Breast Flashcards
Risk factors for breast cancer
Female gender, increasing age, and a family history of premenopausal breast cancer. Family history of breast cancer in males or premenopausal women, bilateral breast cancer, a history of ovarian cancer, and multiple relatives with cancer. BRCA1 or BRCA2 gene mutations. Diethylstilbestrol (DES) exposure, early menarche, nulliparity or childbirth after age 30, and/or late menopause.
Three categories of nipple discharge
Normal milk production (lactation), physiologic nipple discharge, or pathologic nipple discharge.
Characteristics of nipple discharge that suggest cancer
Bloody, spontaneous, unilateral, uniductal, associated with a breast mass, or occurs in women over 40.
What is Peau d’Orange?
Lymph drainage in the breast is compromised by a tumor, resulting in edema expanding the interfollicular dermis, producing characteristic dimples which resemble the texture and appearance of orange peels. When deeper subcutaneous layers are involved, it can also cause pitting.
What is the pathophysiology of nipple retraction?
When a breast tumor infiltrates Cooper’s ligaments, the suspensory ligaments of the breast, it can retract the skin, often at or around the nipples.
What is the triple test for a new breast mass?
Careful examination, imaging, and tissue sampling.
What is a triple negative breast cancer?
Breast cancer that is negative for estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER-2) receptors. Prognosis is worse, requires more aggressive therapy.
What is the premise behind sentinel lymph node biopsy (SLNB)?
A sentinel lymph node is the hypothetical first node or group of nodes from which the lymphatics of the breast drain. The premise behind SLNB is that if the sentinel node(s) is(are) free of metastasis, then other lymph nodes in the axilla will also be disease free, and therefore, there is no need to remove the remaining lymph nodes in the axilla.
What are the boundaries in the axilla for breast dissection?
Axillary vein (superior), floor of axilla (posterior), latissimus dorsi muscle (lateral), pectoralis minor muscle (medial).
Five hormonal therapies for breast cancer
Tamoxifen, Raloxifene, Fulvestrant, Anastrozole, Trastuzumab
Four chemotherapy regimens for breast cancer
Anthracyclines, Alkylating agent, Antimetabolites, Taxanes
Nerves at risk for damage during dissection of lymph nodes for breast cancer
Long thoracic, thoracodorsal, medial pectoral, lateral pectoral
Most common cause of palpable breast mass
Fibrocystic disease
Incidence of breast cancer in women in U.S.
1 in 8 women will develop breast cancer in U.S.
The most common malignant neoplasm of the breast
Invasive ductal carcinoma
The most common breast neoplasm in premenopausal women
Fibroadenoma
Imaging to be ordered for new breast mass based on age
<30 ultrasound, >30 ultrasound + mammogram
Management for early stage breast cancer
Lumpectomy with SLND and radiation OR simple mastectomy with SLND
Why is mammography not useful in women <30 years old?
Younger women tend to have denser breast tissue due to a decreased level of fat. Dense breasts make it difficult to detect abnormal calcifications or masses.
What is the Gail risk model?
AKA Breast Cancer Risk Assessment Tool (BCRAT); a mathematical model used to calculate the risk of developing breast cancer. The model considers factors such as age, age at menarche, reproductive history, family history in first-degree relatives, and prior biopsies.
What impact does lesion size on mammography have on the likelihood of being benign or malignant?
Larger calcifications (macrocalcifications) are almost always benign, while smaller calcifications (microcalcifications) are more frequently seen in patients with breast cancer.
DCIS
Ductal Carcinoma in situ: characterized by malignant epithelial cells within the mammary ductal system, without invasion into the surrounding stroma (does not metastasize). Very high incidence of recurrence.
LCIS
Lobular Carcinoma in situ: characterized by malignant epithelial cells that arise from the lobules and terminal ducts of the breast. Unlike DCIS, it is not a premalignant lesion, but rather is a marker for the development of future ipsilateral as well as contralateral invasive breast cancer (ductal or lobular).
What is the BI-RADS assessment?
American College of Radiology’s Breast Imaging Reporting and Data System (BI-RADS), standardizes the reporting of mammographic findings and indicates the relative likelihood of a normal, benign, or malignant diagnosis.
What are the first steps in management of DCIS?
Lumpectomy, then margins of tissue are inked for remaining cancer cells. If positive, re-excision or mastectomy are recommended.
What are the first steps in management of LCIS?
Excisional biopsy (a smaller tissue size is excised than lumpectomy). The goal is not clear margins (like for DCIS), but instead to check for nearby cancer. If negative, LCIS still indicates increased risk of breast cancer in EITHER breast.
Fibroadenomas: who is at risk, what does it look like, and what do you do?
Young women (teens, early 20’s). Firm rubbery mass that moves easily with palpation. FNA is diagnostic, removal is optional.
Giant Juvenile Fibroadenomas: who is at risk, what does it look like, and what do you do?
Very young adolescents. Grows very fast. Removal is needed to avoid deformity of the breast.
Cystosarcoma phylloides: who is at risk, what does it look like, and what do you do?
Late 20’s. They grow over many years, becoming very large, replacing and distorting the entire breast: yet not invading or becoming fixed. Most are benign, but they have potential to become outright malignant sarcomas. Core or incisional biopsy is needed (FNA is not sufficient), and removal is mandatory.
Intraductal papilloma; who is at risk, what does it look like, and what do you do?
20’s to 40’s. Bloody nipple discharge. Galactogram may be diagnostic and guide resection.
Breast abscess is only seen in what kind of women
Lactating women
Most common form of breast cancer
Invasive ductal carcinoma
Adjuvant systemic hormonal therapy for premenopausal vs. postmenopausal women
Premenopausal get tamoxifen. Postmenopausal get anastrozole
Favorite location for breast cancer metastasis to the spine
Vertebral pedicles
