breast Flashcards
what test differentiates solid and cystic breast masses
ultrasonography
bromocriptine, tamoxifen, danazol, vit B6
mastodynia
common organisim in breast infection and abscesses
staph aureus
significant fever/chills, flu like symptoms, unilateral tenderness
mastitis or abscess
how much of breast is affected in mastitis
one quadrant
mastitis tx
penicillinase resistant- cloxacillin, dicloxacillin, nafcillin; cephalosporin, hot compresses
can a woman still breastfeed with mastitis
yes
fibrocystic breast changes occur in what age
30-50
what test to order in suspected breast cysts
fine needed aspiration both diagnostic and therapeutic. straw colored fluid
most fibrocystic breast changes treated how
supportive bra
3 things you can do for fibrocystic changes
low salt diet, vit E, HCTZ
fibroadenomas age and race
young, black
round, firm, smooth, discrete, mobile, nontender
fibroadenoma
fibroadenoma in pt under 25 y.o
biopsied
fibroadenoma tx
excision
why no mammogram with breast cyst
breast tissue too dense
D/D of breast mass (5)
fibrocystic d/s, fibroadenoma, mastitis/abscess, fat necrosis, cancer
2 common causes of bloody nipple discharge
intraductal papilloma and mammary duct ectasia
what is associated with 5-10% of breast cancer
BRCA1 and BRCA2 genes
nulliparity, early menarche, late menopause, long term estrogen, radiation exposure, delayed childbearing
associated factors in breast cancer
what makes a woman have an increased risk of breast cancer
first degree relative, especially if cancer was premenopausal or bilateral or found in 2 relatives
2 kinds of breast cancer
80-85% infiltrating ductal carcinoma; remainder lobular carcinomas
what 2 disorders predispose to breast cancer
lobular CIS and atypical ductal hyperplasia
what is paget’s disease?
- often what underneath
- % of breast cancers
ductal carcinoma presenting as a eczematous lesion of the nipple/areola.
often DCIS or IDC underneath
1% of breast cancer
all invasive lobular carcinomas and 2/3 of ductal carcinomas are what
estrogen receptor positive
45-60% of breast cancer occur where
25% where
upper outer quadrant
under nipple and areola
breast cancer race
white
single, nontender, immobile, firm mass, ill defined margins
breast cancer
common mets of cancer
BLT with pickle: breast, lung, thyroid, prostate
increased exposure to estrogen how (3)
early menarche, late menopause, nulliparity
axillary nodes matted or fixed to skin
stage III breast cancer
ipsilateral supraclavicular or infraclavicular nodes
stage IV breast cancer
tests to get for a postmenopausal and premenopausal breast mass
mammogram post menopausal
ultrasonography premenopausal
rope like bumpy lumpy breasts
fibrocystic disease
ductal carcinoma in situ
possible malignant, cancerous cells within the milk ducts. DCIS puts pt at increased risk of invasive disease
invasive ductal carcinoma
malignant and invasive neoplastic cells which have broken out of the milk ducts
15% breast cancers
lobular
lobular carcinoma in situ
abnormal cells within the lobule. not considered cancer. it puts the pt at an increased risk of developing cancer
invasive lobular cancer
cancer cells have broken out of the lobule
peau d’ orange
orange skin, think breast cancer
oncotype DX test
to determine the need for chemo with stage 1 or II hormone receptor positive cancer
what stages are most curable with breast cancer
I, IIA, IIB
tx for early stage breast cancer
lumpectomy with sentinal node bx
tamoxifen for what
estrogen receptor antagonist: women with estrogen receptor positive disease and postmenopausal women
breast cancer surgery
modified radical masectomy and partial masectomy with radiation
mammogram screening recommendations
annually for age 45-54
every other year for pts 55
imaging for metastatic disease breast
CT and PET
what is galactorrhea caused by
pituitary prolactinoma
galactorrhea tests (4)
elevated prolactin, b hCG, MRI pituitary/hypothalmus
what 2 drugs can lower prolactin
cabergoline and bromocriptine
cabergoline and bromocriptine
what 2 drugs can lower prolactin
who is gynecomastia seen in (3)
- taller, heavier boys during puberty
- elderly
- obese
6 possible causes of gynecomastia
endocrine issue, chronic liver d/s, chronic kidney d/s, neoplasm, drugs, puberty
gynecomastia: describe…
- prolactin
- testosterone
- estradiol
- karyotype
- prolactin may be elevated
- testosterone low
- estradiol may be increased
- karyotype: Klinefelter’s syndrome
good initial test for a suspicious lesion on mammogram
FNA(careful of false positive) or a core needle bx
CEA, CA 15-3, or CA 27-29
tumor markers for recurrent breast cancer
metastatic breast cancer labs (3)
increased ESR, increased calcium, and increased alk phos(liver and bone mets)
what imaging do you order metatstatic breast cancer
- 3 tests
- 2 other helpful tests
- CXR, CT chest/abdomen/pelvis, brain MRI
- PET and bone scarn
increased ESR, increased calcium, and increased alk phos(liver and bone mets)
breast cancer
early stage breast cancer tx
sx + irradiation or mastectomy +/- radiation(deep cancer)
must do sentinel node biopsy for eval of axillary nodes
locally advanced breast cancer tx
chemo plus medicine; or surgery with sentinal bx
stage IV breast cancer tx
radiation and hormonal. mastectomy
large tumor size, subareolar location, multifocal tumors, fixation to chest wall, prior radiation to chest wall, involvement of nipple or overlying skin
contraindications to breast conserving therapy(lumpectomy)
what occurs in 50% of metastatic breast cancer
- symptom
pleural effusion
edema of the arm
