Breast Flashcards
What correlates best with odds for breast cancer?
Age
A “Must do” in all breast disease?
Rule out cancer
Mammography – typically started when? Unless?
Do not do if? (Why?)
Age 40 (but earlier if family history)
Do not do before age 20 (breast is too dense) or during lactation (only see milk)
Breast masses seen in young women? Description? Diagnosed with? Treatment?
Fibroadenomas
Firm, rubbery mass that moves easily with palpation
FNA or sonogram
Optional removal
Breast masses seen in a very young adolescents? Treatment?
Giant juvenile fibroadenomas
Removal needed to avoid deformity or distortion of breast
Breast masses seen in late 20s? Natural history? Cancerous? Diagnosis? Treatment
Cystosarcoma phyllodes
Grow over many years, become very large, replace/distort breast (but do not invade or become fixed)
Potential to become malignant sarcomas
Core or incisional biopsy (FNA not sufficient)
Mandatory removal
Breast disease seen in reproductive ages? Related to? Diagnosis?
Mammillary dysplasia (fibrocystic disease, cystic prostatitis)
Cystic disease related to menstrual cycle
- Mammogram if no dominant/persistent mass
- If dominant mass, aspiration
- If aspirate bloody fluid, send for cytology
- If mass persists after aspiration, formal biopsy
Reproductive age woman with bloody nipple discharge – likely diagnosis? Testing options? Treatment?
Intraductal papilloma
- Mammography to identify other possible causes (will not show papilloma)
- Galactogram for diagnosis and to guide resection
Resect
Breast disease seen only in lactating women)? Treatment?
Similarly appearing mass in non-lactating woman?
Breast abscess
- Biopsy abscess wall to rule out cancer
- Aspiration
- If aspiration fails, Incision and drainage
Cancer
Strong indicators of breast cancer?
- Ill defined, fixed mass
- Retraction of overlying skin or nipple
- Orange peel skin
- Eczematous lesion of areola
- Palpable axillary nodes
Diagnosis and Treatment of breast cancer during pregnancy?
No difference in diagnosis
Treatment is the same except:
- No radiotherapy during pregnancy
- No chemotherapy during first trimester
Radiologic appearance of breast cancer in mammograms?
Irregular area of increased density with fine microcalcifications
Treatment of resectable breast cancer?
- Lumpectomy with axillary sampling + post op radiation (Only if tumor is small, breast is large, and tumor is away from nipple/areola)
- Modified radical mastectomy with axillary sampling
Axillary sampling is done by identification and removal of sentinel nodes
Standard form of breast cancer? Treatment?
Variants with a better prognosis? Treatment?
Variant with worse prognosis? Treatment?
Variant with the highest incidence of bilaterality?
Infiltrating ductal carcinoma
lobular, medullary, mucinous carcinomas. Treated the same as standard infiltrating ductal carcinoma.
Inflammatory carcinoma. Needs preop chemo.
Lobular – risk not high enough to warrant bilateral mastectomy
Breast cancer that does not need axillary sampling? (Why?)
Treatment?
Ductal carcinoma in situ (cannot metastasize)
- Total simple mastectomy (high risk of recurrence if a local excision, possibility of missing an invasive focus in multicentric disease)
- Can add sentinel node biopsy
- If lesion is confined to one quarter of the breast, can do lumpectomy followed by radiation
