Breast & Axillae Flashcards
What are protective factors against breast cancer?
lactation
early menopause
early childbirth
What are common risk factors for breast cancer?
Female
Increasing age (>40)
Nulliparity, first pregnancy after 30, menarce <12, menopause >55
Fhx
BRCA mutations
>5 hr HRT use, >10 year OCP use
What findings on mammography would indicate higher risk of malignancy?
mass that is poorly defined, spiculated (spiked) border
microcalcifications
architectural distortion
interval mammographic changes
What are the screening mammography reccomendations?
every other year from 40-74 for average risk individuals (some organizations reccomend every year)
What purpose can US serve in regards to breast masses?
Differentiates between cystic and solid masses
What workup should be done to assess for metastasis of breast cancer?
bone scna, abdominal US, chest XR, head CT (if neuro sx are present)
What is ductal carcinoma in situ?
non invasive malignancy of ductal epithelial cells completely contained within breast ducts
What are signs/sx and workup for ductal carcinoma in situ?
80% of DCIS are non-palpable and are detected by screening mammogram
Treatment and prognosis for ductal carcinoma in situ
lumpectomy and radiation
mastectomy if high grade, large area of disease
tamoxifen adjunctively
99% 5 year survival rate
What is invasive ductal carcinoma?
most common type of breast cancer
invasive cancer originating from ductal epithelium and infiltrating into thoracic fascia to become fixed to the chest wall
signs/sx of invasive ductal carcinoma
may extend into the skin (dimpling, retraction)
may invade cooper ligaments within ducts (nipple retraction)
What is inflammatory carcinoma?
invasive ductal carcinoma that invades into dermal lymphatics, no focal lesion, breast becomes asym swollen, **can occur in a lactating female **
most aggresive form of breast cancer
What is Paget’s disease of the breast?
late stage ductal carcinoma that invades nipple and presents unilaterally as a dermatitis
signs/sx Paget’s disease of the breast
unilateral breast dermatitis appearance
skin of the nipple and areola ulcerated and erythematous
oozing with serosanguineous discharge
can have itching or burning
Workup/investigations for Paget’s disease of the breast
scrape cytology (large cells with high nuclear:cytoplasm ratio, occasional acinar formation, intracytoplasmic vacuoles)
punch, wedge, or excisional biopsy
RFs for Paget’s disease of the breast?
postmenopausal women
Treatment and prognosis for Paget’s disease of the breast
refer to oncology
poor prognosis
what are the invasive ductal carcinomas?
invasive ductal carcinoma
Paget’s disease of the breast
inflammatory carcinoma
what is lobular carcinoma in situ?
neoplastic cells completely contained within breast lobule
signs/sx lobular carcinoma in situ
rubbery and ill-defined, no palpable findings, no mammographic findings (usually found incidentally on breast biopsy for other indication)
treatment lobular carcinoma in situ
if dx on core biopsy, excisional biopsy necessary to rule out malignancy
consider chemoprevention - tamoxifen, oncologist
what is a fibroadenoma?
a benign glandular breast tumor with dense fibroblastic stroma; RARELY becomes malignant
most common benign breast tumor in women
signs/sx fibroadenoma
single movable breast nodule, often in upper outer quadrant
not fixed to skin
non-tender, firm, smooth, rubbery, mobile, well-circumscribed
investigations/workup for fibroadenomas
core or excisional biopsy if concerned about malignancy
what is fibrocystic breast disease?
benign fibrous and cytstic hyperplasia of breast tissue due to excess estrogens; usually affecting women of reproductive age
signs/sx fibrocystic breast disease
generalized premenstrual breast tenderness and lumpiness
often B/L
may have multiple nodules and palpable lumps
increase in breast pain/lumpiness from ovulation to just before menses
may regress during pregnancy and with onset of menses
workup/investigations fibrocystic breast disease
dx clinically based on sx and CBE
US can distinguish between fluid-filled cysts and solid masses
what is mastitis
inflammation of the ducts of the breasts due to infection, typically caused by staph aureus
RF mastitis
lactating women, 2-3 weeks postpartum
signs/sx mastitis
unilateral localized breast pain
erythema
malodorous breast milk
pain worse with nursing
workup and tx for mastitis
workup: gram stain with culture
tx:
alternating warm and cold compresses
continue nursing
antibiotics
what is gynecomastia?
enlargment of male breasts
what are physiologic causes of gynecomastia?
puberty
elderly (increased conversion of andorgens to estrogens)
neonatal (maternal estrogens)
what are pathological / non-physiologic causes of gynecomastia?
endocrinopathies: primary hypogonadism, hyperthyroidism, hyperprolactinemia, adrenal disease
tumors: pituitary, adrenal, testicular, breast
chronic diseases: liver disease, malnutrition
medication induced: spironolactone, digoxin, chemo
genetic: klinefelter’s syndrome
work-up for gynecomastia
labs: serum TSH, PRL, LH/FSH, free testosterone, estradiol, LFTs,B-HCG
imaging: chest XR, CT chest, abdomen and pelvis
testicular US to rule out testicular masses
most common female cancer
breast carcinoma
differentiating mastitis and inflammatory breast CA
mastitis is BL and almost always occurs with fever/signs of infxn
ddx pathology affecting nipple/areola
pagets
abscess
ddx pathology affecting lactiferous duct/sinus
intraductal papilloma
galactocele
abscess
plasma cell mastitis
ddx pathology affecting major duct of the breast
fibrocystic change
ductal cancer
ddx pathology affecting terminal duct of the breast
tubular carcinoma
ddx pathology affecting tubular lobe of the breast
lobular carcinoma
sclerosing adenosis
ddx pathology affecting the stroma of the breast
fibroadenoma
cystosarcoma phyllodes
