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Clin Med III exam III > Breast Diseases > Flashcards

Breast Diseases Flashcards

1
Q

What are fibrocystic breast changes

A

hormone induced breast changes

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2
Q

What are the risks for fibrocystic breast disease

A
  • nulliparity
  • late menopause
  • estrogen replacement therapy
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3
Q

In fibrocystic breast disease, estrogen affects what? Progesterone?

A

estrogen: ductal elements
progesterone: stroma

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4
Q

Clinical presentation of fibrocystic breast disease

A

-painful bilateral breasts
-palpable nodular areas with smooth defined
edges
-freely moving nodules
-+/- nipple discharge

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5
Q

The changes in the breast with firbocystic disease fluctuates with what

A

the menstrual cycle

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6
Q

Imaging you want to get for fibrocystic breast disease. Why?

A

US- distinguish cystic mass from a solid mass (done before FNA)

Mammogram- further evaluate suspicious/solid masses

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7
Q

When should you do an FNA

A

after an ultrasound to distinguish between a solid and a cystic mass

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8
Q

If there is no aspiration or bloody aspiration on FNA what do you do next

A

refer for core needle biopsy

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9
Q

What does a core biopsy give you

A

histologic information (epithelial hyperplasia, malignancy)

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10
Q

Besides uncertain FNA findings, when else should a core biopsy be done?

A

if cytology from FNA is benign but the mass persists for 3-6 months

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11
Q

Treatment for fibrocytic breast changes (mild)

A
  • avoid impact sports
  • bra with adequate support
  • ? decrease caffeine
  • ? vit e and oil of pirmrose
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12
Q

If a patient is experiencing significant discomfort associated with fibrocystic changes what can you prescribe

A

Tamoxifen, Danazol

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13
Q

Diangosis of fibrocystic breast disease is made based off of what

A

history and physical

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14
Q

Buzz words for fibrocystic breast disease

A

pre-menstrual painful, lumpy breasts

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15
Q

Who gets firbocystic breast changes

A

women between ages 30-50 (increases with age)

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16
Q

Who gets fibroadenomas of the breast

A

younger women ages 10-30

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17
Q

Characteristic of fibroadenomas

A
  • get bigger with pregnancy
  • goes away after menopause
  • painless
  • round/oval, hard/rubbery, movable nodules
  • 1 to 5 cm in diameter but can vary (not related to menses)
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18
Q

When is excision of a fibroadenoma indicated

A

if diagnosis is uncertain or if very large and uncomfortable

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19
Q

What do you use to monitor fibroadenomas of the breast

A
  • serial breast exams

- mammograms/ultrasound

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20
Q

What is the most common cause of pathogenic nipple discharge

A

benign intraductal papilloma

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21
Q

What types of things can cause benign physiologic nipple discharge (galactorrhea

A
  • rx induced
  • CNS lesions
  • pinuitary adenoma
  • Cushing’s
  • chest wall lesions
  • idiopathic
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22
Q

Important history points to obtain for females presenting with nipple discharge

A

-is there a mass present?
-unilateral or bilateral?
-spontaneous, persistent, intermittent?
relation to menses?
-premenopause of post?

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23
Q

Physical exam findings of a benign nipple discharge

A
  • provoked
  • bilateral
  • multiductal
  • milky, white, clear, yellow, green, brown, gray, blue discharge
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24
Q

Physical exam findings of suspicious of pathologic nipple discharge

A
  • unprovoked
  • unilateral
  • unidutal
  • serous, sanguinous or serosanguinous
  • associated with breast mass
  • women >40
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25
Q

What labs should you do with bilateral/multiductal discharge

A
  • pregnancy test
  • prolactin levels
  • thyroid function
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26
Q

Treatment for pathologic nipple discharge

A

terminal duct excision

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27
Q

Who gets mastitis

A

breast feeding mothers

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28
Q

What causes mastitis

A

S aureus

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29
Q

Sx’s of mastitis

A
  • unilateral inflammation, erythema, mastalgia, sore nipple, engorged breast
  • systemic sx’s (fever chills)
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30
Q

Treatment of mastitis

A
  • regular emptying of the breast

- dicloaxacillin

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31
Q

Complication of mastitis

A

abscess

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32
Q

Risk factors for breast cancer

A
  • age (peak 70)
  • BRCA1/BRCA2 genetic mutation
  • family history of breast/ovarian cancer
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33
Q

Breast characteristics that put a woman at risk for breast cancer

A

-high tissue breast density
-proliferative firbocystic breast disease
ipsilateral breast cancer

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34
Q

Gynecological history that puts a woman at risk for breast cancer

A
  • early menarche
  • late menopause
  • nulliparous
  • never breastfeeding
  • recent and long term estrogen replacement therapy
  • post menopausal obesity
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35
Q

Screening methods for breast cancers

A
  • bilateral self breast exam
  • clinical breast exam
  • mammography
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36
Q

If a suspicious lesion is found on mammography what do you do next?

A
  • US
  • stereotactic biopsy
  • open excision biopsy
  • MRI guided biopsy
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37
Q

Expert opinion on breast self exams

A

DONT DO IT

38
Q

Things to remember when doing a breast exam

A
  • examine the “tail”
  • examine axillary LNs
  • examine sternal border
39
Q

Screening method of choice for asymptomatic women

A

mammogram

40
Q

Mammograms detect cancer ___ before palpable mass is felt

A

2 years

41
Q

Findings on mammogram that are suggestive of cancer

A
  • clusters of 5 to 8 microcalcificatins in a linear distribution
  • soft tissue masses (spiculated lesion, ill defined lesions)
42
Q

When should mammograms start? When should you stop? How often do you do iy

A

> 50 if average risk

stop at 75

get one every 1-2 years

43
Q

If an abnormality is noted on a screening mammorgram whats the next step

A

diagnostic memmogram (magnification view and spot compression views)

target ultrasound

44
Q

What denotes cancer suspicion that you can determine with an ultrasound

A

mass irregularity

45
Q

Ultrasound is useful in distinguishing ___ from ___ masses

A

cystic from solid masses

46
Q

When is mammogram and ultrasound used as diagnostic techniques

A

non palpable mass on mammogram—> US

non palpable calcified mass on mammo–> US guided biopsy

mass on mammo w/ dense breasts–> US

47
Q

If a suspicious malignant mass is found on screening whats next

A

if palpable–> core biopsy or excisional biopsy

if non palpable–> stereotactic biopsy

48
Q

What is a stereotactic breast biopsy

A

procedure in which patient is prone on the mammo table and biopsies are taken with a computer assisted device

49
Q

Three categories benign breast lesions fall under

A
  • non proliferative
  • proliferative without atypia
  • proliferative with atypia
50
Q

Examples of proliferative with typia lesions

A
  • atypical ductal hyperplasia
  • atypical lobular hyperplasic
  • flat epithelial atypia
  • lobular carcinoma in situ
51
Q

Tx for proflierative lesions with atypia

A

excisional biopsy and breast cancer chemoprevention

52
Q

Two types of non invasive breast cancer

A
  • ductal carcinoma in situ

- ductal lobular in situ

53
Q

Types of invasive breast cancer

A
  • infiltrating ductal (76%)
  • invasive lobular
  • ductal/lobular
  • inflammatory
  • mucinous, tubular, medullary, papillary metastatic breast cancer
54
Q

Suspicious symptoms for breast cancer

A
  • bone pain
  • HA
  • seizures
  • double vision
55
Q

What types of breast skin changes should you look for in breast cancer

A
  • erythema
  • edema
  • peau d’prange
56
Q

Early signs and symptoms of breast cancer

A
  • immobile, fixed, ill defined margins, hard

- painless

57
Q

Mammographic abnormalities that make you think early breast cancer

A

linear calcifications

58
Q

Signs and symptoms of late breast cancer

A
  • fixed mass to skin or chest wall
  • skin or nipple retractions
  • breast enlargement (asymmetry) or shrinkage
  • breast edema, erythema, pain
  • bloody nipple diacharge
59
Q

When assessing lymph nodes with breast cancer what is considered normal

A

moveable, non tender <5mm

60
Q

Lymph nodes that present as what are concerning

A
  • matted, hard, firm, immovable
  • fixed to skin or deeper tissue
  • > 1cm
61
Q

What would typically denote metastatic breast cancer

A

axillary lymph node involvement and/or supra/infraclavicular LNs

62
Q

Stage 0 breast cancer =

A

carcinoma in situ

63
Q

Stage I breast cancer

A

<2cm

neg LNs

64
Q

Stage IIA breast cancer

A

<2cm w/ +lymph
OR
2-5cm, - lymph

65
Q

Stage IIB breast cancer

A

> 2cm w/ +LNs
OR
5cm w/ -LNs

66
Q

Stage III breast cancer

A

> 5cm
+LNs
skin and chest wall infiltration

67
Q

Stage IV breast cancer

A

distant metastases

68
Q

Where does breast cancer like to metastasize to

A
  • brain
  • done
  • liver
  • lungs
69
Q

What are sentinel LNs

A

first LNs target by tumor invasion

70
Q

What do sentinel LNs determine

A

biopsied to check LN invasion

if neg–> axillary LNs are spared

71
Q

Prognosis of ER/PR positive tumors

A

better than ER/PR negative tumors because the respond to hormonal treatment

72
Q

HER-2 positive. Good prognosis or bad?

A

bad,high rate of recurrencce
BUT
more responsive to therapy

73
Q

When is breast conserving surgery contraindicated

A
  • > 2 tumors in different quadrants
  • large tumor
  • persistently positive margins
  • diffuse cancer
74
Q

Type of surgical approaches to breast cancer treatment

A
  • radical mastectomy
  • modified radical mastectomy
  • simple mastectomy
  • skin sparing mastectomy
  • skin and nipple sparing mastectomy
75
Q

When is radiation therapy done

A

5-7 weeks after surgery

76
Q

Indications for radiation therapy for breast cancer tx

A
  • breast conserving surgery
  • large tumors >5cm
  • lymph node involvement
77
Q

HER + targeted therapy

A

trastuzumb (herceptin)

targeted against HER-2 receptor oncogene over-expression

78
Q

Herceptin is given with what

A

conventional chemotherapy

79
Q

How long is herceptin given for

A

1 year

80
Q

Herceptin increases a patients risk of what

A

CHF

81
Q

What is the goal for chemotherapy with breast cancer

A
  • eliminate micrometastases and recurrence

- stop disease progression

82
Q

Which population see the best results with chemotherapy

A

LN positive women

83
Q

Indications for chemotherapy

A
  • LN positive
  • ER/PR negative
  • tumor >2cm
  • triple negative
84
Q

What medications given with conventional chemo can increase survival

A
  • paclitaxel

- docetaxel

85
Q

What are paclitaxel and docetaxel good for?

A
  • Her2 negative

- Stage I,II,III

86
Q

Hormonal therapy for ER/PR positive patients

A
  • tamoxifen

- aromatase inhibitors

87
Q

Side effects of tamoxifen

A
  • DVT
  • uterine cancer
  • vasomotor symptoms
88
Q

What population are aromatase inhibitors contraindicated in

A

pre menopausal women

89
Q

Side effects of aromatase inhibitors

A
  • bone loss
  • myalgia
  • arthralgia
90
Q

Only treatment option for triple negative breast cancer

A

chemo

91
Q

Possible risk factors for breast cancer in men

A
  • hx of prostate cancer
  • men with 1st degree relatives with h/o breat cancer
  • BRCA2 gene mutations

Clin Med III exam III (10 decks)

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