Breast Cancer Flashcards
List the risk factors for breast cancer
age >50, family h/o, HRT, h/o benign breast dz, menarche 15, nulliparity, age at first pregnancy >30
Most common tumor type of breast cancer (80%)
infiltrating ductal carcinomas
Specialized form of intraductal carcinoma that arises in the main excretory ducts of the breasts and extends to involve the skin of the nipple and areola, producing an eczematoid appearance
Paget’s disease of the breast
Type of breast cancer associated with pregnancy and is characterized by warmth, redness, and induration of the surrounding breast tissue
inflammatory breast cancer
Areas of lymphatic spread of breast cancer in order of appearance
axillary nodes, internal mammary node chain, supraclavicular nodes
Main locations of hematogenous spread of breast cancer
lungs, liver, and bones
Term for blockage of skin lymphatics causing edema and thickening of the skin
peau d’orange
Procedure that consists of en bloc dissection of the entire breast together with the pectoralis major and minor muscles and content of the axilla
radical mastectomy
Means of determining the tumor status in the axilla that has largely replaced sentinel lymph node dissection
lymphatic mapping and sentinel lymph node resection
What should be the next step of treatment if sentinel node is positive?
axillary dissection
Why is the axilla not routinely irradiated after axillary node dissection?
high incidence of lymphedema
Single most important prognosticator for the prognosis of breast cancer
status of the axillary lymph nodes (83% 5 yr survival for negative nodes compared to 73% with 1-3 + nodes, 45% for 4-5 , and 28% for 13+)
two general categories of mammographic findings suggestive of a breast cancer
spiculated soft tissue masses and clustered microcalcifications
Initial diagnostic approach to palpable mass in younger women
US of breast followed by mammography if US studies suspicious. Bx probably warranted even if mammography is negative
Initial diagnostic approach to palpable mass in older women
bilateral diagnostic mammography performed prior to biopsy
Recommendations for mammography screening
every 2 yrs starting at age 50 and continuing depending on clinical preference (70-75yr or until life expectancy less than 5 yrs)
Recommendations for clincal breast exam based on ACOG
every one to three years from age 20 to 39, and annually thereafter
Describe each BI-RADS assessment category and its associated recommendation
0-incomplete, need further eval
1-normal, normal interval follow-up
2-benign, normal interval follow-up
3-probably benign, shorter interval follow-up
4-suspicious abnormality, consider biopsy
5-most likely malignant, biopsy or surgery
6-biopsy proven carcinoma, appropriate tx
General treatment for early stage breast cancer
primary surgery (lumpectomy or mastectomy) to the breast and regional nodes with or without radiation therapy (RT)
comprised of lumpectomy plus radiation therapy (RT)
breast conserving therapy
Criteria that preclude breast conserving therapy
multicentric disease, large tumor size, diffuse microcalcifications, prior h/o chest RT, pregnancy
General treatment for locally advanced breast cancer
neoadjunvant systemic therapy followed by surgery
“classic” characteristics of a cancerous lesion
hard, immovable, single dominant lesion with irregular borders
signs of more advanced locoregional disease
axillary adenopathy or skin findings such as erythema, thickening, or dimpling of the overlying skin
