Breast Flashcards by Lauren Chorny

what are the major breast cancer susceptibility genes

BRCA1 and BRCA2

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what option exists to decrease the risk fo breast cancer in women with BRCA

prophylactic bilateral mastectomy

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what is the ‘triad of error’ for misdiagnosed breast cancer

age <45
self-diagnosed mass
negative mammogram

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what are the history risk factors of breast cancer

NAACP

nulliparity
age at menarche
age at menopause
cancer of the breast (self or family)
pregnancy with first child

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is ‘run of the mill’ fibrocystic disease a risk factor for breast cancer

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what are the possible symptoms of breast cancer

no symptoms
mass in the breast
pain (most are painless)
nipple discharge
local edema
nipple retraction
dimple
nipple rash

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why does skin retraction occur

tumor involvement of Cooper’s ligaments and subsequent traction on ligaments bull skin inward

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what are the signs fo breast cancer

mass
dimple
nipple rash
edema
axillary/supraclavicular nodes

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what is the most common site of breast cancer

upper outer qudrants

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what are the different types of invasive breast cancer

infiltrating ductal carcinoma
medullary carcinoma
infiltrating lobular carcinoma
tubular carcinoma
mutinous carcinoma
inflammatory breast cancer

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what is the most common type of breast cancer

infiltrating ductal carcinoma

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describe the appearance of the edema of the dermis in inflammatory carcinoma of the breast

peau d’orange

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what is the classic picture of breast cancer on mammogram

spiculated mass

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what option is best initial test to evaluate a breast mass in a woman <30

breast ultrasound

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what tumor is associated with a radial scar

tubular carcinoma

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what is the ‘workup’ for a breast mass

clinical breast exam
mammogram or breast ultrasound
FNA, core biopsy, or open biopsy

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how do you proceed if a mass appears to be a cyst

aspirate it with a needle

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is the fluid from a breast cyst sent for cytology

not routinely

- bloody fluid will be sent for cytology

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when do you proceed to open biopsy of breast cyst

second cyst recurrence
bloody fluid in the cyst
palpable mass after aspiration

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what hormone receptors must be checked for int he biopsy specimen

Estrogen and progesterone receptors

- this is key for determining adjuvant treatment

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what are the sites of metastasis in breast cancer

LNs
lung/pleura
liver
bones
brain

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what are the major treatments of breast cancer

modified radical mastectomy

lumpectomy and radiation + sentinel LN dissection

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what breast carcinomas are candidates for lumpectomy and radiation (breast-conserving)?

stages I and II (tumors <5cm)

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what approach may allow a patient with stage IIIA cancer to have breast-conserving surgery

neoadjuvant chemotherapy

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what is the treatment of inflammatory carcinoma of the breast

chemotherapy first

what is a sentinel node biopsy

instead of removing all the axillary LNs, the primary drawing or 'sentinel' LN is removed

how is the sentinel LN found

inject blue dye and/or technetium-labeled sulfur colloid

how does tamoxifen work

binds estrogen receptors

can tamoxifen prevent breast cancer

yes

what are the side effects of tamoxifen

endometrial cancer | DVT, pulmonary embolus, cataracts, hot flashes, mood swings

what is DCIS

ductal carcinoma in situ

what is DCIS also known as

intraductal carcinoma

describe DCIS

cancer cells in the duct without invasion

what are the signs/symptoms of DCIS

usually none, usually nonpalpable

what are the mammographic findings of DCIS

microcalcifications

what is the major risk with DCIS

subsequent development of infiltrating ductal carcinoma in the same breast

what is LCIS

lobular carcinoma in situ

what are the signs/symptoms of LCIS

none

what are the mammographic findings of LCIS

none

what is the most common cause of bloody nipple discharge in young women

intraductal papilloma

what is the most common breast tumor in patients <30yo

fibroadenoma

what is Paget's disease of the breast

scaling rash/dermatitis of the nipple caused by invasion of skin by cells from a ductal carcinoma

what is the most common cause of green, straw-colored, or brown nipple discharge?

fibrocystic disease

what is the most common cause of breast mass after breast trauma

fat necrosis

what must be ruled out with spontaneous galactorrhea

prolactinoma

what is cystosarcoma phyllodes

mesenchymal tumor arising from breast lobular tissue | - most are benign

what are the signs/symptoms of cystosarcoma phyllodes

mobile, smooth breast mass that resembles a fibroadenoma on exam, mammogram/ultraosund findings

how is cystosarcoma phyllodes diagnosed

through core biopsy or excision

what is the treatment of cystosarcoma phyllodes

if benign, wide local excision | if malignant, simple total mastectomy

what is a fibroadenoma

benign tumor of the breast consisting of stromal overgrowth, collagen arranged in 'swirls'

what is the clinical presentation of a fibroadenoma

solid, mobile, well-circumscribed round breast mass, usually <40-

how is fibroadenoma diagnosed

negative needle aspiration looking for fluid ultrasound core biopsy

what is the treatment of fibroadenoma

surgical resection for large or growing lesions | small fibroadenomas can be observed closely

what is fibrocystic disease

common benign breast condition consisting of fibrous (rubbery) and cystic changes in the breast

what are the signs/symptoms of fibrocystic disease

breast pain or tenderness that varies with menstrual cycle cysts fibrous (nodular) fullness

what is the treatment of symptomatic fibrocystic disease

stop caffeine pain medications (NSAIDs) vitamin E, evening primrose oil

what is mastitis

superficial infection of the breast

in what circumstance does mastitis most often occur

breastfeeding

what bacteria most commonly causes mastitis

staph aureus

why must the patient with mastitis have follow-up

to make sure she does not have inflammatory breast cancer

what are the causes of breast abscess

mammary ductal ectasia and mastitis

what is the most common bacteria causing breast abscess

``` nursing = S. aureus nonlactating = mixed infection ```

what is the treatment of breast abscess

antibiotics | needle or open drainage

what is lactational mastitis

infection of the breast during breastfeeding

what must be ruled out with a breast abscess in nonlacting women

breast cancer

what is male gynecomastia

enlargement of the male breast

what are the causes of male gynecomastia

- medications - drugs (marijuana) - liver failure - increased estrogen - decreased testosterone

what is the major differential diagnosis in an older patient with male gynecomastia

male breast cancer

what is the treatment of male gynecomastia

stop or change medications, correct underlying cause