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Breast Flashcards

1
Q

6 Ds of nipple changes in breast Ca

A

Discharge, deviation, depression, discoloration, destruction, dermatitis

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2
Q

Mx options of mastitis cx breast abscess

A

1) PO antibiotics(non teratogen)
2) Percutaneous aspiration
3) I & D
4) Stop breastfeeding

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3
Q

Red flags for nipple discharge

A

unilateral,uniductal, spontaneous(bra staining), persistent, bloody, elderly

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4
Q

Treatment for Pure Paget’s of the nipple without DCIS/IDC

A

Simple lumpectomy and remove Nipple Areolar Complex

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5
Q

Estrogen related RFs for breast cancer

A

Early menarche before 12?
Late menopause after 55
Nulliparity/ no children before age of 30
No breastfeeding
Hormone replacement therapy
OCPs

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6
Q

Genetic tests for Breast cancer

A

Invitae panel
BRCA 1/2 if young breast Ca < 50y.o or strong family Hx
Cowden syndrome(a/w breast,colon and thyroid Ca)
Hereditary Diffuse Gastric Ca( p53)

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7
Q

Indications for MRI Breast

A

Paget’s disease of the Nipple
- TRO concomitant lesions eg DCIS
Screening for high risk patients aged 35-40
- BRCA mutation
- First deg relative with BRCA
- Prev chest radiation
- Li Fraumeni or Cowden syndrome
- Nodal disease with occult primary
- Multifocal tumors

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8
Q

Breast Cancer TNM staging

A

Tis: DCIS/Paget’s disease of nipple
T1:
=<1mm
>1mm but <=5mm
>5mm but <=10mm
>10mm but <=20mm
T2: 20mm< and >50mm
T3: 50mm<
T4
Direct extension to chest wall ( Ribs, intercostal, serratus anterior, pectoralis minor NOT major ,muscle)
Extension to skin(Peau d’orange, ulceration, satellite skin nodule
T4a + T4b
d: Inflammatory Breast Cancer with lymphedema

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9
Q

3 components of curative breast cancer local mx

A

Breast surgery, Axilla surgery and Reconstruction

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10
Q

Curative options for breast surgery

A

1) Breast conserving therapy: Breast conserving surgery + whole breast RT
2) Simple mastectomy
3) Radical mastectomy

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11
Q

Reconstruction options post breast surgery

A

1) Grafts
-Implants: Silicone, Saline
Autologous
- Lat dorsi myocutaneous flap(LDMF)
- Transverse Rectus myocutaneous flap(TRAM)
- Deep Inferior Epigastric Perforator flap(DIEP), muscle sparing
2) Breast reconstruction
3) Nipple reconstruction

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12
Q

6 Ds of suspicious Nipple Areolar Complex changes

A
  1. Depression
  2. Discharge
  3. deviation
  4. discoloration
  5. destruction
  6. dermatitis
  7. Retraction
  8. Peau d orange(lymphoedema)
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13
Q

Red flags of nipple discharge

A
  1. unilateral
  2. uniductal
  3. spontaneous(bra staining)
  4. persistent
  5. serous and bloody
  6. elderly
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14
Q

Non Estrogen related risk factors for breast cancer

A
  1. BRCA 1/2 (a/w triple negative Breast Ca)
  2. FHx of Breast Ca
  3. Previous chest radiation
  4. High risk lesions
    - Ductal Carcinoma in-situ(DCIS)
    - Lobular carcinoma in-situ(LCIS)
    - Atypical ductal hyperplasia(ADH)
  5. Smoking
  6. Alcohol
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15
Q

Criteria for diagnosis of inflammatory breast cancer(T4d)

A
  1. Rapid onset of erythema, edema and peau d’orange appearance +- breast warmth and palpable lump
  2. Sx present for less than 6/12
  3. Erythema >⅓ of breast
  4. Histo showing poorly differentiated tumor diffusely invading breast parenchyma
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16
Q

Curative mx of inflammatory breast cancer

A

Chemo+RT+ Hormonal+ +surgery(including SLNB)

17
Q

Suspicious features of BI RADS

A
  1. Skin and muscle involvement
  2. Vascularity
  3. Microcalcifications
    Other suspicious features
  4. Heterogenous
  5. Irregular borders
  6. Taller than wide
18
Q

Indications for MRI Breast

A
  1. Paget’s disease of the Nipple
    TRO concomitant lesions eg DCIS/IDC
  2. Screening for high risk patients aged 35-40
    - BRCA mutation
    - First deg relative with BRCA
    - Prev chest radiation
    - Li Fraumeni or Cowden syndrome
    - Nodal disease with occult primary
    - Multifocal tumors
19
Q

Options for histological dx of breast cancer

A
  1. Core biopsy
    6-8x cores, may be done with MMG/US guidance
    Histology and tumor architecture
    Immunochemistry staining: Estrogen, Progesterone and Human epidermal growth factor receptors (ER, PR, HER2)
  2. Punch biopsy
    Especially for suspected inflammatory breast cancer, showing dermal lymphatic invasion by tumor cells
  3. Vacuum Assisted Biopsy(VAB) for non palpable/ tumor surrounded by fluid
20
Q

Contraindications to Breast Conserving therapy( Breast conserving surgery+ Whole breast RT)

A
  • Poor tumor: breast ratio
  • Multicentric disease
  • Tumor >5cm
  • RT contraindicated or patient not agreeable
21
Q

Complications of Axillary clearance

A
  • Thoracodorsal nerve injury
  • Long thoracic nerve injury
  • Lymphedema
  • Joint stiffness
22
Q

Mx of Atypical ductal hyperplasia

A

Microdochectomy kiv major duct excision

23
Q

Mx of DCIS( Ductal carcinoma in situ)

A

BCS w/ WBRT and reconstruction
Unless multicentric disease or poor tumor:breast ratio

SLNB kiv AC only if specific indications

Hormonal therapy if ER/PR +ve, reduces recurrence

24
Q

Indications for SLNB kiv axillary clearance for DCIS

A
  • High grade tumor
  • Comedo necrosis
  • Mass forming
  • Undergoing simple mastectomy( SLNB not accurate after)
25
Q

Palliative options for breast cancer

A

Palliative chemotherapy for triple negative

Palliative RT
fungating mass
Bone mets

Surgical
Toilet mastectomy for sx of discharge
Prophylactic oophorectomy if chemotherapy and pt has not completed family

Enrolment in clinical trials for novel treatments

26
Q

Adjuvant therapies for breast cancer

A
  1. Chemotherapy
  2. Radiotherapy
  3. Hormonal therapy for receptor positive tumors
  4. Immunotherapy/targeted therapy
  5. Clinical trials
27
Q

Indications for neoadjuvant chemo for breast cancer

A
  • Locally advanced tumor
  • HER2+ and >1cm size
28
Q

Contraindications to RT for breast cancer

A

Pregnancy, previous RT, Ataxia telangiectasia gene mutation

29
Q

Side effects of breast cancer hormonal therapy

A

Hot flushes
Increased risk of endometrial ca
Increased VTE risk

30
Q

SEs of breast cancer targeted therapy

A

cardiotoxicity and cardiomyopathy

31
Q
A

GS (11 decks)

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