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ABSITE Review > ABSITE Review - Breast > Flashcards

ABSITE Review - Breast Flashcards

1
Q

What is the main hormone needed for duct development?

A

Estrogen

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2
Q

What is the main hormone needed for duct development?

A

Progesterone

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3
Q

What are the functions of estrogen in the breast?

A

increase breast swelling, GROWTH of glandular tissue

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4
Q

What are the functions of progesterone in the breast?

A

increase MATURATION of glandular tissue; withdrawal causes menses

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5
Q

What is the function of the long thoracic nerve? What happens when it is injured?

A

Innervates serratus anterior; injury results in winged scapula

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6
Q

What is the function of the thoracodorsal nerve? What happens when it is injured?

A

Innervates latissimus dorsi; injury results in weak arm pullups and adduction

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7
Q

What is the function of the medial pectoral nerve?

A

Innervates pectoralis major only

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8
Q

What is the function of the lateral pectoral nerve?

A

Innervates pectoralis major only

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9
Q

What is the function of the intercostobrachial nerve?

A

Lateral cutaneous branch of the 2nd intercostal nerve; provides sensation to medial arm and axilla

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10
Q

What is the Batson’s plexus?

A

Valveless vein plexus that allows direct hematogenous metastasis of breast to spine

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11
Q

Where goes the lymphatic drainage of the breast?

A

97% to the axillary nodes

1-2% to the internal mammary nodes

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12
Q

What is the MCC of primary axillary adenopathy?

A

1 lymphoma

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13
Q

What are the Cooper’s ligaments?

A

Suspensory ligaments, dive the breast into segments

Breast CA involving these strands can dimple the skin

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14
Q

What is the MCC and bacteria in breast abscess?

A

MCC - breastfeeding

MC bacteria - S. Aureus

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15
Q

Mention some causes of gynecomastia.

A

Cimetidine, spironolactone, marijuana; idiopathic in most

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16
Q

What is the cause of neonatal breast enlargement?

A

Due to circulating maternal estrogens; will regress

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17
Q

What is the MC breast anomaly?

A

Accessory nipples which can be found from axilla to groin

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18
Q

What is the Poland’s syndrome?

A

Hypoplasia of chest wall, amastia, hypoplastic shoulder, no pectoralis muscle

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19
Q

What is Mondor’s Disease? What is the treatment?

A

Superficial vein thrombophlebitis of breast. Associated with trauma and strenous exercise. Usually occurs in lower outer quadrant.
Tx - NSAIDs

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20
Q

What are the usual symptoms of fibrocystic disease?

A

Breast pain, nipple discharge (yellow to brown), masses, lumpy breast tissue that varies with hormonal cycle

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21
Q

When fibrocystic disease has cancer risk?

A

Only cancer risk is in atypical ductal or lobular hyperplasia.

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22
Q

What is the MCC of bloody discharge from nipple?

A

Intraductal papilloma

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23
Q

What is the study of choice to fing the papilloma?

A

Contrast ductogram

24
Q

What is the MC breast lesion in adolescents? How it is described?

A

Fibroadenoma - painless, slow-growing, well circumscribed, firm and rubbery

25
Q

What are some mammogram findings for a fibroadenoma?

A

Can have large, coarse calcifications (popcorn lesions) on mammography from degeneration

26
Q

What is the treatment for a fibroadenoma in women 30yrs?

A

Women < 30 yrs - benign on physical exam, US or mammogram, FNA showing the lesion
Women > 30 yrs - excisional biopsy

27
Q

Is nipple discharge likely benign? What color is associated with each lesion?

A

Most nipple discharge is benign.
Green - fibrocystic disease -> reassure patient
Bloody - intraductal papilloma, occassionally ductal CA –> need galactogram and excision of that ductal area
Serous - worrisome for cancer –> excisional biopsy

28
Q

What is the usual mammogram finding and risk of CA in diffuse papillomatosis?

A

Mammogram - swiss cheese appereance

40% get breast CA

29
Q

What is DCIS? What is the risk of CA? What is the treatment?

A

DCIS - Ductal carcinoma in situ - malignant cells of the ductal epithelium without invasion of the basement membrane
Considered a premalignant lesion.
50-60% get cancer if not resected (ipsilateral breast); 5-10% in contralateral breast
Dx - mammogram with cluster of calcifications
Tx - lumpectomy and XRT; possibly tamoxifen - NEED negative margins but no ALND

30
Q

What is the most aggressive subtype of DCIS?

A

Comedo type - has necrotic areas, high risk for multicentricity, microinvasion, and recurrence
Tx - simple mastectomy

31
Q

What is LCIS? What is the risk of CA? What is the treatment?

A

LCIS - Lobular carcinoma in situ
NOT premalignant lesion.
40% get cancer EITHER breast
Tx - nothing, tamoxifen or BL SQ mastectomy (no ALND) - DO NOT need negative margins

32
Q

What is the breast CA risk?

A

1 in 8 women (12%)

33
Q

What is the symptomatic breast mass workup?

A

Ultrasound –> if solid, FNA; excisional bx if FNA nondiagnostic
30-50 yrs –> BL mammograms and FNA; excisional bx if FNA nondiagnostic
> 50yrs –> BL mammogram and excisional or core needle bx

34
Q

What is the minimum size for a breast mass to be detected by mammogram?

A

5mm

35
Q

What is the current recommendation for screening mmmograms?

A

Every 2-3 yrs after age 40, yearly after age 50

High-risk - mammogram 10 yrs before the youngest age of diagnosis of breast CA in first-degree relative

36
Q

What is the BI-RADS classification?

A

1 - Negative - Routine screening
2 - Benign finding - Routine screening
3 - Probably benign finding - Short interval follow up
4 - Suspicious abnormality consider biopsy - Definite probability of malignancy
5 - Highly suggestive of malignancy - High probability of cancer; appropiate action should be taken.

37
Q

What are the 3 node levels in the breast?

A

Level 1 - Lateral to pectoralis minor muscle
Level 2 - Beneath pectoralis minor muscle
Level 3 - Medial to pectoralis minor muscle
Rotter’s nodes - between pectoralis major and minor muscles

38
Q

What is the most important prognostic staging factor in breast cancer?

A

Lymph node status

39
Q

What is the MC distant metastasis in breast CA?

A

Bone

40
Q

What is the TNM staging system for breast CA?

A

T1: 5cm, T4: skin or chest wall involvement, peau d’orange, inflammatory cancer
N1: ipsilateral axillary nodes, N2: fixed ipsilateral axillary nodes, N3: ipsilateral internal mammary nodes
M1: distant metastasis (includes supraclavicular nodes)

41
Q

Which BRCA mutation has higher risk of male breast cancer and ovarian cancer?

A

Male breast CA - BRCA2 5-10%

Ovarian CA - BRCA1 30-45% - consider TAH and BSO

42
Q

What breast cancers have better overall prognosis?

A

Receptor positive tumors - ER +, PR +

PR + > ER+

43
Q

How common is ductal breast cancer and what is the treatment?

A

85% of all breast cancer

Tx - MRM or lumpectomy with ALND (or SLNB); postop XRT

44
Q

How common is lobular breast cancer and what is the treatment?

A

10% of all breast CAs
Signet-ring cells confer worse prognosis
Tx - MRM or lumpectomy with ALND (or SLNB); postop XRT

45
Q

What the pathology of the peau d’orange?

A

Dermal lymphatic invasion

46
Q

What are the ABSOLUTE contraindications to breast conserving therapy?

A

2 or more primary tumors in separate quadrants
Persistent + margins after reasonable attempts
Pregnancy - cannot receive radiation
Hx of prior therapeutic irradiation - due to high dose of radiation
Diffuse malignant-appearing microcalcifications

47
Q

What are the RELATIVE contraindications to breast conserving therapy?

A

Hx of scleroderma or active SLE
Extensive gross, multifocal disease in same quadrant
Large tumor in a small breast
Very large or pendulous breast

48
Q

When is a SLNB indicated?

A

Indicated only for malignant tumors >1cm

49
Q

During a SLNB, if no radiotracer or dye is found, what is the next step?

A

Formal ALND

50
Q

What are some contraindications for SLNB?

A

Pregnancy, multicentric disease, neoadjuvant, clinically positive nodes, prior axillary surgery, inflammatory or locally advanced disease

51
Q

What is a modified radical mastectomy?

A

Removes all breast tissue including the nipple aereolar complex, includes axillary node dissection (Level 1)

52
Q

What are the indications for radiation after mastectomy?

A 
> 4 nodes
Skin or chest wall involvement
Positive margins
Tumor > 5cm (T3)
Extracapsular nodal invasion
Inflammatory CA
Fixed axillary nodes (N2) or internal mammary nodes (N3)
53
Q

Who gets chemotherapy?

A

Positive nodes - everyone gets chemo except postmenopausal women with positive estrogen receptors –> tamoxifen
>1cm and negative nodes - everyone get chemo except pts with positive ER –> tamoxifen
<1cm and negative nodes - no further treatment

54
Q

What are the side effects of tamoxifen?

A

1% risk of DVTs; 0.1% risk of endometrial cancer

55
Q

What is Paget’s disease of the breast?

A

Scaly skin lesion on nipple; biopsy shows Paget’s cells
Pts have DCIS or ductal CA in breast
Tx - need MRM if cancer present; otherwise simple mastectomy

56
Q

What is Cystosarcoma phyllodes? What is the treatment?

A

10% malignant; no nodal metastases
Resembles giant fibroadenoma; has stromal and epithelial elements
Tx - WLE with negative margins; no ALND

57
Q

What is Stewart-Treves syndrome?

A

Lymphangiosarcoma from chronic lymphedema following axillary dissection (MRM)

ABSITE Review (32 decks)

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