Breast/Axillae Flashcards
Types of non-invasive breast cancer
- Ductal carcinoma in situ
- Lobular carcinoma in situ
Types of invasive breast cancer
- Inflammatory carcinoma
- Invasive ductal carcinoma of the breast
Most common benign breast tumor, and where it is typically found
Fibroadenoma, upper outer quadrant
Cause of fibrocystic breast disease
Fibrous and cystic hyperplasia of breast tissue due to excess estrogen (usually B/L)
Name of ductal carcinoma that invades the nipple and presents unilaterally as dermatitis
Paget disease of breast
Infectious agent of mastitis
S aureus
Pathophysiology of gynecomastia
- Endocrine: Primary hypogonadism, hyperthyroid, extreme hyperprolactinemia, arenal disease
- Tumors: Pituitary, adrenal, testicular, breast
- Chronic disease: Liver disease, malnutrition
- Meds: Spironolactone, digoxin, chemo
- Genetic: Klinefelter syndrome
Investigation of gynecomastia
- TSH, PRL, LH, FSH, free T, estradiol, LTFs, B-HCG
- Chest x-ray, CT chest/abdomen/pelvis
- Testicular US to R/O mass
Mastitis etiology and symptoms
S aureus
Unilateral localized breast pain, tenderness, erythema, malodorous breast milk, worse pain with nursing.
Clinical features of imflammatory carcinoma of the breast
Erythema, non-pitting edema, +/- lump, warm/swollen/tender breast, obstruction of lymphatics causes orange peel consistency to skin (peau d’orange)
Cause of nipple retraction in invasive ductal carcinoma of the breast
Cancer invades cooper ligaments within ducts
Identify the dx:
Non-tender, firm, smooth, rubbery, mobile breast mass. Well circumscribed, rarely becomes malignant.
Fibroadenoma
(T or F) 80% of DCIS are non-palpable, and are detected by screening mamogram
True
Tx of DCIS
- Lumpectomy and radiation
- Mastectomy if high grade/large area of disease
- Tamoxifen as adjuvant
Survival rate of DCIS
99% 5-year survival rate
This condition is usually found incidentally on breast biopsy for another indicaiton
Lobular carcinoma in situ
(T or F) 50% of breast cancer is located in the upper outer quadrent
True
(T or F) 90% of breast cancer arise in ductal epithelium
True
Risk factors for breast cancer
- 99% female
- 80% over 40 YO
- Nullparity, first pregnancy over 30, menarche before 12, menopause over 55
- Fhx (greater risk if first degree and premenopausal)
- Obesity, high-fat diet, sedentary lifestyle
- BRCA 1 & 2 gene mutations
- > 5 year HRT use, >10 year OC use
Lower risk with lactation, early menopause, early childbirth
Case 1 / Question 1
What diagnostic test would confirm the suspected diagnosis?
62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast
Biopsy
Case 1 / Question 2
The most likely diagnosis is?
62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast
Breast cancer
Case 1 / Question 3
Which of the following treatments may be considered in non-metastatic hormone receptor-positive breast cancers:
1. Tamoxifen
2. Vinblastine
3. 5-fluorouracil
4. Finasteride?
62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast
1 - Tamoxifen (SERM commonly used in tx of hormone-receptor positive breast cancers)
Case 1 / Question 4
The best tx recommendation to give this pt to prevent recurrence is:
1. 400mg diindolylmethane daily
2. 3000 mg vit C daily
3. Reduce alcohol intake
4. 2000 IU vit D daily
62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast
1 - 400mg diindolylmethane daily
Case 1 / Question 5
She was given a drug to tx her condition and is now experiencing severe hot flashes. Which tx is effective for tx of hot flashes in men with prostate cancer, and has been demonstrated to be effective in women with breast cancer?
1. Vitex agnus-castus
2. Dioscorea villosa
3. Serenoa repens
4. Salvia officinalis
62 YO F - 5’6” 150lbs
Pt presents w a lump in her L breast.
Medical hx: C-section for 2nd child at 28. Tubal ligation at 34. Dx with depression 2 years ago after death of older sister. LMP at 57.
Social hx: Retired, lives w husband in a condo. Eats whole-foods diet. Occasional glass of wine on special occasions. Walks 2km per day.
Meds: Fluoxetine 20mg qd, daily muli, 1000IU vit D
Fhx: Sister died of breast cancer
Vitals: 37C temp, 118/70, HR 70, RR 14
PE: Breast exam revealed hard, non-mobile painless lump in L breast
4 - Salvia officinalis
