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Summer 15 - Women's Health > Breast Benign and Malignant > Flashcards

Breast Benign and Malignant Flashcards

1
Q

What are the boundaries of the breast tissue on the body?

A
  • from infraclavicular space to inframammary fold

- from sternum to latissimus dorsi and axilla

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2
Q

What are you looking for on the breast physical exam?

A
  • overall shape, symmetry
  • lump: note location, size, mobility, shape
  • nipple discharge
  • skin: dimpling, retraction, erythema, nipple crusting, peau d’orange
  • lymph nodes
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3
Q

Screening Mammography Recommendations

A
  • yearly age 50-75
  • screening during 40s and after 75 at discretion of pt and provider
  • high risk: start screening 10 years earlier than age at which youngest relative was diagnosed
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4
Q

Diagnostic Mammogram

A
  • done if screening mammo is abnormal
  • clinical exam finding: mass, pain, discharge
  • BIRADS score 1-4 based on level of suspicion
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5
Q

Ultrasound

A
  • adjunct to diagnostic mammo

- primary diagnostic tool in pts

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6
Q

MRI

A
  • high risk pts: previous CA, dense breasts, significant family hx
  • higher false positive rate than mammogram
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7
Q

What are causes of benign histology from the breast?

A
  • fibrofatty tissue
  • fibrocystic change: fibrosis, cysts, hyperplasia, metaplasia
  • fibroadenoma
  • simple cysts
  • phyllodes tumor
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8
Q

Atypical Ductal Hyperplasia

A
  • precursor to invasive carcinoma 4-5x increased risk

- requires excision w/ clear margin

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9
Q

What is fibrocystic change?

A

-normal change that occurs in the breast in response to hormones

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10
Q

What are symptoms of fibrocystic change?

A
  • lumpy breasts
  • tenderness, esp at menstruation
  • may have significant non-cyclic pain
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11
Q

Treatment of Fibrocystic Change

A
  • reassurance
  • NSAIDs for pain
  • change or stop OCPs
  • vit B complex
  • fish oil
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12
Q

What is a fibroadenoma?

A
  • most common solid mass in women of reproductive years
  • benign w/ no increased CA risk
  • may be multiple and recurrent
  • firm, round, well-circumscribed, mobile mass
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13
Q

How is a fibroadenoma diagnosed and treated?

A
  • Dx: classic US and/or needle biopsy

- Tx: does not require excision, but most pts prefer

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14
Q

Nipple Discharge

A
  • usually a benign process
  • may be clear, milky, greenish, bloody
  • bilateral milky may be galactorrhea (check for pg or high prolactin levels)
  • clear or greenish is normal
  • bloody usually due to intraductal papilloma (benign growth)
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15
Q

Causes of Mastitis/Abscess

A
  • pregnancy, lactation
  • injury
  • nipple piercing
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16
Q

Sxs of Mastitis

A
  • pain

- swollen, erythematous breast

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17
Q

Tx of Mastitis

A
  • antibiotics
  • mammogram to R/O abscess
  • percutaneous aspiration of abscess
  • if no abscess identified and abx don’t clear infx, refer to surgeon for biopsy to R/O inflammatory breast CA
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18
Q

What group is at risk of recurrent retroareolar infections?

A

-smokers

19
Q

Breast Cancer

A
  • most common CA in women
  • 2nd leading cause of CA death
  • incidence increasing, mortality decreasing
20
Q

Risk Factors for Breast CA

A
  • early menarche or late menopause
  • first birth after 30 or nulliparity
  • family hx
  • atypical hyperplasia or LCIS
  • known carrier of BRCA 1 or 2
  • personal hx of ovarian, colon, uterine CA
  • hormone replacement therapy
21
Q

LCIS

A
  • not cancer, but a risk factor for cancer
  • incidental finding
  • tx: close observation, bilateral prophylactic mastectomy
22
Q

DCIS

A
  • usually presents as abnormal appearing microcalcifications
  • proliferation of malignant cells in ducts
  • tx: lumpectomy/radiation, mastectomy; NO lymph node dissection or chemo
23
Q

Invasive Ductal/Lobular Carcinoma

A
  • 80% of breast CA is ductal
  • lobular carcinoma more diffuse and difficult to detect on mammogram
  • lymphatic spread
  • Tx: axillary node biopsy for staging, lumpectomy/radiation or mastectomy, chemo/hormone therapy
24
Q

Inflammatory Breast CA

A
  • stage IIIb, poor prognosis
  • signs: swollen non-tender breast, erythema, peau d’orange, may not have dominant mass
  • Tx: preoperative chemo, mastectomy and axillary node dissection, radiation, hormone therapy
25
Q

Paget’s Dz

A
  • eczematous changes of the nipple
  • associated w/ underlying invasive cancer
  • diagnosed with nipple biopsy
  • tx with mastectomy
26
Q
  1. Incisional Biopsy

2. Excisional Biopsy

A
  1. removing a piece of suspicious mass for diagnosis only

2. completely excising mass for diagnosis; clear margins may be adequate CA surgery

27
Q

Lumpectomy

A
  • excision of mass and normal surrounding tissue
  • reserved for tx of cancers, not benign lesions
  • requires post-op radiation to reduce risk of recurrence
28
Q

Mastectomy

A
  • excision of breast tissue, pectoralis fascia, and overlying skin
  • option of immediate reconstruction
  • modified radical mastectomy includes axillary lymph nodes (usually for inflammatory)
29
Q

Sentinel Lymph Node Biopsy

A
  • remove only lymph nodes with highest likelihood of metastasis
  • radioactive dye injected
  • lymph nodes identified via discoloration
  • reduces post-op pain and risk of upper extremity lymphedema
30
Q

Poor Prognostic Factors

A
  • positive lymph nodes
  • size >2 cm
  • high grade
  • estrogen receptor negative (does not respond to hormones)
  • her-2 positive
31
Q

Chemotherapy

A
  • usually recommended if tumors >2 cm, positive lymph nodes or high risk genomic test
  • adriamycin/cyclophosphamid 4 cycles
  • taxol added if + lymph nodes or poor prognosis
32
Q

Herceptin

A
  • adjuvant therapy in tumors with Her2 gene overexpression

- Her2 controls cell growth and death –> herceptin binds to the Her2 receptors to make them ineffectvie

33
Q

Tamoxifen

A
  • competitive inhibitor of estrogen receptors

- survival advantage and decreased recurrence rates

34
Q

Side Effects of Tamoxifen

A
  • risk of uterine cancer
  • thrombotic events
  • hot flashes
  • weight gain
35
Q

Aromatase Inhibitors (Arimidex)

A
  • inhibits production of estrogen

- only for post-menopausal women

36
Q

Indications for Radiation Therapy

A
  • most pts with lumpectomy
  • mastectomy of tumor >5 cm
  • chest wall involvement
  • postive axillary lymph nodes
37
Q

Therapy at Stage 0 DCIS

A

+/- hormone therapy

38
Q

Therapy at Stage 1

A
  • premenopause: tamoxifen +/- chemo

- postmenopause: arimidex

39
Q

Therapy at Stage 2

A

-chemo and hormone therapy

40
Q

Therapy at Stage 3

A

-chemo, hormone therapy, radiation to chest wall and lymph nodes

41
Q

Therapy at Stage 4

A

-hormone therapy, radiation to metastatic dz

42
Q

Factors Associated w/ Increased Risk of Genetic Cancer

A
  • bilateral cancer in paired organs (breast, lung, kidney)
  • multiple primary CA
  • multifocal CA
  • early age of onset
  • CA in 2 or more relatives
  • Ashkenazi Jewish ancestry
43
Q

What are 4 genetic breast cancer syndromes?

A
  • BRCA1
  • BRCA2
  • Cowden (breast, gastrointestinal, thyroid)
  • Li Fraumeni (breast, brain, adrenal CA, sarcoma, leukemia)

Summer 15 - Women's Health (7 decks)

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