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Undeleted > Breast CA > Flashcards

Breast CA Flashcards

1
Q

what is functional part of breast

A

ducts and lobules

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2
Q

3 locations of drainage -nodal

A
  1. axillary - most
  2. internal mammary
  3. infra/supraclavicular
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3
Q

what cells surround a lobule

A

double cell layer

  1. inner duct-lubular- milk cells
  2. myoepithelial cells- muscle
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4
Q

what happens to breast as ages

A

fibrous CT is replaced with radiolucent adipose tissue

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5
Q

what are borders of breast exam

A

clavicle, sternum, axilla, inframammary ridge

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6
Q

what to look for on breast exam

A 
breast
- size and shape
- change in contour
- color
- nipple
lymphatics
- mass
-
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7
Q

**what are most breast lumps

A

majority are benign

  • fibroadenoma, fibrocystic changes
  • risk for CA increases with age
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8
Q

** what is triple test for lump

A
  1. clinical exam
  2. biopsy
  3. imaging
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9
Q

non-modifiable risk factors for CA

A
  • age
  • positive family Hx
  • BRCA
  • previous breast CA
  • mantle radiation
  • reporductive issues
  • breast density
  • ashkenazi Jewish
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10
Q

6 modificable risk factors

A
  1. diet
  2. vitamins
  3. alcohol
  4. obesity
  5. sedentary lifestyles
  6. HRT use
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11
Q

3 risk reduction strategies

A
  1. lifestyle mod
  2. suregry
  3. chemo
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12
Q

what is effect of alcohol

A
  1. 5x for 3-5/day

- worse for HRT

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13
Q

how can excercise help

A

some walking helps

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14
Q

what is chemoprevention

A

tamoxifene daily for 5 years

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15
Q

4 methods of breast screening

A
  1. breast awareness
  2. clinical breast exam
  3. mammography
  4. MRI
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16
Q

what is breast awareness

A

women getting to know thair breasts so they can see what is abnormal

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17
Q

when should breast exams be used

A

no longer reccomended - not good data

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18
Q

when should mammogram be done

A

every 2-3 years starting at 50

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19
Q

what are probs with mammography

A
  1. false positives
  2. hard to see in dense breasts
  3. over diagnosis of DCIS
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20
Q

when to use screening MRI

A

in high risk patients

  • BRCA
  • chest irradiation before 30
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21
Q

should we give mammography in women under 40

A

lady thinks we should if PT wants

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22
Q

when to stop mammography

A

when less than 10 years life expectancy

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23
Q

what to do if BRCA carrier

A

annual mam and MRI starting at 30

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24
Q

when do errors occur in diagnosis

A
  1. self detected
  2. young
  3. negative mam
  4. non-lump presenting form
  5. preg or breast fedding
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25
Q

3 imaging modalities

A
  1. mamm
  2. MRI
  3. ultrasound
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26
Q

how many images on mam

A

2x

  1. craniocaudal
  2. mediolateral
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27
Q

what is BI-RADS system

A

rating system in which higher scores are worse

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28
Q

4 potential things to find on mammogram

A
  1. assymetries
  2. distortion
  3. masses
  4. calcificaitons
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29
Q

when to use ultrasound

A

when can’t get mamm or MRI for some reason

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30
Q

when to use MRI (4)

A
  1. staging
  2. high risk screening
  3. evaluation surgical margins
  4. monitoring chemo
31
Q

what are 3 genetic factors involved in breast

A
  1. BRCA
  2. li fraumeni
  3. cowden
32
Q

what is BRCA

A

tumor supressor genes

- when mutated get increased risk of carcinoma

33
Q

what are 2 pathologic risk factors

A
  1. proliferative breast disease

2. preinvasive in situ

34
Q

what are epithelial breast lesions

A

wide variety of alterations that may be benign

35
Q

how are epithelial lesions defined

A
  1. non-proliferative
  2. proliferaitve without atypia
  3. proliferative with atypia
36
Q

what are fibrocystic changes

A

NON-proliferative and BENIGN alterations that are very common

  • often bilateral and focal
  • may be painful
  • maybe due to hormones
37
Q

what is proliferative breast disease (2 types)

A
  1. without atypia - florid ductal hyperplasia

2. with atypia - beginning to resemble carcinoma in situ

38
Q

**what is key to proliferative breast disease

A

myoepitelial layer is preserved

39
Q

what is DCIS

A

preinvasive lesion in which the lesion proliferates within the duct and myoepithelial layer is intact
- may involve the nipple

40
Q

what is paget’s disease

A

crrusted red nipple that may be associted with DCIS or carcinoma

41
Q

4 features to presentation of carcinoma

A
  1. plapable mass
  2. nipple changes
  3. skin changes
  4. mammographic features
42
Q

2 ways to diagnose breast carcinoma

A
  1. cytology - fine needle biopsy - cannot diagnose invasion

2. histology - preferred - core biopsy

43
Q

2 general classifications of carcinoma

A
  1. not special type (NST) - most common

2. special type - better prognosis

44
Q

3 general gene profiles of CA and prognosis

A
  1. luminal - ER/PR+ - best prognosis
  2. basal - ER/PR and Her2 -ve - poor prognosis
  3. her2 - low ER/PR - poor prognosis
45
Q

what can we give to Her2 +ve

A

trastuzumab - herceptin

46
Q

when does CA not require staging

A

early breast CA - >5cm and no node

47
Q

what are 2 types of surgeries

A
  1. masectomy

2. lumpectomy

48
Q

what goes with lumpectomy and why

A

radiation - major risk reduciton

49
Q

what to do with sample after lumpectomy

A

mammogram to see if there is still calcificaitons and margin

50
Q

what is better surgery

A

equivalent with radiation

51
Q

what are 5 absolute indications for masectomy

A
  1. multicentric
  2. some collagen vascular disease
  3. pt choice
  4. prior radiation
  5. preg
52
Q

when is axiallary surgery done

A

usually onyl for CA, except DCIS with masectomy

53
Q

why do axillary surgery

A

many nodes not accurately examined

- nodal spread is prognostic

54
Q

what is sentinal node biopsy

A

give blue dye and then pull out first node that should drain the area

55
Q

who should get sentinal node biopsy (3)

A
  1. T1,2 CA with clinically neg nodes
  2. multicentric CA
  3. DCIS with mastectomy
56
Q

what to do with positive node

A

may not do complete dissection if:

- post meno, had lumpectomy, systemic therapy

57
Q

when to do chemo

A

depends on a variety of PT factots

58
Q

when to radiation

A

always after lumpectomy

59
Q

when in breats CA inoperable

A

when can’t remove it all with a surgery

60
Q

why give neo-adjuvant chemo (3)

A
  1. assess response to chemo
  2. prognostication
  3. shrink tumor before
61
Q

3 types of systemic therapy

A
  1. chemo
  2. endocrine
  3. herceptin
62
Q

how does neo adjuvant compare to adjuvant

A

comparable

63
Q

who is most likely to benefit from chemo

A

those with a worse prognosis - more reduction in risk

64
Q

what is best prognosic group for breast

A

luminal A - ER/PR+ and her2 neg

65
Q

what is treatment for luminal A

A

hormones and maybe chemo (pt preference)

66
Q

what is 21 gene recurrence score (21-RS)

A

cancer and reference genes that give an idea about risk

67
Q

what is most modern and used chemp

A

3rd gen

68
Q

short term SE of chemo

A
  • hair loss
  • nausea/vomiting
  • mucostitis
  • fatgure
  • febrile neutropenia
69
Q

long term SE of chemo -

A
  • infert
  • early menopause
  • cardiomyopathy
  • secondary leukemia
  • neurotoxicity
70
Q

what are 2 hormone theapry types

A
  1. tamoxifen - block receoptos

2. aromatase inhibitors

71
Q

what are adv. and dis of tomoxifen

A

adv: good for bones, CV risk

dis - bad for thrombolsis, stroke, CA

72
Q

what are adv. dis of AI

A

more CV risk, more lipids, more osteo

73
Q

how long to give for

A

may give for 10 years for higher risk PTs

74
Q

what are potential survivorship issues

A
  1. hot flashes
  2. vaginal dryness
  3. cognitive funciton
  4. fatigue
  5. psychosocial impact

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