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OB/GYN Boards by Subject > Breast cancer > Flashcards

Breast cancer Flashcards

(61 cards)

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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
Core needle biopsy efficacy
85-100% sensitivity and specificity, provides tissue for diagnosis
26
Needle localized excisional breast biopsy efficacy
Diagnostic, needle directly in lesion then excised; imaging confirms removal
27
Multiple cystic masses, fluctuate with menses, bilateral, tender, possible nipple discharge
Fibrocystic breast disease
28
How common is fibrocystic breast disease?
50% of women
29
Mobile, nontender, firm, solitary mass, benign
Fibroadenoma
30
Most common breast tumor in women 20-35 y/o
Fibroadenoma
31
Management of mastalgia
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
Most common cause of bloody discharge
Intraductal papilloma (others are ductal ectasia or cancer)
33
Causes of physiologic discharge
Idiopathic, breast stimulation, OCPs, hypothyroidism, pituitary tumores, hyperprolactinemia, dopamin inhibitors (ie antipsychtics)
34
Paget's disease of the breast presentation
Eczematoid lesion in nipple/areola complex
35
Associations to Paget's disease of the breast
DCIS, infiltrating ductal carcinoma
36
Who gets ductal carcinoma in situ (DCIS)?
Postmenopausal
37
Likelihood of DCIS progression to cancer
30-50%
38
Treatment for DCIS
Most reasonable wide excision alone (can consider mastectomy, radiation)
39
Who gets lobular carcinoma in situ (LCIS)?
40-50 y/o (<10% postmenopausal)
40
Likelihood of breast cancer after LCIS?
25% (can be either breast, is a risk factor not a precursor)
41
Treatment for LCIS
Most commonly cautious observation, can do prophylactic mastectomy in high-risk patient
42
Most common location for early-detected breast cancer
Upper, outer quadrant
43
Anatomic location of breast cancer
Most commonly terminal duct lobular unit
44
Most common histology of breast cancer
70% invasive ductal carcinoma
45
Indian filing of cells
Invasive lobular carcinoma
46
Molecular assessments of breast cancer
Hormone receptor status, Her2neu overexpression (oncogene protein), Her2gene amplification
47
When to do SLN biopsy
Early breast cancer with nonpalpable lymph nodes (otherwise biopsy the palpable ones)
48
Surgery for breast cancer
Lumpectomy + radiation (used to be radical mastectomy)
49
Who needs adjuvant chemotherapy for breast cancer?
Women with >10% risk of systemic disease
50
Tamoxifen drug type and actions
SERM, blocks ER in breast and stimulates in endometrium
51
Drugs with tamoxifen interaction
Antidepressants (inhibit P450 2D6 enzymes and make tamoxifen less effective) except Effexor or Lexapro
52
Raloxifene drug type and actions
SERM, blocks ER in breast and endometrium
53
Indication for raloxifene
Prevention of breast cancer in postmenopausal women (NOT adjuvant therapy)
54
Indication for aromatase inhibitors in breast cancer
Postmenopausal women with ER pos
55
Aromatase inhibitors compared to Tamoxifen
Increased osteoporosis and bone fracture, decreased endometrial cancer, decreased VTE risk, decreased hot flashes
56
How long can aromatase inhibitor be used?
5 years (usually Tamoxifen for 5 yrs then AI for 5 yrs)
57
What are aromatase inhibitor names?
Anastrozole, letrozole, exemastane
58
Use for trastuzumab (Herceptin)
Overexpression of Her2neu antigen, amplification of Her2 gene
59
When to give trastuzumab
With or after chemo, but not with doxorubicin (increased CHF risk)
60
Most important prognostic factor for breast cancer
Axillary lymph node status
61
Other prognostic factors
Tumor size, histologic rage, ER/PR status, Her2neu overexpression

OB/GYN Boards by Subject (22 decks)

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