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Repro. Med 4 > Breast CA > Flashcards

Breast CA Flashcards

1
Q

Breast CA is the ___ most common CA in women and the ___ leading cause of CA death in women

A

2nd

2nd

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2
Q

___% of women dx with breast CA have no identifiable risk factors

A

70%

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3
Q

5-year survival is ___% for localized dz (Stage 0 or 1)

5-year survival only ___% once it has spread to other organs (Stage 4)

A

100%

20%

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4
Q

What are unalterable RF for developing breast CA? (FYI)

A 
age 
FHx
race
DES (medication)
Radiation
Genetic Factors 
menstrual hx 
reproductive hx
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5
Q

What are controllable factors for breast CA (FYI)

A 
obesity/diet
exercise
no breast feeding 
alcohol
hormone replacement therapy
BC reproductive hx
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6
Q

What is the “most important” RF for breast CA?

A

age

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7
Q

Gail-NCI Model is a risk calculator for what?

A

breast CA

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8
Q

__-___% of Breast CA related to inherited factors (BRCA1/2)

A

5-10%

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9
Q

What are RF associated w/ BRCA mutations?

A 
multiple cases of early onset breast CA 
ovarian ca with FHx of breast CA
Ovarian and breast CA in the same woman
b/l breast CA 
Ashkenazi jewish jeritgae 
male breast ca
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10
Q

What is the risk of breast CA in women w/ BRCA-1?

A

50-85%
2nd primary breast CA (40-60%)
ovarian CA 15-45%

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11
Q

What other CA are associated w/ BRCA 1?

A

prostate

colon

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12
Q

What are examples of breast CA prevention?

A

Clinical Breast Examination
Screening mammography
Chemoprevention
Surgical prophylaxis

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13
Q

When should a woman perform her self breast exam if premenopausal?

A

7-8 days post menses

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14
Q

__% of breast masses found by pt! (most non-malignant)

A

90%

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15
Q

___ is a woman’s awareness of the normal appearance and feel of their breasts

A

Breast Self Awareness

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16
Q

When should clinical breast examinations begin?

A

Age 20-39 every 1-3 years

Age 40 and older annually

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17
Q

When is screening mammography recommended?

A

Annually >40 y/o
Or 10 years prior to youngest relative age at dx
Recommendations >75—studies inconclusive

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18
Q

If BCA positive

Monthly breast self-examinations should begin at ____ y/o

Semiannual clinical breast examination beginning at ____ y/o

Annual mammography and breast MRI beginning at ____ y/o or earlier depending on FHx

A

18 y/o
25 y/o
25 y/o

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19
Q

T/F: Mammograms do not save lives

A

F, duh.

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20
Q

T/F: Women w/ breast implants should not have a mammogram because the implant may pop

A

F (but MRI is usually gold standard)

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21
Q

What medications are used for chemo-prevention of breast CA? (x3)

A

tamoxifen
Raloxifene
Aromatase Inhibitors

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22
Q

Using tamoxifen can reduce invasive breast CA up to ___%

A

50%

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23
Q

What are the risks and side effects of using tamoxifen?

A 
increased endometrial CA and DVT
cataracts
depression
vasomotor symptoms
vaginal dryness/discharge
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24
Q

What are the side effects of raloxifene?

A

less ute CA
TE events
cataracts
improved bone density

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25
Q

What is raloxifene FDA approved for?

A

prevention of osteoporosis

26
Q

What are the side effects of Aromatase Inhibitors?

A

osteoporosis
vasomotor sx
joint pain
depression

27
Q

What are surgical prophylaxis options of breast CA?

A

Prophylactic mastectomy
Prophylactic bilateral salpingo-oophorectomy (BSO)
**need Genetic testing of high risk women

28
Q

___% presenting complaint in breast CA is painless breast lump
___% breast masses found by pt on SBE
___ is location of ~60% of breast CA

A

70%
90%
UOQ

29
Q

What is included in the CLINICAL exam of breast CA?

A

inspection

palpation (breast and lymph noses)

30
Q

What are s/s of breast CA?

A
  • painless lump or thickening in breast
  • d/c or bleeding
  • change in size or contour of breast
  • change in color or appearance of areola
  • redness or pitting of skin over the breast
31
Q

What is the most common s/s of breast CA?

A

Painless lump or thickening in breast

32
Q

What imaging studies do you use in the work up of breast CA?

A

mammogram
US
(MRI)

33
Q

____ is performed by compression aided radiographic study of the breast.
It is the most reliable means to detect breast CA before _______ is present

A

Mammography

palpable mass

34
Q

Slow growing tumors can be identified __ or more years before palpable w/ a mammogram

A

2

35
Q

T/F: A palpable mass needs biopsy regardless if it is seen on mammogram or not

A

T

36
Q

What are the different types of mammography?

A

Digital mammography
Computer assisted detection (CAD)
3-D mammography (tomosynthesis)

37
Q

What are characteristic findings of breast CA on mammography?

A

calcifications
masses
ill-defined

38
Q

What does BI-RADS stand for? Why is it used?

A

Breast Imaging Reporting and Data System

Standard way to describe mammogram findings and results
Also describes breast density

39
Q

What is the grading system of BI-RADS?

A

0-6 (inconclusive to obvious malignancy)

40
Q

T/F: The probability of CA is not directly related to BI-RADS assessment

A

F: Probability of CA IS directly related to BI-RADS assessment

41
Q

What characteristic of a breast tissue can make is more difficult to detect breast CA?

A

More glandular tissue, less fat

**CA can be hidden

42
Q

What is the main purpose of using breast US?

A

differentiating cystic from solid mass

US guided aspiration of cyst

43
Q

How do you evaluate the pathology of breast CA?

A

FNAC (fine needle aspiration cytology)

Biopsy: Excisional, Core Bx

44
Q

What are examples of different breast CAs?

A

Ductal Carcinoma in situ (DCIS)
Invasive Ductal Carcinoma (IDC )
Invasive Lobular Carcinoma (ILC)

45
Q

What are characteristics of invasive breast CA?

A

CA cells invade blood vessels

CA cells invade lymph duct

46
Q

What is the TNM system used for? What does it stand for?

A

Breast CA staging
T=tumor
N=regional lymph nodes
M=distant metastases

47
Q

Describe stage 0-4 breast CA (FYI?)

A

Stage 0 –carcinoma in situ
Stage I – tumor < 2 cm, no nodes
Stage II—tumor 2-5 cm, +/- nodes*
Stage III – locally advanced disease, fixed or matted lymph nodes and variable tumor size**
Stage IV – distant metastases (bone, liver, lung, brain)

48
Q

What factors are considered when establishing a prognostic value for a woman w/ breast CA?

A 
Age/menopause status
Tumor sz
histological grade
histological tumor type
axillary lymph node involvement
Distant mets
Steroid receptors status
49
Q

What is the primary therapy for breast CA?

A

Surgical resection followed by adjuvant radiation and/or chemotherapy

Neoadjuvant therapy
- Chemo to shrink large tumors pre-op to allow lumpectomy instead of mastectomy

50
Q

What are some after breast CA tx effects?

A 
Risk for local/distant recurrence,  new primary CA—need for close follow-up
Lymphedema of upper extremity
“Chemo-brain”
Menopausal symptoms
Osteoporosis, cardiovascular issues
51
Q

Paget carcinoma occurs in ____%, in the ____(anatomical location)____

A

1%

nipple

52
Q

What are sx of paget carcinoma?

A

itch/burn/superficial erosion of nipple

looks innocuous

53
Q

Why is the dx of paget carcinoma difficult?

A

often missed or delayed treated for dermatitis or infection

54
Q

____ occur is in <3% of breast CA and is the most malignant for of breast CA

A

Inflammatory Carcinoma

55
Q

What are the sx of Inflammatory Carcinoma?

A

(RED, HOT BREAST)
rapidly growing painful breast
inflammatory changes
sometimes a mass

56
Q

What is Inflammatory Carcinoma most commonly mistaken for?

A

mastitis

57
Q

Breast CA during Pregnancy and Lactation dx is often delayed, but should you work up a breast mass even if the women is pregnant?

A

yes

1/3000 pregnancies

58
Q

For women w/ an augmented breast, capsule contracture/scarring occurs in ___-___%
Implant rupture in __-__%

A

15-25%

5-10%

59
Q

____ _____ is palpable enlargement of male breast, it may be asymmetric or unilateral and is occasionally tender

A

Benign Gynecomastia

60
Q

What is the tx for Benign Gynecomastia?

A

tx underlying cause

Rx or surgical reduction if ongoing and symptomatic

61
Q

What are RF for male breast CA?

A

age
prostate CA
hyperestrogenic
BRCA2 +

62
Q

Is prognosis for male breast CA better or worse than women?

A

worse than women, dx late/mets

Repro. Med 4 (7 decks)

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