Breast Cancer Flashcards
Position of the patient tuwing breast exam
Supine and upright
Inspect and palpate which areas?
All tissue between clavicle and costal margins
Lateral sternal border to posterior axillary line
Axilla
Supraclavicular area
What do you inspect sa breast examination?
REDNESS, SWELLING SKIN DIMPLING NIPPLE RETRACTION or INVERSION SCALY LESIONS PEAU DE ORANGE PALPABLE AXILLARY LYMPH NODES LUMP - size, consistency, location, mobility, margin
how would you describe a lump
size, consistency, location, mobility, margin
peau de orange
edema and pitting and results from blockage of lymphatic drainage with or without associated stromal infiltration.
Age appropriate imaging
Cut off age
30 years old and younger - Ultrasound
> 30 years old - Mammography and/or Ultrasound
7 things na iaask sa patient sa history about a breast mass
- onset
- fluctuate in size?
- progression in size?
- history of trauma to breast
- procedures done to breast
- personal history of breast cancer
- any family history of breast/ovarian/colonic cancer
significant family history of breast cancer
breast, ovarian, colonic
Risk factor (clue: anything that has high exposure to estrogen)
early menarche (before <12 yo)
late menopause (>55 yo)
nulligravid
obesity
smoking, alcohol use
HIGH RISK for Breast Cancer
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
best time to perform breast self exam
7 days after period
2 most common benign breast masses
fibroadenoma
fibrocystic breast changes
most common benign breast neoplasm among 15-25 years old (adolescents and early 20s)
FIBROADENOMA
describe fibroadenoma
well defined, firm/rubbery, mobile
ddx for fibroadenoma
phylloides tumor - similar to fibroadenoma but may behave like a malignant tumor which can invade locally and may cause distant metastasis
MANAGEMENT for FIBROADENOMA
conservative management with follow up
surgical excision if no complete regression by 35 years old
Most common benign breast complaint in women of 30-50 years old reproductive age
Fibrocystic breast changes
Describe the lesion of fibrocystic breast changes
Nodular/lumpy, dense, swollen and tender before menses
Histology slide of fibrocystic changes
(+) fibrosis
(+) adenomatous changes
Management of Fibrocystic Breast Changes
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)
MOA of Danazol (100 mg BID) for 3-6 months
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
MOA of Tamoxifen (10 mg/day)
Competes with 17B estradiol
binds DNA after metabolic activation to initiate carcinogenesis
Broad-based or pedunculated polypoid epithelial lesions that may obstruct and distend the involved duct (perimenopause)
INTRASDUCTAL PAPILLOMA
Intermittent but spontaneous discharge from one nipple involving one of two ducts
INTRADUCTAL PAPILLOMA
