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OB/GYN Boards by Subject > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

Anatomic border for breast LND

A

Pectoralis minor

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2
Q

Clinical risks for breast cancer

A

Thoracic RT (highest risk - 50x), first birth after 35 y/o, HRT, early menarche, late menopause, nulliparity

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3
Q

Pathologic risks for breast cancer

A

Lobular CIS, atypical ductal or lobular hyperplasia, proliferative disease without atypia (fibroadenoma with complexity, hyperplasia, sclerosing adenosis, intraductal papilloma)

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4
Q

Genetic risks for breast cancer

A

BRCA, family hx

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5
Q

Factors protective against breast cancer

A

Breastfeeding at least one year, menopause before 40 y/o

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6
Q

ACOG screening guidelines

A

Annual mammogram starting at age 40 y/o

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7
Q

Factors that make mammogram less sensitive and specific

A

Young age, dense breast tissue

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8
Q

Mammographic signs of malignancy

A

Clusters of calcifications, radiodense mass, parenchymal distortion, skin thickening or edema

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9
Q

BIRADS 0

A

Need further imaging

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10
Q

BIRADS 1-2

A

Routine screening

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11
Q

BIRADS 3

A

<2% risk of cancer, plan mammogram q6 mos for 1-2 yrs and bilateral mammogram yearly for 3 yrs

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12
Q

BIRADS 4-5

A

Biopsy

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13
Q

BIRADS 6

A

Known malignancy

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14
Q

BRCA, type of genes

A

Cancer suppressor genes

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15
Q

How many breast cancers are associated with BRCA?

A

5%

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16
Q

Lifetime breast cancer risk with BRCA

A

50-85%

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17
Q

How many genetic-associated breast cancers are associated with BRCA?

A

40-50%

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18
Q

Factors indicative of genetic causes

A

Dx <40 y/o, Ashkenazi Jewish, family history, bilateral breast cancer, adnexal or peritoneal high-grade or serous cancer

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19
Q

Surveillance for BRCA carriers or those with hx of thoracic radiation

A

Start at 25 y/o

BSE monthly, CBE twice yearly, mammogram annually, breast MRI alternating with mammogram

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20
Q

Risk-reducing surgery for BRCA carriers

A

Prophylactic mastectomy, risk-reducing BSO, risk-reducing BS

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21
Q

Use for breast ultrasound

A

Differentiate between cystic and solid mass, no sensitive so not a screening tool, good for eval of known mass

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22
Q

Use for breast MRI

A

If other modalities result in less adequate conclusions (highly sensitive but not specific)

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23
Q

Downsides of FNA for diagnosis

A

10-15% non-diagnostic rate, complications of hematoma or infection

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24
Q

Triple test (CBE, breast imaging, FNA) efficacy

A

99-100% if all concordant

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25
Q

Core needle biopsy efficacy

A

85-100% sensitivity and specificity, provides tissue for diagnosis

26
Q

Needle localized excisional breast biopsy efficacy

A

Diagnostic, needle directly in lesion then excised; imaging confirms removal

27
Q

Multiple cystic masses, fluctuate with menses, bilateral, tender, possible nipple discharge

A

Fibrocystic breast disease

28
Q

How common is fibrocystic breast disease?

A

50% of women

29
Q

Mobile, nontender, firm, solitary mass, benign

A

Fibroadenoma

30
Q

Most common breast tumor in women 20-35 y/o

A

Fibroadenoma

31
Q

Management of mastalgia

A

Bra, d/c hormonal therapies like OCPs, avoid cigarettes / caffeine / stress, NSAIDs
Vit E and evening primrose do not have enough evidence
Risks of tamoxifen, bromocriptine, danazol, and GnRH outweight benefits

32
Q

Most common cause of bloody discharge

A

Intraductal papilloma (others are ductal ectasia or cancer)

33
Q

Causes of physiologic discharge

A

Idiopathic, breast stimulation, OCPs, hypothyroidism, pituitary tumores, hyperprolactinemia, dopamin inhibitors (ie antipsychtics)

34
Q

Paget’s disease of the breast presentation

A

Eczematoid lesion in nipple/areola complex

35
Q

Associations to Paget’s disease of the breast

A

DCIS, infiltrating ductal carcinoma

36
Q

Who gets ductal carcinoma in situ (DCIS)?

A

Postmenopausal

37
Q

Likelihood of DCIS progression to cancer

A

30-50%

38
Q

Treatment for DCIS

A

Most reasonable wide excision alone (can consider mastectomy, radiation)

39
Q

Who gets lobular carcinoma in situ (LCIS)?

A

40-50 y/o (<10% postmenopausal)

40
Q

Likelihood of breast cancer after LCIS?

A

25% (can be either breast, is a risk factor not a precursor)

41
Q

Treatment for LCIS

A

Most commonly cautious observation, can do prophylactic mastectomy in high-risk patient

42
Q

Most common location for early-detected breast cancer

A

Upper, outer quadrant

43
Q

Anatomic location of breast cancer

A

Most commonly terminal duct lobular unit

44
Q

Most common histology of breast cancer

A

70% invasive ductal carcinoma

45
Q

Indian filing of cells

A

Invasive lobular carcinoma

46
Q

Molecular assessments of breast cancer

A

Hormone receptor status, Her2neu overexpression (oncogene protein), Her2gene amplification

47
Q

When to do SLN biopsy

A

Early breast cancer with nonpalpable lymph nodes (otherwise biopsy the palpable ones)

48
Q

Surgery for breast cancer

A

Lumpectomy + radiation (used to be radical mastectomy)

49
Q

Who needs adjuvant chemotherapy for breast cancer?

A

Women with >10% risk of systemic disease

50
Q

Tamoxifen drug type and actions

A

SERM, blocks ER in breast and stimulates in endometrium

51
Q

Drugs with tamoxifen interaction

A

Antidepressants (inhibit P450 2D6 enzymes and make tamoxifen less effective) except Effexor or Lexapro

52
Q

Raloxifene drug type and actions

A

SERM, blocks ER in breast and endometrium

53
Q

Indication for raloxifene

A

Prevention of breast cancer in postmenopausal women (NOT adjuvant therapy)

54
Q

Indication for aromatase inhibitors in breast cancer

A

Postmenopausal women with ER pos

55
Q

Aromatase inhibitors compared to Tamoxifen

A

Increased osteoporosis and bone fracture, decreased endometrial cancer, decreased VTE risk, decreased hot flashes

56
Q

How long can aromatase inhibitor be used?

A

5 years (usually Tamoxifen for 5 yrs then AI for 5 yrs)

57
Q

What are aromatase inhibitor names?

A

Anastrozole, letrozole, exemastane

58
Q

Use for trastuzumab (Herceptin)

A

Overexpression of Her2neu antigen, amplification of Her2 gene

59
Q

When to give trastuzumab

A

With or after chemo, but not with doxorubicin (increased CHF risk)

60
Q

Most important prognostic factor for breast cancer

A

Axillary lymph node status

61
Q

Other prognostic factors

A

Tumor size, histologic rage, ER/PR status, Her2neu overexpression

OB/GYN Boards by Subject (22 decks)

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