosmetic radiation

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

2-3

What are the 3 types of invasive breast cancer?

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

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

50-70

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

10 | single file

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

stroma epithelium leaf

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

benign malignant local excision local excision/mastectomy +adjuvant therapy

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

IIB-IIIB | locally

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

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

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

no LN 1-3 4-9 9

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

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

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

``` axillary LN 2 grade estrogen/progesterone HER2 ```

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

liver lungs bones

The risk for breast cancer in BRCA is _-_%

50-70%

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

45% | 20-30%

LCIS will usually require __/__/__

follow-up/local excision/tamoxifen

DCIS will usually require __+__/__ + __

lumpectomy + radiation | mastectomy + SLND

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

``` local excision 1 local excision 1 mastectomy adjuvant radiation ```

Stage I-II: 1. __ + __ /__ 2. ___ 3. ___/___ adjuvant therapy 4. ___ adjuvant therapy for patients in high risk/positive LN

lumpectomy + radiation / mastectomy SLND biological / hormone chemo

Stage III: 1. ___ chemotherapy 2. __ + __ /__ 3. ___ 4. adjuvant ___ (also after mastectomy) 5. ___/___ adjuvant therapy 6. ___ adjuvant therapy for patients in high risk/positive LN

``` neoadjuvant lumpectomy + radiation / mastectomy ALND adjuvant radiation biological / hormone chemo ```

Stage IV: ___

systemic therapy