Breast CA Flashcards
what is functional part of breast
ducts and lobules
3 locations of drainage -nodal
- axillary - most
- internal mammary
- infra/supraclavicular
what cells surround a lobule
double cell layer
- inner duct-lubular- milk cells
- myoepithelial cells- muscle
what happens to breast as ages
fibrous CT is replaced with radiolucent adipose tissue
what are borders of breast exam
clavicle, sternum, axilla, inframammary ridge
what to look for on breast exam
breast - size and shape - change in contour - color - nipple lymphatics - mass -
**what are most breast lumps
majority are benign
- fibroadenoma, fibrocystic changes
- risk for CA increases with age
** what is triple test for lump
- clinical exam
- biopsy
- imaging
non-modifiable risk factors for CA
- age
- positive family Hx
- BRCA
- previous breast CA
- mantle radiation
- reporductive issues
- breast density
- ashkenazi Jewish
6 modificable risk factors
- diet
- vitamins
- alcohol
- obesity
- sedentary lifestyles
- HRT use
3 risk reduction strategies
- lifestyle mod
- suregry
- chemo
what is effect of alcohol
- 5x for 3-5/day
- worse for HRT
how can excercise help
some walking helps
what is chemoprevention
tamoxifene daily for 5 years
4 methods of breast screening
- breast awareness
- clinical breast exam
- mammography
- MRI
what is breast awareness
women getting to know thair breasts so they can see what is abnormal
when should breast exams be used
no longer reccomended - not good data
when should mammogram be done
every 2-3 years starting at 50
what are probs with mammography
- false positives
- hard to see in dense breasts
- over diagnosis of DCIS
when to use screening MRI
in high risk patients
- BRCA
- chest irradiation before 30
should we give mammography in women under 40
lady thinks we should if PT wants
when to stop mammography
when less than 10 years life expectancy
what to do if BRCA carrier
annual mam and MRI starting at 30
when do errors occur in diagnosis
- self detected
- young
- negative mam
- non-lump presenting form
- preg or breast fedding
3 imaging modalities
- mamm
- MRI
- ultrasound
how many images on mam
2x
- craniocaudal
- mediolateral
what is BI-RADS system
rating system in which higher scores are worse
4 potential things to find on mammogram
- assymetries
- distortion
- masses
- calcificaitons
when to use ultrasound
when can’t get mamm or MRI for some reason
when to use MRI (4)
- staging
- high risk screening
- evaluation surgical margins
- monitoring chemo
what are 3 genetic factors involved in breast
- BRCA
- li fraumeni
- cowden
what is BRCA
tumor supressor genes
- when mutated get increased risk of carcinoma
what are 2 pathologic risk factors
- proliferative breast disease
2. preinvasive in situ
what are epithelial breast lesions
wide variety of alterations that may be benign
how are epithelial lesions defined
- non-proliferative
- proliferaitve without atypia
- proliferative with atypia
what are fibrocystic changes
NON-proliferative and BENIGN alterations that are very common
- often bilateral and focal
- may be painful
- maybe due to hormones
what is proliferative breast disease (2 types)
- without atypia - florid ductal hyperplasia
2. with atypia - beginning to resemble carcinoma in situ
**what is key to proliferative breast disease
myoepitelial layer is preserved
what is DCIS
preinvasive lesion in which the lesion proliferates within the duct and myoepithelial layer is intact
- may involve the nipple
what is paget’s disease
crrusted red nipple that may be associted with DCIS or carcinoma
4 features to presentation of carcinoma
- plapable mass
- nipple changes
- skin changes
- mammographic features
2 ways to diagnose breast carcinoma
- cytology - fine needle biopsy - cannot diagnose invasion
2. histology - preferred - core biopsy
2 general classifications of carcinoma
- not special type (NST) - most common
2. special type - better prognosis
3 general gene profiles of CA and prognosis
- luminal - ER/PR+ - best prognosis
- basal - ER/PR and Her2 -ve - poor prognosis
- her2 - low ER/PR - poor prognosis
what can we give to Her2 +ve
trastuzumab - herceptin
when does CA not require staging
early breast CA - >5cm and no node
what are 2 types of surgeries
- masectomy
2. lumpectomy
what goes with lumpectomy and why
radiation - major risk reduciton
what to do with sample after lumpectomy
mammogram to see if there is still calcificaitons and margin
what is better surgery
equivalent with radiation
what are 5 absolute indications for masectomy
- multicentric
- some collagen vascular disease
- pt choice
- prior radiation
- preg
when is axiallary surgery done
usually onyl for CA, except DCIS with masectomy
why do axillary surgery
many nodes not accurately examined
- nodal spread is prognostic
what is sentinal node biopsy
give blue dye and then pull out first node that should drain the area
who should get sentinal node biopsy (3)
- T1,2 CA with clinically neg nodes
- multicentric CA
- DCIS with mastectomy
what to do with positive node
may not do complete dissection if:
- post meno, had lumpectomy, systemic therapy
when to do chemo
depends on a variety of PT factots
when to radiation
always after lumpectomy
when in breats CA inoperable
when can’t remove it all with a surgery
why give neo-adjuvant chemo (3)
- assess response to chemo
- prognostication
- shrink tumor before
3 types of systemic therapy
- chemo
- endocrine
- herceptin
how does neo adjuvant compare to adjuvant
comparable
who is most likely to benefit from chemo
those with a worse prognosis - more reduction in risk
what is best prognosic group for breast
luminal A - ER/PR+ and her2 neg
what is treatment for luminal A
hormones and maybe chemo (pt preference)
what is 21 gene recurrence score (21-RS)
cancer and reference genes that give an idea about risk
what is most modern and used chemp
3rd gen
short term SE of chemo
- hair loss
- nausea/vomiting
- mucostitis
- fatgure
- febrile neutropenia
long term SE of chemo -
- infert
- early menopause
- cardiomyopathy
- secondary leukemia
- neurotoxicity
what are 2 hormone theapry types
- tamoxifen - block receoptos
2. aromatase inhibitors
what are adv. and dis of tomoxifen
adv: good for bones, CV risk
dis - bad for thrombolsis, stroke, CA
what are adv. dis of AI
more CV risk, more lipids, more osteo
how long to give for
may give for 10 years for higher risk PTs
what are potential survivorship issues
- hot flashes
- vaginal dryness
- cognitive funciton
- fatigue
- psychosocial impact
