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Breast Flashcards

1
Q

Palpable Breast Mass HPI?

A

HPI- cyclic pain, nipple dc, skin color changes, personal hx, family hx of breast or ovarian, reproductive hx, hormonal or HRT, trauma, ASK Bone pain, XRT

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2
Q

Palpable Breast Mass PE?

A
  • PE- bilateral breast, size, nipple dc, erythema, adenopathy (ax, supraclavicular nodes, cervical), Palpate the liver
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3
Q

Palpable Breast Mass Ddx?

A
  • DDx- Cyst, fibroadenoma, fat necrosis, ca, lipoma, fibrocystic dz
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4
Q

Palpable Breast Mass Gail, Triple test, needle bx doesn’t match up?

A
  • Note-
    • GAIL- 5 yr and lifetime risk could benefit from chemoprevention 50% risk prevention
    • Triple Test =US/MMG/CNB is std, 100% accuracy dx benign lesions
    • Be careful when the needle biopsy does not match clinical or MMG-need to still excise
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5
Q

BIRADS?

A

BIRADS- 0- indeterminate 1-Normal (repeat 1yr) 2-Benign (no bx) 3-likely benign (f/u MMG 6mo, follow for 2 yrs then downgrade to 2) 4 - suspicious (needs a bx 40% malignant) 5- Malignant (5% will be normal) 6 - known

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6
Q

Palpable Breast Mass imaging?

A
  • Imaging
    • US-for any palpable mass (not good for screening but diagnostic), cyst vs solid
    • MMG-Still need, and bilateral
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7
Q

Palpable Breast Mass CNB?

A
  • CNB (clips, receptor status) ((If Palpable)) - at least 14 G multiple passes 10-14 typically all removed (no need for imaging if palpable), better than a surgical bx just as accurate, cheaper, less cosmetic effects, leave clips
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8
Q

Palpable Breast Mass CNB indeterminate ?

A

CNB results indeterminate, LCIS, atypical hyperplasia, RADIAL scar, papilloma —>excision (30% have DCIS or cancer) and send of ER/PR receptors can be done under local or general

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9
Q

Palpable Breast Mass fibroadenoma?

A
  • Fibroadenoma -most can be left alone AFTER confirmation of core biopsy. May excise if growing, painful, or large >3cm
  • Fibroadenoma, Fat Necrosis, Sclerosis (can mimic BCA clinically and path) require local excision and f/u
  • prepubescent fibroadenoma >3 cm
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10
Q

Palpable Breast Mass that is a cyst?

A

Cyst (simple) - clear fluid if collapses f/u in 6mo after FNA aspiration and repeat unto 3 times, if solid component- bx solid component, Bloody fluid send to path

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11
Q

Palpable Breast Mass that is fibrocystic dz?

A
  • Fibrocystic dz - need to r/o cancer or solid mass, Mondors dz, costochondritis and pregnancy once dx-
    • 1st decrease caffeine, fat intake, better support, take NSAIDs for pain 2nd primrose oil (prolactin inhibitor), danazol, bromocriptine, tamoxifen (thought increase risk of endometrial cancer-
      • f/u 6mo, SBE,CBE, annual MMG
    • last resort is mastectomy segmental or total
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12
Q

Palpable Breast Mass thats an abscess?

A
  • Abscess- I and D. may try aspirate with abx c staph coverage
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13
Q

Palpable Breast Mass phyllodes tumor?

A
  • Phylloides tumor (90% benign) no LN- 1-2 cm margins (unless clinically malignant and invading surrounding tissue (20% at which time mastectomy and no LND), CXR, and chemo only if >5cm doxorubicin and ifosfamide
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14
Q

Palpable Breast Mass plasma cell mastitis? Granulomatous mastitis? lactation mastitis? Non lactation mastitis?

A
  • Plasma cell mastitis, duct ectasia and subareolar chronic abscess require I&D, ABX, Subareolar Excision
  • Granulomatous mastitis - steroids no surgery
  • lactation mastitis - usually staph- tx increase breast pump (dispose) and ABX and if abcess perc drain it
  • Non lactation mastitis- usually anaerobe - drainage plus abx
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15
Q

Palpable Breast Mass c palpable LN?

A
  • If palpable LN then need FNA for staging (can help avoid SLNB if + ) - Note
    • Can consider neoadj therapy for larger tumors for BCT consideration 80% effective in conv mastectomy —> BCT
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16
Q

Palpable Breast Mass c SLNB steps?

A
  • SLNB
    • should be consider with node neg invasive breast cancer and woman undergoing mastectomy for DCIS
    • micromets =10% of the hottest node or suspicious palpated LN
    • if more than 5 LN and the hottest was removed than stop at five
    • if failed mapping then ALND
    • Methylene blue can cause anaphylaxis, skin necrosis
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17
Q

Palpable Breast Mass post mastectomy ? and follow up?

A
  • Oncotype- assessed postop for postmen ER positive cases c borderline tumor characteristics assess the benefit of chemo
  • triple neg can benefit from chemo
  • post mastectomy XRT improve survival and decreases survival in pts c >4 mets LN, >5 cm
    • 5000 rads in divided doses
  • BCT postop
  • 20 yo SBE monthly, CBE q 3yrs
  • 40 yo SBE monthly, CBE annually, MMG annually until 70 yrs
  • BRCA 25 yrs MMG and consider alt MRI
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18
Q

Suspicious Mammography Abnormality if path dx doesnt match up?

A
  • if path dx doesn’t account for other findings then repeat or do an excisional bx
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19
Q

Suspicious Mammography Abnormality relative CI to BCT?

A
  • BCT must have postop XRT to match the local recurrence rates as a mastectomy
  • relative CI to BCT >5cm, large tumor to breast ratio, pregnancy; absolute is T4 (Inflammatory), multi centric, collagen vascular, previous XRT, central subareolar location, breast too small
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20
Q

Suspicious Mammography Abnormality surgical approach?

A
  • surgical approach - Langer lines, periareolar incision (centrally located), if lower half then radial incision
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21
Q

Suspicious Mammography Abnormality mastectomy borders?

A
  • mastectomy borders
    • elliptical incision including NAC, bx site and skin over lesion
    • develop superior and inferior flap
    • Clavicle, lateral border sternum, latissimus dorsi, inframammary fold
    • remove all breast tissue, nipple areolar complex and fascia overlying the pec major
    • +/- immediate reconstruction - PRS surgeron, tissue expanders, TRAM
    • leave drains
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22
Q

Suspicious Mammography Abnormality c axillary dissection?

A
  • Axillary dissection
    • en bloc resection level 1/2 LN
    • borders- Posteriorly -subscapularis, latissimus dorsi, Medially- chest and serratus anterior, superiorly- axillary vein laterally -Skin
    • avoid injury over skeletonize axillary vein, thoracodorsal nerve, long thoracic nerve
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23
Q

DCIS (stage 0) w/u?

A
  • Hx, Dx, RF, Triple test
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24
Q

DCIS (stage 0) what to ask for on imaging?

A
  • usually pleomorphic changes on MMG
    • questions to ask path
    • How large is it the tumor, multifocal (mastectomy and SLNB because you won’t be able to do one after) or unifocal
    • comedo necrosis in the specimen
    • How well differentiated (high grade is worst), grade
    • ER/PR receptor status
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25
Q

DCIS (stage 0) what if stereotactic bx can’t be done?

A
  • Need tissue dx

- if stererotactic biopsy can’t be done then wireloc bx

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26
Q

DCIS (stage 0) surgery?

A
  • Surgery - BCT vs Simple (total) mastectomy + SLNB (cuz you won’t have another chance and you may find invasive cancer in the specimen)
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27
Q

DCIS (stage 0) BCT CI?

A
  • Contraindications
    • Large size, small breast
    • previous radiation
    • T4 lesions
    • central subareolar mass
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28
Q

DCIS (stage 0) c SLNB???

A
  • SLNB can be considered for high grade lesions (controversial) >4cm comedonecrosis, microinvasion. its a must for invasive cancer, o/w no need
  • wire loc if needed, check imaging
  • create gross 1 cm margins, amputate and orient specimen (permanent) and check X-ray to verify clip and wire
  • palpate for any residual disease
  • leave clips for whole breast radiation
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29
Q

DCIS (stage 0) c XRT??

A
  • XRT is mandatory
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30
Q

DCIS (stage 0) notes?

A
  • Mastectomy (risk reduction in recurrence but no survival benefit to a BCT)
  • Optimal DCIS margin unknown, but a width of 1 mm or more is associated with decreased chance of recurrence
  • Stage is upgraded from 0 if micro invasion or occult invasive dz and treat like invasive disease
  • Hormone therapy for ER,PR, HER
  • Whole breast radiation
  • Std follow up CBE and MMG 6mo for 2 years and annual
  • Isolated tumor cells in LN- considered node negative, may have gotten there from biopsy manipulation rather than mets
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31
Q

LCIS (detected on bx as usually as an incidental finding)

A
  • High risk path detected incidental finding on CNB (LCIS, atypical hyperplasia) indicates the need for f/u dx surgical wire localization bx which will reveal coexisting cancer 15% of the time so need to do something
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32
Q

LCIS high risk path?

A
  • High risk path detected incidental finding on CNB (LCIS, atypical hyperplasia) indicates the need for f/u dx surgical wire localization bx which will reveal coexisting cancer 15% of the time so need to do something
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33
Q

LCIS margins?

A
  • when detected incidentally margins free aren’t needed
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34
Q

LCIS marker?

A
  • Marker for increase lifetime risk of cancer (1% per year)
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35
Q

LCIS options?

A
  • 3 options after you confirm its just LCIS after your resection
    • 1st- close observation / surveillance alone (annual or biannual CBE, annual MMG, possible annual MRI)
    • 2nd - chemoprevention tamoxifen pre or raloxifene for post
    • 3rd- bilateral Px mastectomy (No axillary staging) -high risk
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36
Q

LCIS with tamoxifen side effect?

A
  • tamoxifen
    • avoid getting pregnancy
    • nights sweats, hot flashes, DVT, uterine problems, decreased libido
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37
Q

Advanced Breast Cancer w/u?

A
  • Work up
    • CBC, Renal, CXR
    • Bone scan if alkaline phosphatase or calcium elevated
    • CT scan if LFT elevated
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38
Q

Advanced Breast Cancer TNM?

A
  • TNM
    • T
      • T0 -in situ
      • T1- 5cm
      • T4 skin/chest (inflammatory)
    • N
      • N1- axillary nodes
      • N2-matted axillary nodes
      • N3- infra/supraclavicular nodes or inframmary
    • Stage 0 - DCIS
    • Stage 1 -T1NO
    • Stage 2A- T0-1N1, T2N0
    • Stage 2B- T2N1, T3N0
    • Stage 3A- T0-2N2, T3N1-2
    • Stage3B- T4N1-2, TN3
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39
Q

Advanced Breast Cancer BRCA testing?

A
  • BRCA testing-

- first degree dx BCA

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40
Q

Advanced Breast Cancer risk and benefits BCS vs MRM?

A
  • Discuss risk and benefits
  • BCS pros-
    • preserve breast, smaller operation, cons-increased recurrence and risk of positive margins requiring more surgery
  • MRM-
    • decreased recurrence, only one operation unless recon cons-removal of breast, need recon
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41
Q

Advanced Breast Cancer neo adjuvant tx?

A
  • neoadj- no diff in seroma rates, wound infxn, delayed wound healing
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42
Q

Advanced Breast Cancer SLNB vs Mastectomy?

A
  • Mastectomy should try SLNB however after neoadj therapy slight increase in false-negative rates
  • if invasion into pec muscle need to resect with specimen
  • leave drains
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43
Q

Advanced Breast Cancer when chemo?

A
  • chemo if >1 cm
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44
Q

Advanced Breast Cancer when XRT?

A
  • radiation if 4 or more LN, tumor >5cm
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45
Q

Advanced Breast Cancer - Stage 2B, 3A Tx?

A
    1. MRM or 2. Neoadjuvant & if responds —> BCT c SLNB

- Documented LN disease even if complete response no SLNB

46
Q

Advanced Breast Cancer - Stage 3A-C?

A

Primary (Neoadjvant chemo) 6 wks or 4 cycles and if become resectable —>MRM and postop chemo 8 cycles, radiation, hormonal and f.u

47
Q

Advanced Breast Cancer - Stage 4 (mets)?

A
  • premenapausal- oopherectomy, tamoxifen and if no response then taxol
    • postmen- aromatase inhibitor
48
Q

Advanced Breast Cancer Stage 1 =

A
  • Stage 1 = 0.5cm because usually more aggressive
    - all post menopausal with invasive BCA should receive tamoxifen. chemo if >2cm or LN positive
    - Postop chemo usually 6 mo of CMF (cyclophosphamide, methotrexate, 5-FU) or AC (adriamycin, cytoxan)
49
Q

Advanced Breast Cancer - Stage 2b= 2-5cm c regional nodes or >5cm
- Stage 3a >5cm c nodes or bulky but operable ax adenopathy tx?

A
  • Stage 2b= 2-5cm c regional nodes or >5cm
  • Stage 3a >5cm c nodes or bulky but operable ax adenopathy
    • Neoadj to shrink tumor (downstage it) to try BCS
    • Examine for nodes and FNA if palpable
    • Consider PET and CT
    • If doesn’t shrink than mastectomy followed by irradiation
50
Q

advanced BCA- Local Recurrence?

A
  • Local Recurrence
    • Stage c CT/PET scan
    • Parencyhmal recurrence re excise
    • If skin recurrence after radiation determine if can have more XRt and excise +XRT if possible
51
Q

BRCA testing?

A
  • BRCA testing-

- first degree dx BCA

52
Q

Inflammatory Breast Cancer T4 HPI?

A
  • HPI- non lactating women, erythema and edema over more than one third of breast that doesn’t get better c abx
53
Q

Inflammatory Breast Cancer T4 Ddx?

A
  • DDX- Mondors dz (inframammary cord), mastitis, abscess)
54
Q

Inflammatory Breast Cancer T4 characteristics?

A
  • Characteristics- peau d orange
55
Q

Inflammatory Breast Cancer T4 tx and dx?

A
  • Tx and Dx- Try antibiotics one week if good patient
    • U/S and MMG (and if mass CNB) receptor status
    • Punch biopsy or incisional bx, FNA the LN if palpable,
    • Mets w/u- CXR, Liver CT, Bone scan
56
Q

Inflammatory Breast Cancer T4 multimodality tx?

A
  • Multimodailty treatment
    • Three cycles of neoadjuvant chemo and once complete resolution (however if no good response give XRT 5000 rads)
    • Then an “interval” MRM (total c 1/2 LN),
      • BCT is CI, (unacceptably high false neg for SLNB)
      • if residual dz is left behind mark it with clips for xrt
    • Followed by 8 cycles of chemtherapy
    • And + Chest Wall XRT
    • Tamoxifen
    • ongoing abx not recommended
57
Q

Inflammatory Breast Cancer T4 complications?

A
  • Complications - bleeding from lack of ctrl of the internal mammary perforators, axillary vein, thoracodorsal branches which bleeding from these sites usually requires reexploration
    • skin flap necrosis start prompt ABX, wait until clear demarcation
58
Q

Inflammatory Breast Cancer T4 chemo?

A
  • Chemo- neoadj Taxol 12 weeks, followed by CAF (cyclophoshamide, Adriamycin, 5-FU) 4 cycles and if no response then XRT upfront prior to MRM and add 4 more wks of Taxol
59
Q

Inflammatory Breast Cancer T4 notes?

A
  • Note- If initial inflammatory breast cancer is eroding through the skin or is infected we have to start the treatment actually by XRT tx
  • Note- adriamycin cardiotoxic get an echo prior
60
Q

Inflammatory Breast Cancer T4 mets every where?

A

mets every where - start aromatase inhibitor and if no response then add tamoxifen, only do surgery if tumor becomes too painful or infectious

61
Q

Inflammatory Breast Cancer T4 5 YS?

A
  • 5 YS- poor 5%
62
Q

Breast Cancer During Pregnancy ddx?

A
  • DDx- fibroadenoma, lipoma, phyllodes, fat necrosis, fibrocystic dz, galactocele, cyst, abscess, accessory breast tissue
63
Q

Breast Cancer During Pregnancy galacotocele?

A
  • galactoceles develop months after d/c lactation
64
Q

Breast Cancer During Pregnancy w/u?

A
  • Std w/u is preferred

- Alk Phosp is typically elevated in pregnancy

65
Q

Breast Cancer During Pregnancy imaging things to remember?

A
  • Abdominal shielding MMG or digital MMG premenapuasal pts dense breast
  • U/S more sensitive than MMG detecting breast cancer in pregnancyf
  • MRI not good gadolinium, and prone position not safe
  • U/S guided CNB
  • gestational age and stage is important
66
Q

Breast Cancer During Pregnancy terminate a pregnancy?

A
  • never terminate a pregnancy - doesn’t improve outcomes, early delivery may be considered if felt to help maternal oncological outcome
67
Q

Breast Cancer During Pregnancy staging?

A
  • stage - CXR, U/S liver; CT scan PET scan deferred till after delivery
68
Q

Breast Cancer During Pregnancy when is chemo ok?

A
  • systemic chemo 2,3rd ok
  • usually MRM is preferred or (total mastectomy c SLNB)
  • DCIS vs Invasive think about it??
69
Q

Breast Cancer During Pregnancy 1st trimester?

A
  • 1st trim - attempt to defer to second trim, o/w surgery but not BCT, risk effects of ogranogenesis and poss spontaneous abortion
70
Q

Breast Cancer During Pregnancy 2nd trimester?

A
  • 2nd trimester optimal-where organogenesis is complete and risk of preterm labor is low- MRM
71
Q

Breast Cancer During Pregnancy 3rd trimester?

A
  • 3rd trimester- attempt to defer surgery til postpartum period 2/2 risk preterm labor - MRM vs a slight possibility of BCT with post part radiation after the chemo
72
Q

Breast Cancer During Pregnancy avoid?

A
  • avoid methotrexate and 5 FU?
  • Radio isotope tech 99 ok for SLNB
  • no tamoxifen or Herceptin in pregnancy only postpartum
73
Q

Breast Cancer Recurrence (see How to Win) wu?tx?

A
  • review reports, examine
  • essentially need a diagnosis and then restage it
  • FNA, cxr, CT a/p routine blood work, alkaline phosp, LFTs
  • basically upstage your treatment BCT—>MRM or MRM—> systemic tx
  • axillary nodes immobile then chemo and hormonal therapy (XRT if not already given)
74
Q

Dissemminated BCA and Recurrences if ER/PR +?

A
  • If ER/PR receptor positive
    • tamoxifen
    • Luteinizing hormones releasing analog (LHRH) suppresses pituitary gland , medical oophorectomy
    • Aminoglutethimide- aromatase
    • androgens
75
Q

Dissemminated BCA and Recurrences if ER/PR - ?

A
  • If ER/PR negative
    • chemo
    • chemo plus bone rescue
    • bisphosphonates treating bone mets
76
Q

Bloody Nipple D/C hx?

A
  • Hx- spontaneous, unilateral, clear or bloody, quadrant
77
Q

Bloody Nipple D/C ddx?

A
  • DDx- intraductal papilloma
78
Q

Bloody Nipple D/C w/u?

A
  • MMG, US, CNB if a mass
79
Q

Bloody Nipple D/C tx?

A
  • observe if colored for 6 weeks, stop caffeine, smoking if cytology is negative
  • cytology (if benign doesn’t mean anything)
  • milky check prolactin level
  • If there is a mass then resection of it with a subareolar wedge excision if you know what quadrant
  • if you don’t know where it is have the patient go home and see if can find it o/w total subareolar ductal system resection
  • no ductoscopy
80
Q

Bloody Nipple D/C operation?

A
  • operation
    • cannulize duct and inject methylene blue or leave probe
    • semicircular areolar incison
    • locate it and dissect out the ducts in this area
    • tie off the proximal and distal ends (avoid seroma)
    • take 1 cm area of tissue around duct and orient for pathology for permanents
    • 10% malignant
81
Q

Gynecomastia Men (How to Win) HPI?

A
  • Ask about Marijuanna, steroids, meds, liver dz, change in libido
82
Q

Gynecomastia Men (How to Win) w/u?

A
  • MMG, US, HCG, LFTs
  • Mass then triple test
  • check receptors usually receptor positive tamoxifen should be given, chemo and XRT same
83
Q

Gynecomastia Men (How to Win) diffuse enlargement

A
  • Diffuse enlargement probably pseudogynecomastia
84
Q

Gynecomastia Men (How to Win) causes?

A
  • testicular tumors (High HCG), Hyperthyroidism (high LH and testosterone), prolactin secreting tumors (low LH, Low testosterone), adrenal and Leydig tumors (high estradiol)
85
Q

Enlarged Axillary Node ddx?

A
  • DDx-Breast Cancer, Infection, Hydradenitis, Cat Scratch, Lymphoma, GI mets, melanoma, ENT mets
86
Q

Enlarged Axillary Node HPI?

A
  • Ask infections, B sx, GI cancers, Skin cancer
87
Q

Enlarged Axillary Node thats an adenoma?

A
  • 25% adenoma in axillary is BCA
88
Q

Enlarged Axillary Node w/u?

A
  • Triple test, ER/PR, Mucin r/o melanoma, CXR, CT Scan, upper and lower endoscopy, CEA, MRI
89
Q

Enlarged Axillary Node tx?

A
  • tx- most likely breast- maybe get an MRI to see if MMG, US missed something
    • options MRM or just ALND and observe
90
Q

Enlarged Axillary Node ALND?

A
  • ALND
    • take levels 1 and 2 not 3 (medial to pec minor)
      • lateral to and underneath the pectorals minor muscle
    • Transverse incision in axilla
    • incise clavipectoral fascia
    • ID lateral border of pec major
    • dissect onder pec major preserving pec neurovascular bundle
    • ID and dissect under pec minor
    • ID axillary vein - upper limit
    • ID long thoracic and thoracodorsal neuromuscular bundle and preserve
    • take all fatty tissue bounded by axillary vein/serratus anterior/lat dorsi
    • place drains and close
91
Q

Enlarged Axillary Node SLNB?

A
  • SLNB
    • preop pt has radiotracer lymphoscintigraphy
    • isosulfan blue injection - 1-5 cc intradermally over lesion
    • gamma probe to ID maximal radioactivity
    • transverse axillary incision
    • use gamma probe and blue dyt to ID sentinel node
    • excise palpable large nodes
    • Frozen section- if + proceed with ALND
92
Q

Pagets what is it?

A
  • Cells that migrated from DCIS or Invasive Cancer

- 50% association with the above

93
Q

Page’s using steroids?

A
  • Don’t use steroids can cause regression of the disease
94
Q

Pagets w/u?

A
  • Don’t use steroids can cause regression of the disease
  • MMG, US possible CNB
  • make sure no underlining mass
95
Q

Page’s treatment?

A
  • wedge resection of NAC check pathology if shows pagets then do a Simple Mastectomy consider SLNB o/w if cancer in specimen do a ALND
  • No steroids - causes regression
  • Central lumpectomy, SLNB, XRT ??
96
Q

Pagets No palpable mass, no mass on imagin

A
  • wedge resection of the NAC under local anesthesia c sedation and send to pathology
  • if pages cells patient should have a simple mastectomy +/- XRT
  • If invasive breast cancer patient should have a complete ALND unless SLNB was done at initial surgery
97
Q

Pagets - Identifiable breast mass?

A
  • Identifiable breast mass
    • excisional biopsy of mass and wedge resection of the NAC
    • if invasive breast cancer and paget cells in NAC then need a MRM plus postoperative tx as indicated
98
Q

Pagets SLNB?

A
  • consider SLNB initial surgery if patient higher risk
99
Q

Enlarged Axillary LN benign causes?

A
  • infection, hidradenitis, cat scratch, ascending lymphagcinitis, generalized lymphadenopathy, viral, fungal
100
Q

Enlarged Axillary LN c adenocarcinoma causes?

A
  • Malignant causes
    • ipsilateral breast cancer
    • lymphoma
    • melanoma
    • lung Ca
    • GI cancer (rare)
101
Q

Enlarged Axillary LN c adenocarcinoma PE?

A
  • exam both breast, other LN, skin upper half of body, listen to chest , test stool guaiac and palpate live
102
Q

Enlarged Axillary LN c adenocarcinoma - Everything negative with adenocarcinoma?

A
  • Everything negative with adenocarcinoma
    • MMG, CXR, CT A/P, Bone scan, UGIS/BE?
    • Excisional biopsy to confirm FNA done in office
      • path
        • ER/PR
        • Mucin stain (melanoma, lymphoma)
    • still negative
      • MRM treat if she had cancer with mets from breast
103
Q

Large Mass >5cm adhered to chest wall Breast Cancer and or fixed enlarged ALN what to do?

A
  • Start c H&P
  • FNA and MMG
    • FNA is + non-inflammatory BCA
    • Do metastatic w/u
    • Generous Incisional Bx and send ER/PR rec
    • Give induction chemotherapy (3-4 cycles) and follow U/S for response
    • MRM
    • followed by R.T
    • then completion Chemo (6-12 wks)
    • Tamoxifen
104
Q

Large Mass >5cm adhered to chest wall Breast Cancer and or fixed enlarged ALN if cancer is fungating and ulcerative?

A
  • If cancer is fungating and ulcerating
    • Forced to do Salvage Mastectomy or R.T
      • Because giving chemo in the presence of infected ulceration can kill the patient from sepsis
105
Q

Male Breast Cancer HPI?

A
  • HPI- Lump under his nipple
106
Q

Male Breast Cancer Ddx?

A
  • Ddx- Gynecomastia or normal subareolar “disk” seen in puberty
    • Liver dz/ cirrhosis
    • Meds - Mainly anti-HTN
    • testicular mass (some HCG secreting tumors cause it)
    • bilateral or unilateral , firm, central, and tender vs hard, irregular, non tender
107
Q

Male Breast Cancer w/u?

A
  • W/U
    • Full PE
    • LFTs, HCG
    • FNA and even incisional bx
    • US, MMG
108
Q

Male Breast Cancer tx?

A
  • Tx
    • Wide MRM (may include pec if involved)
    • Tamoxifen
    • Chemo and XRT same indications as woman
    • If disseminated disease
      • orchiectomy and hormonal manipulations have good palliative effects
    • SLNB c Total Mastectomy - valid option in smaller tumors and negative ALN
109
Q

BCA Notes on SLNB micromets?

A
  • need to go back
110
Q

BCA Notes on SLNB isolated tumor cells?

A
  • considered node negative, don’t go back (probably from biopsy manipulation rather than mets)
111
Q

BCA c CT shows mets all over, bone and liver etc?

A

aromatase inhibitor, if no response add tamoxifen, and finally chemo only do surgery if becomes painful or infectious because the cancer is going to kill her

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