Breast Cancer Flashcards
What is the blood supply of the breast?
internal mammary (off subclavian) and lateral thoracis (off axillary) arteries
What LN drain the breast
Axillary»_space;» internal mammary
Effect of __ on breast
- estrogen
- progesterone
- PRL
- oxytocin
- estrogen = ductal development and fat deposition
- progesterone = lobar-alveolar (stromal) development
- PRL = milk production
- oxytocin = milk let down
Pt comes in with breast pain, next step?
h/o trauma = get US
high risk = get mammo
likely benight from H&P = reassurance, NSAIDs, sports bra, compress
Blood discharge, think
intraductal papilloma
milky discharge from nipple, think
preganacy
hyperPRL
hypothyroid
what meds are they taking (anti-psych)
yellowish discharge from breast, think
fibrocystic change
galactocele
acute mastitis
green/stick discharge from nipple, think
mammary duct ectasia
wiki: the lactiferous duct becomes blocked or clogged. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.
purulent nipple discharge, think
breast abcess
what is the incidence of breast cancer
1 in 8 women
who gets screened for breast cancer
> 50 q2year
> 40 q year if strong fam history
What is the MC location of breast cancer?
upper outer quadrant
What are the MC site of breast cancer mets?
bone, liver, lung, brain, pleura
What is the MC breast mass in
< 25 yo?
24-50?
> 50?
< 25 yo = fibroadenoma
24-50 = fibrocystic change
> 50 = infiltrating ductal carcinoma
are malignant masses usually painful or painless?
painless
find a breast mass in > 30 yo, next step?
mammo + core needle Bx –> excision if non-diagnostic
Find breast mass in < 30 yo, next step?
US
You get an US of a brast mass and it is solid, what is next step?
FNA
You get an US of a brast mass and it is cystic, what is next step?
drain it, if it is bloodyor recurrent, get a core needle bx
**f/u in 4 weeks
What is the BI-RADS
classification of mammos
what does the BI-RADS score mean? 0 1 2 3 4 5 6
0 = incomplete/needs addnl imaging 1 = negative/routine follow up 2- benight/routine follow up 3= probably benign/short term follow up (6mo) 4 = suspicious/core needly bx 5 = probmalignant/core needle bx 6 = def malignant/seek treatment
firm, mobile mass <5cm, in young woman
fibroadenoma
a firm moblie mass > 5cm seen in teens with rapid breast growth, Tx?
giant juvenile fibroadenoma, tx is excision to avoid breast defomity
bloodly nipple discharge + tx
intraductal papilloma, tx galactogram/ductogram guided excision (due to small risk of carcinoma)
huge benign tumor that distorts breast
phyllodes tumor
mammo that shows clustered microcalcifications is most liekly
DCIS/infiltrating
mamo that shows multiple/bilateral tumors is most likely
LCIS/infiltrating
MC breast cancer
infiltrating ductal carcinoma
“crusty” nipple eczema
paget’s disease
Staging for breast cancer
1= < 2cm 2= < 2cm or LN+ 3 = 2+ nodes 4= distant mets
treatemtn for ER/PR+ breast cancer
tamoxifen and aromatise inhibitors (letrozole, anastrazole, exemstane)
Her2/neu+ inficates good or poor prognosis
poor
treatment for Her2/neu+
trastuzamab
what is a modified radical mastectomy
removes breast, pec maj/min and axillary LN
painful, multiple, bilateral lumps that vary with menstrual cycle + Tx?
fibrocystic change
dec tea/caffine/chocolate, aspirate domainant lump
next step if pt has atypical ductal hyperplasia on bx?
excision bc has hish risk of becoming cancer
treatment for acute mastitis
dicloxacillin + CONTINUE Breast feeding
b/l breast pain and green/sticky d/c in perimenopausal woman
mammary duct ectasia
presents as breast lump and calcification following trauma, next step?
dystrophic calcification, excision and bx to r/o cancer
