Breast Disease Flashcards
What is the best treatment for infiltrating breast cancer in 26 wk pregnant woman?
Chemotherapy now, followed by lumpectomy and adjuvant radiation after delivery
Other options:
- MRM w/ chemo if indicated (as long as it’s not 1st trimester)
- BCS w/ SLNB + chemo if indicated + post-partum XRT
What treatments are contra-indicated in pregnancy?
Radiation and tamoxifen
What is the recommended screening regiment for pts w/ atypical ductal hyperplasia or LCIS
Clinical exam every 6-12 months + ANNUAL mammography
What’s the importance of comedo pattern of intraductal carcinoma on core-needle biopsy of breast?
More likely to be associated w/ multi-focal dz
Higher incidence of recurrence OR invasive cancer
What is the management of biopsy with pleomorphic LCIS?
Pleomorphic LCIS more likely associated w/ infiltrating lobular carcinoma so you need to make sure that you have NEGATIVE MARGINS ON EXCISION
How do you work up inflammatory breast cancer if both mammogram and US are both negative?
Skin punch biopsy - numerous dermal tumor emboli in the papillary and reticular dermis of the skin
What can you offer women w/ biopsy proved atypical ductal hyperplasia to help reduce risk of cancer development?
Tamoxifen can provide risk reduction in more than 50% of pts
What is the normal NCCN guidelines for breast cancer screening in average risk pts?
Annual screening starting at age 40
What side effects can be seen w/ lymphazurin blue dye used in SLNB?
Type I hypersensitivity reaction ==> Urticaria (benadryl/diphenhydramine) or Anaphylaxis (epinephrine)
What are the side effects and contraindications for tamoxifen?
Side effects: VTE (DVT, PE, Stroke), cataracts, endometrial cancer
Contraindications: pregnancy, prior VTE, warfarin
NOTE: Anastrazole has a lower risk of these side effects but has increased risk of fractures from osteoporosis
When is trastuzumab indicated? Side effects?
Give for pts w/ Bcx who are Her 2 + & have >1 cm tumors OR positive nodes
Side effect: heart failure/cardiotoxicity
What is the treatment for a metastatic flare?
Tx: XRT can provide relief & consider steroids
Sxs: Pain, swelling, erythema in metastatic areas
What is the treatment for Paget’s disease of the breast?
MRM or simple mastectomy but MUST INCLUDE nipple areolar complex
Dx: full thickness incisional biopsy including skin (showing Paget’s cells in skin)
What is the treatment for phyllodes tumor? Do you need to do ALND/SLNB?
Tx: Wide local excision of 1 cm
No need for nodal dissection since it typically doesn’t spread via lymphatics but rather hematogenously
NOTE: considered malignant if >5-10 mitoses per HPF
