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Oral Boards > Breast > Flashcards

Breast Flashcards

1
Q

List of benign breast masses

A

Fibroadenoma Cyst Fat necrosis Fibrocystic changes Phylloides tumor

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2
Q

Elements of breast mass history

A

timing

meds history (hormones)

Risk factors (age of menstruation, pregnancies, previous biopsies)

Family history

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3
Q

Bi-RAds

A

1: Negative for mass 2. Benign 3. Probably benign (6 mo follow up) 4: Suspicious (tissue dx) 5: Highly suspicious (tissue dx) 6. Known malignancy.

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4
Q

How to deal with palpable lymph nodes on initial examination

A

FNA

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5
Q

Diagnostic mammogram views

A

Cradiocaudal mediolateral oblique

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6
Q

Immunohistochemistry equivicol for Her2 then request…

A

FISH testing.

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7
Q

Requirements for SLNB in patient with clinically positive nodes prior to neoadjuvant chemotherapy. (ACOSOG 1071)

A
  1. Dual tracer
  2. 2, and ideally, 3 SLN
  3. Removal of clipped, clinically positive node. (If residual disease identified in SLN, then completion ALND)
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8
Q

SLNB removal criteria

A

Highest radioactivity - get number palpable blue > 10% of max SLN.

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9
Q

Post op considerations regarding cancer treatment

A
  1. Multidisciplinary approach 2. Hormones 3. Radiation 4. Chemotherapy (typically prior to radiation) 5. Mammogram 6 months after completion of therapy 6. Annual visit, exam, and mammogram
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10
Q

Breast mass algorithm

A
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11
Q

Findings on CNB that confer increased risk of breast cancer

A
  1. Atypical ductal hyperplasia
  2. Lobular neoplasia
  3. Papillomas with or without atypia
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12
Q

Margin required for DCIS

A

2 mm

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13
Q

Contraindications for radiation therapy

A
  1. Collagen vascular dissease
  2. Previous radiation
  3. Pregnancy
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14
Q

Extent of dissection in mastectomy

A
  1. clavicle superiorly
  2. sternum medially
  3. Latissimus laterally
  4. inframammary fold inferiorly.
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15
Q

Length of adjuvant hormonal therapy to achieve risk reduction

A

5 years

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16
Q

consideration for SLNB in DCIS

A

lesions > 4 cm

comedonecrosis

Mastectomy

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17
Q

Benefits of adjuvant radation in DCIS partial mastectomy

A

Decreased local recurrance. No survival benefit.

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18
Q

Size of needle for core needle biopsy

A

14 or 16 gauge (must place clip if doing it yourself)

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19
Q

Breast cancer risk for LCIS

A

1% per year (need tamoxifen or raloxifene for 5 years)

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20
Q

Side effects of estrogen receptor antagonists

A

tamoxifen (night sweats, hot flashes, increased uterine cancer risk in post menopausal women)

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21
Q

Treatment for DCIS

A
  1. Biopsy with determiniation of receptor status
  2. discussion at MD conference
  3. Lumpectomy with whole breast radiation
  4. Risk reduciton with tamoxifen
  5. H&P Q6 mo for 5 years, then annually with annual mammogram
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22
Q

Work up when diagnosis of breast cancer made

A
  1. Receptor status
  2. MD conference meeting
  3. consider genetic counseling
  4. pregnancy test
  5. Focused H&P looking for abdominal symptoms or neurological symptoms, and LN exam, followed by possible labs, CXR, head MRI
23
Q

When should neoajuvant chemotherapy be considered

A

T2 (greater than 2 cm) or N1 lesions

24
Q

What to do if nodes found on SLNB

A

ZII trial?

Consider staging work up if not obtained before.

25
Q

Only real case where post op radiation is NOT indicated

A

Mastectomy with no positive nodes, tumor < 5 cm, and margin > 1 mm

26
Q

Favorable histologic subtypes

A
  1. Pure tubular
  2. Pure mucinous
  3. Pure cribiform
  4. encapsulated or solid papillary

Important if also node negative, then don’t need adjuvant chemotherapy. All others get adjuvant chemo considered.

27
Q

2 scenarios that may not need adjuvant chemotherapy

A

Favorable histologic subtypes with node negative disease

Standard subtypes with node negative disease ER/PR positive HER2 negative, < 0.5 cm

Above > 0.5 cm, consdier 21-gene assay

28
Q

Work up prior to neoajuvant chemotherapy

A

Standard H&P, diagnostic mammogram, U/s of breast, biopsy, receptor status, MD conference, consider genetics

should also consider axillary U/S with FNA of suspicious nodes followed by possibly

labs, chest/a/p CT, bone scan

29
Q

General treatment strategies for recurrence of breast cancer

A

Try to resect and stage axilla if possible

If axilla already dissected, resect recurrence

If havn’t recieved RT, gets resection and RT

If recurrent supraclavicular or internal mammary - RT

30
Q

Z11 requirements

A
  1. T1 or T2 tumor
  2. 1 or 2 positve Sentinel lymph nodes
  3. Breast conserving surgery
  4. WBRT planned
  5. No pre-op chemo
31
Q

What if can’t identify sentinel lymph node?

A

Must do axillary LN disseciton

32
Q

What prompts concern for phyllodes tumr

A

U/S characteristics of fibroadenoma but > 3cm

33
Q

Treatment of phyllodes tumor

A

Excision with 1 cm margins. (small % are malignant) no need for axillary staging.

34
Q

Physical exam findings raising concern for Paget’s disease

A

areolar ezcema, bleeding, ulceration, itching

35
Q

Work up for Paget’s disease

A

Clinical history and exam

diagnostic mammogram and u/s

Core needle biopsy of mass and full thickness skin biopsy of NAC

36
Q

Treatment for Paget’s disease

A

Atleast central lumpectomy including NAC with WBRT

if cancer, may need SLNB

37
Q

Work up for inflammatory breast cancer

A
  1. H&P with axillary exam
  2. Bilateral diagnostic mammogram and ultrasound
  3. CbC, CMP
  4. CT chest/abdomen/pelvis
  5. bone scan
  6. Biopsy with recetor status
  7. Disccussion at MD board
  8. Genetic counseling
38
Q

Treatment for inflammatory breast cancer

A
  1. Neoadjuvant chemotherapy (anthracycline plus taxane) +/- trastuzumab/pertuzumab if HER2 positive
  2. Modified radical mastectomy
  3. Post op radiation, completion of HeR2 chemo, and endocrine therapy for receptor positive.
39
Q

Cumulative risk of cancer with ADH

A

30% in 25 years (4.5X normal risk)

40
Q

% DCIS upstaged on pathology

A

10-20%

41
Q

% ADH diagnosed with concurrent cancer

A

up to 40%

42
Q

Lifetime risk of breast cancer in BRCA1 or 2

A

40-90%

43
Q

Risk of ovarian cancer in BRCA 1 and 2

A

BRCA 1 up to 60%

BRCA2 up to 30%

44
Q

Treatment for Stewart Treves syndrome

A

amputation, chemotherapy for metastatic disease.

45
Q

Margin needed if specimen has both invasive ductal carcinoma and DCIS

A

just no tumor on ink (do not need 2 mm margin if both in specimen)

46
Q

Pale staining cells between keratinocytes

A

Paget’s disease

47
Q

Well circumscrobed mass which may have calcifications

A

fibroadenoma

48
Q

Eggshell calcifications

A

fat necrosis

49
Q

Clustered microcalcifications on mammogram

A

DCIS

50
Q

Other name for complex sclerosing lesion

A

radial scar

51
Q

better prognosis Luminal A or B

A

Luminal A

52
Q

Sometimes mammogram of inflammatory breast cancer can appear as mastitis, this is necessary if course of Abx has failed

A

skin biopsy

53
Q

most common etiology of fat necrosis

A

most are idiopathic

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