breast cancer

Question 1

risk factors for breast cancer

Answer 1

dense tissue >75%
obesity
smoking
drinking >3drinks
night shift work
exposure to estrogen (early menarche, late menopause, first child greater then 30, no or little breast feeding, obesity post menopause, higher testosterone, post menopause hormones)
family hx
tall stature

Question 2

clinical breast self exam

Answer 2

every 2-3 years from 20-39 then annually

spend 3-5 min on each breast

Question 3

non invasive breast cancer

Answer 3

ductal carcinoma in situ- clustered microcalcifications with or without a palpable mass. tx w/ mastectomy or breast conserving therapy
lobular carcinoma in situ- never a palpable nodule. tx- excisional biopsy or breast conserving therapy

Question 4

most common breast cancer

Answer 4

invasive breast cancer (involves stroma of breast tissue- supporting structures of breast)

Question 5

invasive breast cancer

Answer 5

infiltrating ductal carcinoma
lubular invasive carcinoma
ductal/lobular

Question 6

neoadjuvant systemic therapy

Answer 6

chemotherapy, endocrine therapy (postmenopausal patients with hormone receptor-positive disease)before surgery

Question 7

should ppl undergo surgery after neoadjuvant systemic therapy

Answer 7

yes

Question 8

paget disease

Answer 8

disease of nipple or areola
Eczematoid appearance w/ crusting, scaling and erosion
Always associated w/ underlying mammary carcinoma either in situ or invasive

Question 9

inflammatory breast cancer

Answer 9

Pain and tender, firm enlarged breast
Skin is warm, thickened and has a peau d’ orange appearance
Often misdiagnosed as mastitis or cellulitis

Question 10

clinical eval of invasive breast cancer

Answer 10

CXR
Liver enzymes
Bone, liver & CT scans not indicated unless symptomatic or an Increase in liver enzymes

Question 11

selective estrogen receptor modulator

Answer 11

tamoxifen; good for cancers that are ER/PR positive

Question 12

aromatase inhibitors

Answer 12

given to post menopausal women
Amastrozole
Letrozole
Exemetave

Question 13

Her2 drugs

Answer 13

trastuzumab* or lapatinib

Question 14

breast cancer follow up

Answer 14

Annual H & P and mammograms
H & P every 3-6 months first 3 years
Then every 6-12 months for 2 years
Then annually

greatest risk is first 5 years

Question 15

common mets of breast cancer

Answer 15

Bone: constant aching pain
Skin & subcutaneous: lumps, skin changes, axillary discomfort or mass
Liver: anorexia, weight loss, RUQ pain, jaundice
Pulmonary: cough, dypnea, pleuritic CP
CNS: HA, N/V, mental status changes