breast cancer Flashcards
what is the most common basis for lawsuits involving breast CA
delayed diagnosis
what are some factors that inc risk of breast CA
> 65yrs, Bx confirmed atypical hyperplasia, inherited genetic mutations BRCA1,2, mammographically dense breast, 2 or more 1st deg relatives
what are the 2 standard views for mammography
craniocaudal (CC), mediolateral oblique (MLO)
if there is suggestion of a nodule what views would better evaluate
spot compression, for medial- cleavage view, magnification, additional views
according to american college of radiology BI-RADS classification at what lvl do you have a suspicion of malignancy
4A (0-4A,B,C,-6) 0=needs additional imaging 4A=low;B=intermediate;C=moderate concern for malignancy 5=highly suggestive-refer to surgeon 6=known Bx proven malig-axn
in a young pt with inconclusive MMG results with dense breast what imaging modality would you use
Ultrasonography- better differentiates between solid and cystic mass- can guide core needle Bx
what diagnostic test is not recommended for eval of breast mass
MRI- used for staging
IV gadolinium dye- check renal fxn
when would you use a fine needle aspiration Bx
low probability of CA, determine if cyst
when is a core needle Bx used
if you need samples from larger solid breast mass
T/F in the US 12% of women will develop invasive breast CA
true! 1 in 8
what type of noninvasive (in situ) breast carcinoma is treated as a malignancy for potential to develop into invasive CA
DCIS
how does DCIS present
clustered pleomorphic calcifications on MMG, 80% non palpable, ill defined mass on US
how do you treat DCIS
breast conserving therapy c/ radiation, sentinel node Bx, hormone therapy if ER and PR + (Tamoxifen, Arimidex)
what is the most common INVASIVE breast malignancy
ductal- 80%
commonly palpable mass or MMG abnormality
5-10% of all invasive breast malignancies, does not form microcalcifications, more apt to be bilteral
Lobular
various presentations - unilateral erythematous, scaly, weeping “eczema” that involves the nipple
discoloration/ desquamation of nipple and areola-
Paget dz of breast - may also present c/ bloody discharge, pain, burning, pruritis
pain c/ rapidly progressing, tender, firm, enlarged breast, peau d’ orange, erythema
inflammatory breast CA- almost all involve lymph nodes- 1/3 mets
what is the difference between radical and modified radical mastectomy
modified spares pectoralis
what is brachytherapy
seed or wire in or near tumor- shorter duration of tx
T/F estrogen receptor (+) breast CA is more responsive to endocrine therapy than ER (-)
true
what is a targeted treatment for Her2/neu overexpression
herceptin
breast CA lymph mets to
axillary, internal mammary, supraclavicular nodes
hematogenous mets to
lung, liver, bone, ovaries, brain
T/F BRCA 1 has 44-78% risk of breast CA by 70yrs
24-40% ovarian CA
true
T/F BRCA 2 has a lower risk for breast CA in males than BRCA1
false- BRCA2 is higher
at what age does everyone agree to screen for breast CA
50-69yrs
according to ACS MRI screen should be done
BRCA mutation or Fhx, Hx of chest radiation
how often should you follow up breast CA
Hx and PE q 3-6mo x 5yrs; then annualy
if previous mastectomy how often should you screen other breast
annually
chemoprevention >35yrs no prior Dx of breast CA- but increased risk
if premenopause- tamoxifen
post- arimidex, raloxifene
what are the risks ass c/ tamoxifen, arimidex, raloxifene
inc DVT and endometrial CA
