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Essentials - General surgery > 6. Breast lump/Screening > Flashcards

6. Breast lump/Screening Flashcards

1
Q

Identify the structures

A
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2
Q

Name categories of causal conditions of breast lumps (3)

A
  • Breast Cancer
    • Invasive
    • Non-invasive
  • Non breast-specific Malignancy (found in breast tissue)
  • Benign breast disease
    • Infectious
    • Non-infectious
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3
Q

Name DDX of invasive breast cancer (6)

A
  • Ductal
    • Invasive ductal carcinoma
  • Lobular
    • Invasive lobular carcinoma
  • Other
    • Tubular
    • Medullary
    • Papillary
    • Mucinous
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4
Q

Name DDX of non-invasive breast cancer (2)

A
  • Ductal
    • Ductal carcinoma in situ
  • Lobular
    • Lobular carcinoma in situ
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5
Q

Name DDX of Non breast-specific Malignancy (found in breast tissue) (2)

A
  • Sarcoma
  • Lymphoma
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6
Q

Name infectious benign breast disease (4)

A
  • Lactation related
    • Lactational mastitis
    • Breast abscess
  • Not lactation- related
    • Acute mastitis
    • Subareolar abscess
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7
Q

Name non-infectious benign breast disease (11)

A
  • Fibro cystic changes (nodularity)
  • Gross cyst
  • Galato cele
  • Fibro adenoma
  • Fat necrosis
  • Papilloma
  • Duct ectasia
  • Sclerosing adenosis
  • Lipoma
  • Neurofibroma
  • Ductal/lobular hyperplasia
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8
Q

Describe HX of breast cancer (5)

A
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9
Q

Name risk factors for breast cancer (14)

A
  • Age (>50)
  • Female
  • Prior Hx of breast or ovarian cancer
  • Prior breast biopsy (regardless of pathology)
  • Prior radiation therapy at site
  • Family Hx of breast or ovarian cancer in 1st/2nd degree relatives
  • Hx of prolonged hormone exposure
  • Nulliparity
  • First pregnancy > 30 y.o.
  • Menarche < 12 y.o.
  • Menopause > 55 y.o.
  • HRT > 5yr
  • Obesity
  • Excessive alcohol intake
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10
Q

Describe: Triple diagnosis

A

Refers to diagnosing palpable breast lumps, with concurrent use of:

    1. Physical exam
    1. Mammography
    1. Skilled Fine-needle aspiration biopsy (FNAB)

Very few breast cancers are missed using triple diagnosis.

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11
Q

Describe characteristics of cancerous lesions (7)

A
  • Location: Unilateral
  • Number: Solitary
  • Size: > 2 cm (A lesion that is < 2 cm or movable may still be cancerous.)
  • Borders: Irregular
  • Consistency: Firm/hard
  • Mobility: Immovable (A lesion that is < 2 cm or movable may still be cancerous.)
  • Changes with menses: No change
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12
Q

Describe physical exam of breast lump (Figure)

A
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13
Q

Describe this investigation of breast lump: Mammography

  • Indications
  • Use
A
  • Indications: Any woman with a new/ concerning breast lump
  • Use:
    • Search for other lesions that are clinically occult
    • Evaluate lump
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14
Q

Name features suggesting malignancy in mammography (4)

A
  • Increased density
  • Irregular margins
  • Spiculation
  • Accompanying clustered irregular microcalcifications
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15
Q

Describe this investigation of breast lump: U/S

  • Indications
  • Use
  • Interpretation
A
  • Indications: Any woman with a new/ concerning breast lump
  • Use: Differentiate between simple or complex cystic or solid lumps
  • Interpretation:
    • Risk for cancer is low if lesion is a simple cyst
    • Complex cystic or solid lumps require further investigation
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16
Q

Describe this investigation of breast lump: Fine-needle aspiration biopsy (FNAB)

  • Indications
  • Use
  • Interpretation
A
  • Indications: Complex cyst or solid lump found on U/S
  • Use: Collect samples for cytology
  • Interpretation:
    • Fluid obtained without blood unlikely to be cancer
    • If fluid is bloody, send for cytology
    • If no fluid, aspirate cells for cytology
17
Q

Describe this investigation of breast lump: Core needle biopsy

  • Indications
  • Use
  • Interpretation
A
  • Indications: Atypical or suspicious FNAB
  • Use:
    • Collect samples for histology
    • Allows staining for ER, PR, and HER2/neu where indicated
  • Interpretation: Can differentiate between atypical hyperplasia and ductal carcinoma in situ from invasive disease
18
Q

Describe this investigation of breast lump: MRI

  • Indications
  • Use
A
  • Indications: Any women for whom mammogram and U/S results are inconclusive
  • Use:
    • Detection of breast lump
    • Further characterization of mass detected on screening for breast cancer
19
Q

Name features suggesting malignancy in breast MRI (5)

A
  • Increased density
  • Irregular margins
  • Spiculation
  • Rim pattern of enhancement
  • Washout of signal intensity
20
Q

Describe breast cancer screening: Mammography (± Clinical Exam) (3)

A
  • 40–49 y.o.
    • No evidence to include or exclude screening exam as it has not been consistently shown to reduce mortality
  • 50–69y.o.: Every 1 – 2yr
  • Positive family Hx in 1st degree relative
    • Every 1–2 yr starting 10 yr before youngest age of presentation
21
Q

Describe breast cancer screening: Breast Self-Exam (1)

A

No clear evidence of benefit in reduction of breast cancer mortality

22
Q

Describe breast cancer screening: Genetic Testing for Breast Cancer 1 or 2 Gene (8)

A
  • Ashkenazi Jewish women: Any 1st degree relative or two 2nd degree relatives from the same side of the family with breast cancer or ovarian cancer
  • All other women
    • Patient age < 35 at diagnosis of breast cancer
    • Patient or 1st degree relative with both breast cancer and ovarian cancer regardless of age at diagnosis
    • Patient or 1st degree relative with bilateral breast cancer
    • Patient with strong family Hx of breast cancer and/or ovarian cancer
    • Two 1st degree relatives, one age < 50 at diagnosis or three 1st degree relatives regardless of age at diagnosis
    • Combination of two or more 1st or 2nd degree relatives with ovarian cancer regardless of age at diagnosis
    • Hx of breast cancer in male relative
23
Q

Describe : Clinical decision making of breast lump. (Figure)

A
24
Q

Describe the management of In Situ Breast Cancer (3)

A
  • Lumpectomy Or
  • Lumpectomy + radiotherapy* Or
  • Mastectomy**

*Lumpectomy plus radiotherapy achieves the same survival benefit as mastectomy with in situ and stage I&IIdisease

**If patient undergoes mastectomy, radiation therapy is not required

25
Q

Describe the management of T1 or T2 Breast Cancer

A
26
Q

Describe the management of T3 Breast Cancer (4)

A
  • Neoadjuvant chemotherapy followed by:
  • Lumpectomy or mastectomy
    • Axillary Node Dissection AxND
    • Radiotherapy
27
Q

Describe the management of T4 Breast Cancer (3)

A
  • Neoadjuvant chemotherapy followed by: Mastectomy
    • Axillary Node Dissection
    • Radiotherap
28
Q

Describe staging of breast cancer (3)

A
  • Breast cancer staging requires removal of the primary tumor and ipsilateral axillary lymph node dissection.
  • If tumors are > 5 cm and axillary lymph nodes are positive, additional staging tests (chest x-ray, bone scan, CTAbdo) are required.
  • Smaller tumors with negative axillary lymph nodes do not mandate additional staging tests unless symptoms of metastatic involvement are present.
29
Q

In breast cancer, name indications for adjuvant therapy: Radiotherapy (3)

A
  • After lumpectomy
  • After mastectomy in stage IIIB disease
  • With axillary node involvement
30
Q

In breast cancer, name indications for adjuvant therapy: Hormonal (3)

A
  • Almost all patients with tumor size > 1 cm, ER/PR positive following surgery
  • Premenopausal: tamoxifen, or ovarian ablation, or ovarian ablation and aromatase inhibitor (anastrozole, letrozole)
  • Postmenopausal: tamoxifen, or aromatase inhibitor
31
Q

In breast cancer, name indications for adjuvant therapy: Chemotherapy (4)

A
  • Depends on tumor size, number of involved lymph nodes, and patient performance status
  • Most patients with stage II or III disease
  • Stage I disease with HER2/ neu positive tumor
  • Trastuzumab (Herceptin) should be used in all HER2/ neu overexpressing tumors
32
Q

Name Oncologic emergencies (not specific to breast cancer) (8)

A
  • Metabolic
    • Tumor lysis syndrome
    • Hypercalcemia of malignancy
  • Neurologic
    • Strokes and seizures
  • Mecanical
    • Superior vena cava syndrome (SVCS)
    • Spinal cord compression
  • Treatment-Related
    • Extravasation of chemotherapeutic drugs
    • Neutropenic fever
  • Hematology
    • Disseminated Intravascular Coagulation (DIC) of malignancy
33
Q

Describe: Tumor lysis syndrome (3)

A
  • Triad of hyperuricemia, hyperkalemia, hyperphosphatemia
  • Results from rapid release of intracellular contents of tumor cells into bloodstream
  • Hyperkalemia is the most life-threatening problem
34
Q

Describe: Hypercalcemia of malignancy (2)

A
  • Disorder of calcium metabolism due to alterations in the pathways of calcium regulation involving PTH, calcitonin, and (1,25[OH]2 vitamin D)
  • Patients are invariably dehydrated
35
Q

Describe: Superior vena cava syndrome (SVCS) (2)

A
  • Cough; dyspnea; dysphagia; swelling and discoloration of the neck, face, or upper extremities; and possibly vocal cord paralysis and Horner syndrome
  • Results from an increase in central venous pressure caused by vena caval obstruction
36
Q

Describe: Spinal cord compression (3)

A
  • Sx include pain, weakness, sensory deficits, autonomic dysfunction
  • Results from spinal cord being compressed by tumor
  • Not immediately life threatening unless involving level C3 or above, but may lead to profound, permanent morbidity
37
Q

Describe: Extravasation of chemotherapeutic drugs (2)

A
  • Leakage of chemotherapeutic drugs into the skin, leading to pain, redness, swelling, and possibly necrosis
  • Typically results from infusion therapy
38
Q

Describe: Neutropenic fever (2)

A
  • Neutrophil count < 0.5 × 10(9)/L(500/mm3), or < 1.0 × 10(9)/Land expected to decline below < 0.5 soon
  • Fever defined as single temperature of 38.3°C (101.0°F) or a temperature of 38.0°C (100.4°F) or higher lasting over 1 h
39
Q

Describe: Disseminated Intravascular Coagulation (DIC) of malignancy (4)

A
  • Hx of malignancy
  • Clinical presentation of bleeding, thromboembolism, liver dysfunction, kidney failure, respiratory distress, or change in CNS exam
  • Thrombocytopenia
  • MAHA (microangiopathic hemolytic anemia) on blood smear

Essentials - General surgery (10 decks)

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