Breast Cancer

Question 1

Position of the patient tuwing breast exam

Answer 1

Supine and upright

Question 2

Inspect and palpate which areas?

Answer 2

All tissue between clavicle and costal margins
Lateral sternal border to posterior axillary line
Axilla
Supraclavicular area

Question 3

What do you inspect sa breast examination?

Answer 3

REDNESS, SWELLING
SKIN DIMPLING
NIPPLE RETRACTION or INVERSION
SCALY LESIONS
PEAU DE ORANGE
PALPABLE AXILLARY LYMPH NODES
LUMP - size, consistency, location, mobility, margin

Question 4

how would you describe a lump

Answer 4

size, consistency, location, mobility, margin

Question 5

peau de orange

Answer 5

edema and pitting and results from blockage of lymphatic drainage with or without associated stromal infiltration.

Question 6

Age appropriate imaging

Cut off age

Answer 6

30 years old and younger - Ultrasound

> 30 years old - Mammography and/or Ultrasound

Question 7

7 things na iaask sa patient sa history about a breast mass

Answer 7

1. onset
2. fluctuate in size?
3. progression in size?
4. history of trauma to breast
5. procedures done to breast
6. personal history of breast cancer
7. any family history of breast/ovarian/colonic cancer

Question 8

significant family history of breast cancer

Answer 8

breast, ovarian, colonic

Question 9

Risk factor (clue: anything that has high exposure to estrogen)

Answer 9

early menarche (before <12 yo)

late menopause (>55 yo)

nulligravid

obesity
smoking, alcohol use

Question 10

HIGH RISK for Breast Cancer

Answer 10

BRCA gene mutation carriers
1st degree relative with breast cancer
Radiation exposure to chest before age 30
history of atypical hyperplasia

women are candidtas for genetic counselling

Question 11

best time to perform breast self exam

Answer 11

7 days after period

Question 12

2 most common benign breast masses

Answer 12

fibroadenoma

fibrocystic breast changes

Question 13

most common benign breast neoplasm among 15-25 years old (adolescents and early 20s)

Answer 13

FIBROADENOMA

Question 14

describe fibroadenoma

Answer 14

well defined, firm/rubbery, mobile

Question 15

ddx for fibroadenoma

Answer 15

phylloides tumor - similar to fibroadenoma but may behave like a malignant tumor which can invade locally and may cause distant metastasis

Question 16

MANAGEMENT for FIBROADENOMA

Answer 16

conservative management with follow up

surgical excision if no complete regression by 35 years old

Question 17

Most common benign breast complaint in women of 30-50 years old reproductive age

Answer 17

Fibrocystic breast changes

Question 18

Describe the lesion of fibrocystic breast changes

Answer 18

Nodular/lumpy, dense, swollen and tender before menses

Question 19

Histology slide of fibrocystic changes

Answer 19

(+) fibrosis

(+) adenomatous changes

Question 20

Management of Fibrocystic Breast Changes

Answer 20

Non pharmaco:
Wear well-fitted, supportive bras
heating pad or warm water bottle
low fat, caffeine intake
Vitamin E supplementation

Evening primrose - changes balance of fatty acid Evening primrose oil 500 mg/cap

pain - Acetaminophen and NSAID

Danazol (100 mg BID) for 3-6 months

Tamoxifen (10 mg/day)

Question 21

MOA of Danazol (100 mg BID) for 3-6 months

Answer 21

androgen receptor antagonist leading to anti estrogenic effects

antagonizes E and P receptors in the breast, hypothalamus and pituitary

S/Sx: masculinizing effect

Therapy cannot be more than 6 months

Question 22

MOA of Tamoxifen (10 mg/day)

Answer 22

Competes with 17B estradiol

binds DNA after metabolic activation to initiate carcinogenesis

Question 23

Broad-based or pedunculated polypoid epithelial lesions that may obstruct and distend the involved duct (perimenopause)

Answer 23

INTRASDUCTAL PAPILLOMA

Question 24

Intermittent but spontaneous discharge from one nipple involving one of two ducts

Answer 24

INTRADUCTAL PAPILLOMA

Question 25

INTRADUCTAL PAPILLOMA management

Answer 25

Excisional biopsy of the uninvolved duct and a small amount of surrounding tissue

Tumors tend to regress in postmenopausal women but excision should be considered to rule out malignancy

Question 26

Surveillance after INTRADUCTAL PAPILLOMA

Answer 26

3 to 4th month intervals if papilloma not surgically excised

Question 27

MASTITIS

Answer 27

infection of the ductal systems or smaller sebaceous glands

Question 28

MASTITIS

Answer 28

Doxycycline or Sulfamethoxazole/trimethoprim

Question 29

When is Breast Cancer Suspected?

B R E A S T

Answer 29

Breast mass - hard, consistency, ill defined border

Retraction of nipple

Edema (peau d orange of the skin)

Axillary node

Skin Dimpling, Ulceration

tumor metastasis

Question 30

Classification for Breast Mass

Answer 30

BIRADS