Breast cancer (Tieman) Flashcards
Stroma forms epithelial-lined clefts resembling leaves
stroma grows rapidly
benign or malignant
phyllodes tumor
Areas of fibrosis in the ducts with destruction and dilatation of terminal ductules and lobules, which fill with cystic fluid
breast pain, bilateral, diffuse, cyclic
no masses usually
fibrocystic breast disease
Cysts may present as breast masses and are usually easily identified by U/S and amenable to aspiration
Cyst fluid may be clear, yellow or green
If cyst disappears with aspiration and fluid not bloody, cytology not needed
Risk of malignancy very low
If cyst recurs, it may be re-aspirated
Multiple recurrences should be biopsied or excised
how do you treat fibrocystic breast disease
Support bra, analgesics, avoid trauma
Danazol and tamoxifen can be used in severe cases
Oil of evening primrose (gamolenic acid)
Low-fat diet
? Avoiding caffeine and chocolate, alcohol
? Vitamin E
difference b/w expressed and spontaneous nipple discharge
Expressed nipple discharge usually goes away when the manipulation of the nipple is stopped
Spontaneous nipple discharge may require evaluation, if the discharge is serous or bloody
Evaluation usually requires cytology, mammogram, and/or ultrasound
If discharge is spontaneous,unilateral, bloody or serous, and coming from a single duct, duct excision is required
95% benign papillomas, 5% papillary CA
which medications cause male boobies
Digoxin, thiazides, estrogens, phenothiazines, theophylline
what are lobules in the breast controlled by
progesterone
what are the ducts in the breast under control of
estrogen
risk factors for breast cancer
menstrual status
> 35 for first baby or nulliparous
History of other malignancy
breast
Ovarian (BRCA gene?)
Endometrial CA
Other systemic disease
cardiac, respiratory, blood dyscrasias, etc. (that might affect the patient’s candidacy for surgery)
Prior surgeries
breast biopsies, TAH-BSO, endocrine
Meds
BCP, estrogens, tamoxifen/raloxifene, anticoagulants,
family history = breast cancer in first degree relative
ovarian cancer (BRCA)
what factors are included in the risk assessment model GAIL model
age age at menarche age at 1st birth primary relative breast cancer number of biopsies race
diagnostic tools in breast lumps/mass
ultrasound
mammogram
MRI
biopsy
uses of MRI in breast disease
Screening in very high-risk patients (BRCA)
Dense Breasts
Small multicentric lesions
Implants
atypia on FNA or core needle biopsy requires what
excision of the entire lesion to R/O malignancy
atypical hyperplasia is seen on breast biopsy. what does this mean
3-6 times increased risk of later invasive CA
lobular CA in situ found on biopsy. what does this mean
Treated as a risk factor, not invasive CA
15-20% risk of invasive ductal CA bilaterally
ductal CA in situ found on biopsy
Usually treated the same as small invasive CA with lumpectomy and irradiation
