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Breast Conditions > Breast Conditions > Flashcards

Breast Conditions Flashcards

1
Q

What is the GAIL model?

A

calculate risk invasive CA in next 5 years & overall lifetime risk

Factors: race/ethnicity, Hx breast biopsy, LCIS or DCIS, current age, menarche, age/1st live birth & # 1st degree relatives w/breast CA

Only model validated for AA women

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2
Q

What is the CLAUS model?

A

high risk women

Incorporates age of onset: 1st & 2nd degree male & female relatives; expanded version: family members w/ovarian CA

No personal, lifestyle or reproductive risk factors

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3
Q

What is the BRCAPRO model?

A

high risk women in given family

incorporated: Mutation frequencies, penetration/affected carriers, contralateral breast CA

Age of onset: 1st & 2nd degree male & female relatives

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4
Q

What is the HBOC model?

A

hereditary breast & ovarian cancer (autosomal dominant & associated w/ BRCA 1 & 2 genetic mutations)

Suspect: breast CA

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5
Q

What if the HBOC model is POSITIVE?

A

prophylactic mastectomy &/or oophorectomy

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6
Q

Other BRCA mutation screening tests?

A

BOADICEA: breast & ovarian analysis of disease incidence & carrier estimation algorithm
Tyrer-Cuzick

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7
Q

What is primary chemoprevention for women at HIGH RISK?

A

SERMs and ALs or surgical , can also be used post -CA

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8
Q

When are false negatives an issue?

A

Low sensitivity tests

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9
Q

When are false positives and issue?

A

Low specificity tests

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10
Q

Average risk recommendation for CBE?

A

q 1-3 years from 20-39

annually > 40

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11
Q

High risk recommendation for CBE?

A

Annually at 25, or 5-10 years prior to age of when relative was diagnosed

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12
Q

Average risk recommendation for mammogram?

A

annually >40 y/o

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13
Q

High risk recommendation for mammogram/ mri?

A

Begin annually 25-30, or 5-10 years prior to age of when relative was diagnosed

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14
Q

What is the BI-RAD System?

A

1: negative
2: benign findings
3: probably benign; initial short term interval follow up suggested (

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15
Q

What are the factors leading to lifetime risk of >/= 20-25% chance of Breast Cancer? (high risk)

A

Known BRCA gene mutation
1st degree maternal/paternal relative (parent, brother, sister or child) w/BRCA mutation
Hx chest irradiation between ages 10-30
Patient or 1st degree relative has high risk syndrome

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16
Q

Contraindications for MRI?

A

Pacemakers, cochlear implants
Any non-compatible MRI device/implant (deep brain stimulators)
Claustrophobia unamenable to anxiolytics
Wt/circumference limitations of MRI table

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17
Q

What meds cause galactorrhea?

A

Dopamine antagonists, MOAIs

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18
Q

What is the pharm option for pit tumor treatment?

A

Dopamine agonist : Cabergoline

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19
Q

What is the surgical tx for pit tumor and when is it indicated?

A

Transsephenoidal

Intolerance to meds, resistance to meds, large tumor or mass effect, if patient wants definitive tx

20
Q

When should pt return for f/u after initial meds for tumors?

A

1 month after initiation to check for dosage and adjustment

21
Q

When should therapeutic levels be checked for tumor meds?

A

3rd month, 6th month, and every 6 months after that

22
Q

After pt stops taking meds for tumor when should the prolactin level be checked?

A

q 3 months for first year and if good then annually

23
Q

When should MRI be done when checking tumor?

A

Baseline then 6 months, 12 months, 24 months

24
Q

What meds can treat mastalgia?

A

OCPs, depo, SERMs

25
Q

How is pagets diagnosed?

A

Nipple bx w breast assessment , direct or guided bx to confirm DCIS or invasive CA

26
Q

What is the general spread of breast cancer?

A

Locally then to LN / bloodstream or both

27
Q

What are early findings or breast cancer?

A

mass or asymmetry (size, contour or non-diffuse slightly firmer thickening in one breast), eczematous nipple changes

28
Q

What are findings for advanced breast cancer?

A

mass fixation to chest wall or skin, matted or fixed nodes; Inflammatory: peau d’orange, breast enlargement but usually no mass d/t entire breast involvement

29
Q

What is diagnostic for breast CA?

A

H&P, mammography + MRI w/indications

Oncology referral : Direct or guided imaging w/core biopsy

30
Q

What is the breast cancer grading based on?

A
  1. histology (ductal, lobular, nipple)
  2. TNM (tumor, nodes, mets)
  3. Receptor status : estrogen, progesterone, and HER2
31
Q

What needs to follow up after biopsy for breast cancer?

A

Pre treatment work up

  1. Evaluate metastatic dx : CBC, CXR, LFT, ab ct, bone scan,
  2. MRI : tumor size and #, chest wall involvement
32
Q

What is definitive staging and tx for breast cancer?

A
  1. Surgical and sentinel LN biopsy at oncology referral
    * Not on focal DCIS
    * Determines HER2, estrogen, and progesterone status
33
Q

What are surgical options for PDB?

A
  1. Central lumpectomy if lesion confined to NAC with clear margins.
  2. Partial mastectomy if tumor
34
Q

What are the surgical options based on sentinel LN - breast CA?

A

Lumpectomy (breast conservation)

Simple mastectomy: excise only the breast

Modified radical mastectomy: breast & axillary LN

Complete radical mastectomy: reserved for dz invades chest wall - excise breast, axillary LN, pectoral muscles

35
Q

What are adjuvant hormonal tx?

A

SERMs: tamoxifen and raloxifene

36
Q

When do you use estrogen antagonists?

A

ER positive CA

37
Q

What are the ADR of adjuvant hormonal tx?

A

Thromboembolic events, endometrial CA

38
Q

When are adjuvant hormonal aromatase inhibitors (AI) used?

A

systemic therapy

- primary CA, mets, or prevention along with SERMs

39
Q

What are the ADR or AI?1

A

Decreased bone density, fracture risk

40
Q

What should be used if HER2 is positive?

A

TRASTUXZUMAB

41
Q

ADR of Trastuxzumab?

A

HF
Respiratory distress
Anaphlyaxis

42
Q

Factors that lead to a poorer prognosis?

A

Young age, BRCA gene expression
Larger primary tumor, high grade tumor (poorly differentiated)
Positive LN
ER receptor negative, HER2 gene expression

43
Q

What is the MOA of pagets in breast cancer?

A

Epidermotrophic theory - begins in breast and spread to nipple areolar complex

44
Q

What is the stalk effect?

A

Non secretory adenopathy or lesion that interferes with dopamine inhibitory control ,leads to increased prolactin

45
Q

What can tumor size cause

A

Bitemporal Hemianopsia with ha diplopia vision changes

Breast Conditions (1 decks)

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