approach to breast lump

Question 1

how to approach breast lump?

Answer 1

triple assessment:
1. history and physical exam
2. imaging (US<40yr, mammo>40)
3. biopsy (fine needle, punch biopsy and receptor testing)

Question 2

important findings in biopsies for each cancer?

Answer 2

DCIS= comedo (central necrosis)
invasive ductal= stromal invasion, microcal, surrounding fibrosis
invasive lobular= single file pattern of cells
inflammatory= dermal lymphatic involvement
paget= paget cells

Question 3

surgery options with brief indication and contraindications?

Answer 3

1. breast conserving surgery (remove the cancer with clear surgical margins and preserving breast tissue like in wide local excision)
   indicated in non metastatic breast cancer and DCIS
   contraindicated in inflammatory breast cancer, extensive microcal in imaging, no clear surgical margins
2. mastectomy
   indicated if pt preference, if there’s contraindication to breast conserving surgery, prophylaxis if previous hx of breast cancer or genetic predisposition

Question 4

complications of breast cancer surgery?

Answer 4

injury to long thoracic nerve= winging of scapula

lymphadema of the arm= arm swelling, immobility, cosmetic concerns, tx with hyperbaric o2, manual draining, low-level laser therapy

Question 5

screening for the population and high risk individuals?

Answer 5

general population: begin screening at 40yrs with annual mammo

pt with first degree relative of BC hx= begin screening 10 years before the relative diagnosis but not before 30 yrs

pts with genetic mutations= screen from 25 yrs with MRI and mammo annually