Breast Flashcards
Risk factors of breast CA
Family Hx
Hx of prev breas Bx
Hx of LCIS on breast Bx (10x)
Hx of ADH on breast Bx (4x)
Early menarche
Late menopause
BRCA gene mutation
High risk patients may benefit from prophylactic Tamoxifen therapy (50%reduction at 5yrs)
Chromosomes BRCA 1 and 2 genes located on
BRCA 1 - 13 — strong association w Ovarian CA
BRCA 2 - 17
Route of matastasis for breast CA
Batson’s plexus
Her-2 (erb-2) positivity of breast tumor
Increase tumor aggresiveness
–tyrosine kinase for epidermal hrowth factor
HERCEPTIN (monoclonal antibody) - Beneficial
Herceptin (Trastuzumab) toxicity
Cardiac toxicity when combined w doxyrubicin and cyclophosphamide
Role of p53 in breast CA
Mutation of the tumor suppressor gene results in unrestricted propagation of cells w/ mutated DNA (cancer cells)
– allows overexpression of apoptosis inhibiting oncogenes such as bcl-2 in breast CA
Adverse effect of methylene blue and isosulfan
Isosulfan – cause allergic reaction w intraoperative hypotension
Methyline blue – cause skin necrosis if injected intradermally
When should screening mammogram obtained?
Starts at age of 40 years every 1 to 2 years and annually after age 50 years
Tender
Firm
Cord mass on lateral aspect of breast
Dx?
Tx?
Dx: mordor’s disease - thrombophlebitis of superficial vein on the breast
Tx: NSAIDs
Definitive tx of DCIS in breast mass
Lupectomy + RT
Tx high grade DCIS in multiple quadrant of breast w/o any invasive carcinoma
Mastectomy w sentinel LN biopsy
Sensory innervation of breast
Lateral and Anterior Cutaneous branches of 2nd through 6th intercoastal nerves
Location of Rotter’s node
Interpectorial region
Tx for subareolar abscess in a 35yo
Needle aspiration
MC cause STAPHYLOCOCCUS
LN located behind pectoralis minor muscle
Level II LN
Positive supraclavicular LN in breast cancer confer what stage?
Stage IIIC (former stage IV)
UTZ: disrupted tissue and fascial planes
Hyperechoic border to the mass
Displacement of surrounding breast tissue
Dx: Invasive breast CA
Tumor markers negatively associated withoutcome in breast CA
ER (-)
PR (-)
Her-2 Nu (+)
Indication of ductography
Evaluation of bloody nipple discharge
MC cause of bloody nipple discharge
Intraductal Papilloma
Tx for mammary fistula w recurrent subareolar abscess
Probe-guided fistulectomy
Initial diagnostic procedure with palpable breast mass
Fine needle aspiration (FNA)
Current technique for localizing nonpalpable breast masses
Mammographic needle localization
Treatment for hypercalcemia associated with metastatic breast CA
Calcitonin (inhibits osteoclast)
IV fluid
Lasix
Bisphosphonates (bind hydroxyapetite)
Fungal infections affects the breast
Blastomycosis
Sporotrichosis
Borders of formal axillary dissection
Latissimus dorsi
Chest wall
Axillary vein
Thoracodorsal nerve
Nerve innervates the muscle responsible for arm ADDuction
Thoracodorsal nerve
Innervates Latissimus dorsi
Nerve responsible for sensation of medial aspect of arm
Intercostobrachial
Hypoplastic shoulder
Amastia
Absence of pectoralis muscle
Poland syndrome
Management for Mordpr’s disease
Salicylates
Warm compress
Restriction of range of motion
Shoulder and brassiere support
Side effects of Tamoxifen
Increase Endometrial CA
Increase DVT and cataracts
Inhibits p450 system – increase level of Coumadin
Ca channel blockers etc
Ethiology of skin dimpling in women with breast CA
Glandular fibrosis and shortening of Cooper’s ligaments
Perimenopausal woman
Palpable lumpiness beneath areola
Nipple discharge
Ductal ectasia
Characteristic gross appearance of a fibroadenoma
Sharp circumscription w smooth boundaries and glistening, white cut surface
Most frequently employed hornonal manipulation in patients with breast cancer
Estrogen blockade
(Tamoxifen - receptors;
Arimidex/Anastazole - synthesis)
MC initial site of metastasis in breast CA
Bone
Type of breast CA most frequently presents with palpable mass
Infiltrating ductal carcinoma
Primary ductal CA presents with
Chronic, erythematous
Oozing
Eczematoid rash
Involving nipple and areola
Paget’s disease of the breast
Tx for Inflammatory breast CA
- Chemotherapy
- Surgical excision and XRT
*Dermal lymphatic invasion of tumor cells on skin biopsy is diagnostic key for inflammatory breast CA
MC primary sarcoma of breast
Cystosarcoma (phyllodes tumor)
Tx: wide excision w/o LN biopsy as sarcomas spread hematogenously
Woman hx of ovarian CA has increased risk of breast CA
T/F
True
Tx for patient w/ small localized phyllodes tumor
Local excision w/o LN biopsy
Most important prognostic indicatir for recurrent breast CA and metastatic disease in women with breast cancer
Nodal status at time of initial dx
Average age of diagnosis of invasive breast CA
60years
Distinguishing feature of LCIS
Cytoplasmic mucoid globules
MC complications of breast cancer radiation therapies
Skin erythema and desquamatikn
Lymphedema after axillary therapy
Medical tx of radiation mastitis
Trenal (pentoxifylline)
