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ABSITE > Breast > Flashcards

Breast Flashcards

1
Q

Main nerves encountered during axillary dissection?

A

Long thoracic nerve (serratus anterior), thoracodorsal nerve (latissimus dorsi), intercostal brachial nerve (lateral cutaneous branch of 2nd intercostal nerve, sensation to medial arm/axilla)

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2
Q

Cord-like breast mass: dx/tx?

A

Mondor’s disease, superficial vein thrombophlebitis, tx w/ NSAIDs - rule out malignancy w/ MMG/US

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3
Q

Tx options for DCIS, margins, lymph nodes, cancer risk

A

lumpectomy w/ XRT, consider SLNBx in high grade DCIS or w/ large/palpable masses (unable to do SLNBx after most lumpectomies and all mastectomies given disruption of lymphatics) 50% get ipsilateral cancer if not resected, 5% cancer contralateral

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4
Q

Tx options for LCIS, margins, lymph nodes, cancer risk

A

marker for development of breast ca (not a premalig lesion), ex biopsy or tamoxifen, bilateral mastectomy; more likely to have ductal Ca, 40% get breast ca in either breast

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5
Q

explain the BIRADS classification and recommendation

A

BIRADS 1 negative - routine screening, 2 benign finding - routine screening, 3 probably benign finding - short term follow up, 4 suspicious abnormality i.e. indeterminate calcification or architecture - CNBx, 5 highly suggestive of Ca - CNBx

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6
Q

Breast cancer screening guidelines

A

MMG every 2-3 years after age 40, yearly after age 50; high risk screening MMG 10 years before youngest age of first breast ca 1st degree relative

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7
Q

explain levels of axillary lymph nodes

A

level 1 = lateral to pec minor, 2 = under pec minor 3 = medial to pec minor

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8
Q

What are Rotter’s nodes?

A

nodes between pec major and pec minor muscles

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9
Q

What is the most important prognostic staging factor in breast ca?

A

Node status

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10
Q

Explain TNM staging in breast cancer

A

T1 <2 cm, T2 >2 cm <5 cm, T3 >5 cm, T4 = extension to chest wall, skin edema, ulceration, satellite nodules, inflammatory; N1 = 1-3 axillary/IM nodes, N2 = 4-9 axillary nodes or clinically apparent IM nodes without axillary mets, N3 = 10+ axillary nodes, infraclavicular nodes, or IM nodes in presence of axillary nodes

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11
Q

Ca associations and lifetime risks in BRCA1? BRCA2? hormone receptor status in BRCA1?

A

BRCA1 - female breast Ca 60%, Ovarian Ca 40%, male breast Ca 1%; BRCA2 = female breast ca 40-55%, ovarian Ca 10%, male breast Ca 10% (100x increase) – BRCA are tumor suppressor genes – BRCA1 breast ca tend to be hormone receptor negative / triple negative

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12
Q

Tx of male breast cancer w/ clinically node negative dz?

A

Simple mastectomy + SLNBx

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13
Q

Indications for XRT after mastectomy

A

positive nodes (>4), skin/chest wall involvement, positive margins, large tumor (T3 >5 cm), extracapsular nodal invasion, inflammatory Ca, fixed axillary nodes (N2) or internal mammary nodes (N3)

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14
Q

scaly nipple lesion

A

Paget’s disease, underlying DCIS/ductal Ca, bx w/ punch/full thickness biopsy, mastectomy+RT or BCT+RT are acceptable, need to include nipple areolar complex – mastectomy often required given extent of underlying cancer

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15
Q

dark purple nodules on arm 10 years after axillary dissection – dx, tx?

A

Stewart-Treves syndrome -> lymphangiosarcoma from chronic lymphedema; dx via open biopsy, tumor is highly aggressive w/ early mets to lung, tx consists of early wide surgical debridement (may require amputation), survival <2 years

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16
Q

stromal/epithelial frond like pattern breast mass - dx, tx, spread?

A

Phyllodes tumor, no nodal metastasis -> hematogenous spread, 10% malignant based on mitoses per HPF, WLE w/ 1 cm margins, no ALND

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17
Q

Borders of an axillary lymph node dissection

A

Axillary vein (superior), serratus anterior (medial), latissimus dorsi (lateral)

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18
Q

hypoplasia of chest wall, amastia, hypoplastic shoulder, no pec muscle

A

Poland syndrome - men > women, R > L

19
Q

Gynecomastia: demographics, Ca risk, tx

A

infancy, puberty, and age >50; not considered risk factor for breast Ca, mammography useful to differentiate from malignancy, can tx w/ tamoxifen (surgery rarely)

20
Q

Features of pathologic nipple discharge

A

Serous or bloody, unilateral, uni-duct, spontaneous

21
Q

Tamoxifen decreases breast cancer risk in high risk patients by ….? What about prophylactic mastectomy

A

50% risk reduction in subsequent breast Ca (NSABP-P01 trial), 90% risk reduction in prophylactic mastectomy

22
Q

major side effects of tamoxifen?

A

increased risk of endometrial adenocarcinoma, increased risk of VTE; cataract formation

23
Q

Ultrasound features of a benign breast mass?

A

Homogenous, bilateral edge shadowing, wider than tall

24
Q

Ultrasound features of a malignant breast mass?

A

Heterogenous, taller than wide (means the lesion is infiltrative of the natural elements of the breast)

25
Q

Atypical ductal hyperplasia: risk of breast cancer, management?

A

5x higher relative risk of breast cancer, similar to DCIS, surgical excision is recommended, margins are not needed, tamoxifen is recommended after excisional biopsy confirms absence of cancer (50% reduction in subsequent cancer); no axillary staging is needed

26
Q

features of invasive lobular cancers

A

15% of invasive breast cancers, typically hormone positive, indiscrete on MMG/US, hard to appreciate nodal mets on frozen section

27
Q

Success rate of SLNBx? Safety of radioactive technetium in pregnancy?

A

> 95%. false negative rate is around 10%. Radioactive technetium low dose, safe in pregnancy

28
Q

Summarize main points of NSABP B17

A

NSABP B17 established that XRT significantly reduces local recurrence when administered after lumpectomy,

29
Q

Summarize main points of ACOSOG Z0011

A

ACOSOG Z0011 demonstrated that pt w/ early invasive breast Ca T1/T2 undergoing BCT do not need completion ALND if the SLNBx is positive in <3 nodes

30
Q

Summarize main points of AMAROS trial

A

women w/ early breast Ca and no clinically palpable nodes could undergo radiotherapy in place of axillary dissection if LN were determined to be positive

31
Q

Contraindications to nipple-sparing mastectomy?

A

Extensive intraductal cancer, associated nipple discharge, Paget disease, cancer within 2 cm of nipple

32
Q

Pathologic difference between phyllodes and fibroadenoma?

A

stromal hypercellularity

33
Q

mammogram showing stellate lesion with transulcent central portion

A

radial scar (<1 cm) and complex sclerosing lesions (>1 cm) - characteristic central area of fat which differentiates it from carcinomas, need excisional biopsy of entire lesion

34
Q

Risk factors for breast ca (RR >4, RR 2-4, RR <2)

A

RR>4 - BRCA2, multiple family members w/ bilateral or premenopausal breast ca, DCIS/LCIS/ADH, RR 2-4 - prior breast ca, rads exposure, 1st deg relative w/ breast ca, age >35 1st birth; RR <2 - early menarche, late menopause, nulliparity, proliferative benign dz, obesity, EtOH use, hormonal replacement therapy

35
Q

Features of tubular breast carcinoma?

A

Ductal, 2%, well differentiated, most favorable prognosis

36
Q

Features of papillary breast carcinoma?

A

Ductal, <1%, occurs in post menopausal, favorable prognosis (vs micropapillary carcinoma which are aggressive)

37
Q

Features of medullary breast carcinoma?

A

Ductal, associated with BRCA1, poorly differentiated w/ aggressive features but generally have favorable prognosis

38
Q

Features of mucinous breast carcinomas?

A

Ductal, 5% of invasive breast ca, characterized by mucin component, well differentiated, w/ low rate of mets

39
Q

Management of early stage triple negative breast cancer?

A

Lumpectomy/XRT/SLNBx or mastectomy/SLNBx – followed by chemotherapy

40
Q

Indications for axillary lymph node dissection in breast cancer

A

clinically node-positive axilla, occult breast cancer presenting as axillary node metastasis, SLN positive patients who fall outside the Z0011 selection criteria (i.e. >2 SLN positive), inflammatory, clinical stage T4, or high-risk T3 breast cancer, sentinel or axillary nodes which remain positive after neoadjuvant chemotherapy, axillary recurrence

41
Q

Management of inflammatory breast cancer

A

neoadjuvant chemotherapy followed by either surgery or XRT depending on resectability

42
Q

route of bone metastasis from breast cancer?

A

Batson plexus

43
Q

breast lymphoma: most common type, tx, most common mets

A

most are B cell (diffuse large B cell), if lesion localized/low grade can consider primary excision, intermediate/high grade need CHOP+radiation, tend to mets to central nervous system

44
Q

most significant side effect / complication associated with trastuzumab?

A

herceptin; cardiac toxicity - assoc. w/ cardiac failure manifesting as decreased LVEF, need serial assessment of LVEF

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