Breast Conditions Flashcards
What is the GAIL model?
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
What is the CLAUS model?
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
What is the BRCAPRO model?
high risk women in given family
incorporated: Mutation frequencies, penetration/affected carriers, contralateral breast CA
Age of onset: 1st & 2nd degree male & female relatives
What is the HBOC model?
hereditary breast & ovarian cancer (autosomal dominant & associated w/ BRCA 1 & 2 genetic mutations)
Suspect: breast CA
What if the HBOC model is POSITIVE?
prophylactic mastectomy &/or oophorectomy
Other BRCA mutation screening tests?
BOADICEA: breast & ovarian analysis of disease incidence & carrier estimation algorithm
Tyrer-Cuzick
What is primary chemoprevention for women at HIGH RISK?
SERMs and ALs or surgical , can also be used post -CA
When are false negatives an issue?
Low sensitivity tests
When are false positives and issue?
Low specificity tests
Average risk recommendation for CBE?
q 1-3 years from 20-39
annually > 40
High risk recommendation for CBE?
Annually at 25, or 5-10 years prior to age of when relative was diagnosed
Average risk recommendation for mammogram?
annually >40 y/o
High risk recommendation for mammogram/ mri?
Begin annually 25-30, or 5-10 years prior to age of when relative was diagnosed
What is the BI-RAD System?
1: negative
2: benign findings
3: probably benign; initial short term interval follow up suggested (
What are the factors leading to lifetime risk of >/= 20-25% chance of Breast Cancer? (high risk)
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
Contraindications for MRI?
Pacemakers, cochlear implants
Any non-compatible MRI device/implant (deep brain stimulators)
Claustrophobia unamenable to anxiolytics
Wt/circumference limitations of MRI table
What meds cause galactorrhea?
Dopamine antagonists, MOAIs
What is the pharm option for pit tumor treatment?
Dopamine agonist : Cabergoline
What is the surgical tx for pit tumor and when is it indicated?
Transsephenoidal
Intolerance to meds, resistance to meds, large tumor or mass effect, if patient wants definitive tx
When should pt return for f/u after initial meds for tumors?
1 month after initiation to check for dosage and adjustment
When should therapeutic levels be checked for tumor meds?
3rd month, 6th month, and every 6 months after that
After pt stops taking meds for tumor when should the prolactin level be checked?
q 3 months for first year and if good then annually
When should MRI be done when checking tumor?
Baseline then 6 months, 12 months, 24 months
What meds can treat mastalgia?
OCPs, depo, SERMs
How is pagets diagnosed?
Nipple bx w breast assessment , direct or guided bx to confirm DCIS or invasive CA
What is the general spread of breast cancer?
Locally then to LN / bloodstream or both
What are early findings or breast cancer?
mass or asymmetry (size, contour or non-diffuse slightly firmer thickening in one breast), eczematous nipple changes
What are findings for advanced breast cancer?
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
What is diagnostic for breast CA?
H&P, mammography + MRI w/indications
Oncology referral : Direct or guided imaging w/core biopsy
What is the breast cancer grading based on?
- histology (ductal, lobular, nipple)
- TNM (tumor, nodes, mets)
- Receptor status : estrogen, progesterone, and HER2
What needs to follow up after biopsy for breast cancer?
Pre treatment work up
- Evaluate metastatic dx : CBC, CXR, LFT, ab ct, bone scan,
- MRI : tumor size and #, chest wall involvement
What is definitive staging and tx for breast cancer?
- Surgical and sentinel LN biopsy at oncology referral
* Not on focal DCIS
* Determines HER2, estrogen, and progesterone status
What are surgical options for PDB?
- Central lumpectomy if lesion confined to NAC with clear margins.
- Partial mastectomy if tumor
What are the surgical options based on sentinel LN - breast CA?
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
What are adjuvant hormonal tx?
SERMs: tamoxifen and raloxifene
When do you use estrogen antagonists?
ER positive CA
What are the ADR of adjuvant hormonal tx?
Thromboembolic events, endometrial CA
When are adjuvant hormonal aromatase inhibitors (AI) used?
systemic therapy
- primary CA, mets, or prevention along with SERMs
What are the ADR or AI?1
Decreased bone density, fracture risk
What should be used if HER2 is positive?
TRASTUXZUMAB
ADR of Trastuxzumab?
HF
Respiratory distress
Anaphlyaxis
Factors that lead to a poorer prognosis?
Young age, BRCA gene expression
Larger primary tumor, high grade tumor (poorly differentiated)
Positive LN
ER receptor negative, HER2 gene expression
What is the MOA of pagets in breast cancer?
Epidermotrophic theory - begins in breast and spread to nipple areolar complex
What is the stalk effect?
Non secretory adenopathy or lesion that interferes with dopamine inhibitory control ,leads to increased prolactin
What can tumor size cause
Bitemporal Hemianopsia with ha diplopia vision changes
