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Women's health > Breast Disorders > Flashcards

Breast Disorders Flashcards

1
Q

3 components of the female breast

A
  1. Glands and ducts (organized
  2. into lobes)
  3. Stroma (fibrous tissue) to bind lobes together
  4. Adipose tissue within and between lobes
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2
Q

each breast is made up of how many lobes?

A

12-20 lobes

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3
Q

which part of the breast contains major excretory duct for the lobe

A

apex of the breast

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4
Q

Each lobe has a group of lobules that have several ducts which unite to form the ?

A

major duct for the lobe

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5
Q

Each major duct widens to form ____ and then narrows at its individual opening in the nipple

A

an ampulla

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6
Q

Areola also contains sebaceous glands (______ ______) which may be visible as punctate prominences

A

Montgomery glands

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7
Q

what % of a normla breast is composed of adipose tissue?

A

80-85%

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8
Q

difference in breast in Nonpregnant, nonlactating; pregnant; lactation

A
  • Nonpregnant, nonlactating - small, tightly packed alveoli
  • Pregnant - alveoli hypertrophy and lining cells proliferate
  • Lactation - alveolar cells secrete lipids and proteins (milk)
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9
Q

Deep surface of breast lies on what structure

A

fascia of chest wall muscles

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10
Q

Fascia is condensed into multiple bands - _____ _____ - support breast in upright position

A

Cooper’s ligaments

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11
Q

lymphatic drainage Ultimately drains into where?

A

axillary lymph nodes

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12
Q

receive most lymphatic drainage and therefore are the most common site of breast cancer metastases

A

AXillary nodes - sentinel nodes

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13
Q

alt pathways of lymphatic drainage

A

internal mammary, supraclavicular, epitrochlear, contralateral axillary and abdominal lymph nodes

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14
Q

development of fetal nipple and prepubertal breast?

A
  1. Fetal - Primordial breast arises from basal layer of epidermis
  2. Prepubertal - breast is rudimentary bud
    - Few branching ducts
    - Ducts are capped with alveolar buds, end buds, or small lobules
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15
Q

at what age do the breast begin to grow?
what hormone affects breast tissue?

A

age 10-13

  1. estrogen/progesterone affect breast tissue
    - Communication between epithelial and mesenchymal cells
    - Extensive branching of ductal system and lobule development
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16
Q

what structures change during overall breast growth

A

increased:

  1. acinar tissue
  2. ductal size & branching
  3. adipose
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17
Q

Premenstrual - breast epithelial cells proliferate during the _____ phase when estrogen and progesterone are increased
what other changes happen?

A

luteal

  • Acinar cells increase in number and size
  • Ductal lumens widen
  • Overall increased breast size, turgor/fullness, and tenderness - 1 week before menses
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18
Q

Postmenstrual - breast epithelial cells undergo _______ at the end of the luteal phase when estrogen and progesterone levels decline
what other changes happen?

A

programmed cell death

  1. Decreased size and turgor (may still be tender)
  2. Reduced number and size of breast acini
  3. Decreased diameter of ducts
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19
Q

Final breast tissue differentiation occurs under the influence of _____ and _____ and is not complete until first full-term pregnancy

A

progesterone
prolactin

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20
Q

changes to the breast during pregnancy

A
  1. Marked increase in breast size and turgidity
  2. Deepening pigmentation of the nipple-areolar complex
  3. Nipple enlargement
  4. Areolar widening with increased number and size of lubricating glands
  5. Branching and widening of breast ducts
  6. Increased acini
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21
Q

changes to breast during late pregnancy (~34 wks)

A

fatty tissues are almost completely replaced by cellular breast parenchyma

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22
Q

Drop in what hormone triggers onset of milk production

A

progesterone

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23
Q

what is main regulator of milk production

A

Prolactin

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24
Q

menopausal changes to breast?

A

Decrease in estrogen and progesterone

  • atrophy and involution
  • Decr # and size of ducts and acini
  • regresses to almost infantile state
  • Adipose tissue may or may not atrophy
  • Parenchymal elements are lost
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25
Q

Fluid can be expressed from ducts in who?

A
  • 40% of premenopausal women
  • 55% of parous women
  • 75% of women who have lactated within 2 years
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26
Q

green nipple discharge is related to ?

A

cholesterol diepoxides

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27
Q

what presentation of nipple discharge is more physiologic?
which one needs further eval?

A
  1. Multiduct discharge elicited only following manual pressure with no blood
    - Physiologic - no further evaluation needed
    - May see bloody multiduct discharge in pregnancy
  2. Spontaneous or single duct discharge - needs evaluation
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28
Q

causes of abnml nipple discharge

A
  1. Normal lactation
  2. Galactorrhea
  3. Benign physiologic nipple discharge
  4. Pathologic nipple discharge
    - MCC: intraductal papillomas
    - Other causes - carcinoma, fibrocystic change
    - Usually unilateral and single-duct discharge - Can be serous, bloody, or serosanguineous
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29
Q

important questions to ask about abnml nipple discharge

A
  1. +/- breast mass
  2. Location of discharge - Unilateral or bilateral; Single or multiple ducts
  3. Qualities of discharge - Spontaneous or must be expressed; Constant or intermittent; Elicited by pressure at a single site or general pressure
  4. Menses/Hormonal - Timing in relation to menstrual cycle; Pre- or post-menopausal; History of hormone use (contraception, HRT)
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30
Q

causes of galactorrhea

A
  1. Idiopathic
  2. Physiologic - pregnancy, postpartum, breast stimulation, neonatal
  3. Meds - antipsychotics, methyldopa, imipramine, amphetamine, metoclopramide, OCPs, herbals
  4. Neoplasm - lung, renal, lymphoma, pituitary, hypothalamic
  5. Diseases - CKD, sarcoidosis, Cushing’s, hypothyroidism, acromegaly
  6. CNS lesions - pituitary adenoma, empty sella, head trauma
  7. Chest wall irritation - clothing, burns, VZV, eczema, esophagitis, surgery
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31
Q

bilateral multiductal milky discharge in nonlactating patient

dx?
W/u if PE otherwise normal, negative imaging and multiductal discharge?

A
  • galactorrhea
  • Pregnancy test, prolactin, renal function, thyroid function, endocrinology consult
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32
Q
  1. unilateral, spontaneous serous or serosanguineous discharge from single duct
    - Intraductal papilloma or intraductal malignancy
    - Palpable mass may not be present

dx?
Bloody discharge - more suggestive of ?

A
  • pathologic discharge
  • cancer but usually due to benign papilloma
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33
Q

w/u for pathologic discharge?

A
  • Cytology rarely helpful - negative doesn’t r/o cancer
  • Mammography or US - may reveal underlying abnormalities in duct
  • Ductography - may show intraductal filling defect
  • Ductoscopy - endoscopic evaluation of ducts
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34
Q

definitive and tx for pathologic discharge

A

subareolar duct excision (microductectomy)

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35
Q
  • Palpable glandular breast tissue in males
  • Pubertal - 60% of boys - Usually resolves spontaneously in 1 year
  • Palpate carefully to determine true (glandular) gynecomastia from fatty pseudogynecomastia - Compare subareolar tissue to nearby adipose; Fatty tissue - diffuse, nontender; True glandular enlargement - central, may be tender
  • Grade findings according to severity - Higher number = more severe
  • Pubertal - tender 2-3 cm discoid enlargement of glandular tissue beneath areola

dx?

A

Gynecomastia

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36
Q

50% of athletes who abuse what substances that can cause Gynecomastia

A

androgens or anabolic steroids

50% of athletes who abuse what substances that can cause Gynecomastia

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37
Q

Gynecomastia s/s suggestive of CA

A
  1. Asymmetry
  2. Enlargement not beneath areola
  3. Unusual firmness
  4. Nipple retraction
  5. Bleeding or discharge
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38
Q

w/u for gynecomastia

A
  1. Serum prolactin & hCG
    - + beta-hCG usually 2o testicular tumor or other CA (i.e., lung or liver) - may see mildly elevated hCG in pts with primary hypogonadism and high LH
  2. Serum free testosterone & LH
    - Low testosterone & high LH - primary hypogonadism
    - High testosterone & high LH - androgen resistance
  3. Serum estradiol
    - Increased - testicular tumors, elevated hCG, liver disease, obesity, adrenal tumor, hermaphroditism, aromatase gene mutations
  4. Serum TSH & FT4
  5. Karyotype (for Klinefelter syndrome)
  6. CXR - search for metastatic or bronchogenic carcinoma - If suspicious/unclear diagnosis
  7. Needle bx with cytology -If suspicious enlargement
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39
Q

tx for pubertal & med-induced gynecomastia

A
  • usually resolves spontaneously in 1-2 years
  • Medication-induced - stops after d/c offending drug
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40
Q

tx for painful or persistent gynecomastia

A

treat for 9-12 mo

  1. SERM - for true glandular gynecomastia
    - raloxifine (Evista) 60 mg orally daily (more effective)
    - tamoxifen 10-20 mg orally daily
  2. Aromatase inhibitor
    - anastrozole (Arimidex) 1 mg orally daily
    - Causes decreased serum estradiol and increased testosterone
  3. Testosterone therapy - For men with hypogonadism - may improve or worsen
  4. Radiation therapy
    - Prophylactic - men with prostate CA receiving antiandrogen tx
    - Reduces incidence 52% to 85%
  5. Surgery - persistent or severe
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41
Q

what gyneomastia tx is not recommended for Teens long-term?
what are the risks?

A
  • aromatase inhibitor
  • Risk of osteoporosis, delayed epiphyseal fusion
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42
Q
  1. MC with lactation and nursing
    - primiparous nursing patients
    - Rare prior to 5th day postpartum
  2. Uncommon if pt is not nursing and no other obvious cause (i.e., radiation tx for CA)
    - Should prompt work-up (imaging, bx) to exclude inflammatory breast CA

dx?
MCC?

A
  • mastitis
  • Staph aureus
43
Q
  1. painful erythematous lobule in outer quadrant of breast noted during 2nd or 3rd week of puerperium
  2. Systemic signs of infection - F, malaise, myalgias, leukocytosis
    - Do not ascribe high fever to simple breast engorgement
  3. Abscess - pitting edema and fluctuation
  4. Antibody-coated bacteria in milk supports dx

dx?

A
  • Mastitis
44
Q

tx for mastitis

A
  • Avoid milk stasis - Continue breastfeeding or use breast pump; warm compresses; Well-fitted bra; Instruct on proper breastfeeding techniques; Analgesics - acetaminophen or ibuprofen
  • Abx x 10-14 d; Dicloxacillin / cephalexin (500 mg QID); Alt - clinda, bactrim
  • Severe - inpatient IV Vancomycin + ceftriaxone OR pip-taz
45
Q

mastitis - avoid bactrim if infant is how old/has what?

A

if breastfeeding infant is < 1 month old or has hx of G6PD deficiency, jaundice, or prematurity

46
Q

what may arise arise from pre-existing mastitis
Redness, tenderness, induration
Palpable mass or fluctuance

A

breast abscess

47
Q

difference between peripheral vs subareolar breast abcess?
tx for each?

A

Non-puerperal - peripheral or subareolar

  1. Peripheral - skin infections (folliculitis, infected epidermal cyst)
    - I&D + abx as for mastitis
  2. Subareolar - keratin-plugged milk ducts behind nipple
    - Often fistulas between multiple abscesses
    - Simple I&D - 40% recurrence rate
    - Needs subareolar duct excision and complete removal of sinus tracts
    - Bx of abscess wall to rule out breast CA
48
Q
  1. Mass, often accompanied by skin or nipple retraction
    - +/- ecchymosis, tenderness
    - Clinically indistinguishable from breast CA
  2. Trauma, radiation or surgery - presumed etiology
  3. Only ~50% of pts recall hx of trauma

dx?
w/u?
mgmt?

A

Fat Necrosis

  1. May use US or mammo to help with dx
  2. If untreated, mass gradually disappears
    - If no resolution after several weeks - bx
    - No need to excise unless persistent or unclear dx
49
Q

MCC of cyclic breast pain or mastalgia in reproductive age women

A

Fibrocystic Breast Changes

  1. MC age - 30-50 yrs
  2. Rare after menopause unless pt is on HRT

Benign changes in breast epithelium

50
Q

cause of Fibrocystic Breast Changes?

A
  • Thought to be due to hormonal imbalance that may produce asymptomatic breast lumps on palpation
  • Estrogen considered a causative factor
51
Q

fibrocystic breast changes may be increased risk in women who consume what?

A

drink alcohol
especially ages 18-22

52
Q
  1. Pain or tenderness associated with a mass
    - Pain 2o proliferation of normal glandular tissue
    - Estrogen stimulates ducts, progesterone stimulates stroma
    - Change in pain/tenderness over the course of menstrual cycle - Usually present or worse during premenstrual phase
  2. Fluctuations in size
  3. Multiplicity of lesions
  4. +/- Nonbloody green or brown nipple discharge
  5. Caffeine may worsen sx

dx?
w/u?
tx?

A
  • fibrocystic breast
  • US/mammo (no mammo if < 30yo); US +/- aspiration useful if cystic vs mass; bx for dominant mass
  • reassurance; avoid trauma; good bra; CAM; OTC analgesics; drainage if large

Things that may be helpful: Abstaining from caffeine, coffee, chocolate; Low-fat diets may help

53
Q

options of CAM for fibrocystic breast

A

efficacy controversial

  1. Evening primrose oil - 44-58% of users report relief
  2. Vitamin E 400 IU daily
54
Q

mgmt for severe pain in fibrocystic breast?
refractory severe cases?

A
  • danazol, tamoxifen have been used - limited by SE
  • surgery
55
Q

prognosis for fibrocystic breast

A
  1. Exacerbations may occur at any time until menopause
  2. sx usually resolve following menopause
  3. Single nonproliferative lesions (fibrocystic changes) = no increased risk of breast CA
    - proliferative or atypical - may have higher CA risk
56
Q
  • Common, benign neoplasm - Focal abnormality of breast lobule
  • Usually in young women (within 20 yrs of puberty)
  • More frequent and earlier age of onset in black women

dx?

A

Fibroadenoma

57
Q

cause of Fibroadenoma

A

Etiology unknown - suspected possible hormonal link

  • Increase in size during pregnancy and with estrogen therapy
  • Decrease in size after menopause
58
Q

Classic - round, firm, discrete, relatively mobile, nontender mass
1-5 cm in diameter
Usually discovered by accident

dx?
w/u? findings? definitive dx?

A
  • Fibroadenoma
  • MC clinical; US - well-defined solid mass with benign features
  • Definitive dx - core biopsy or mass excision
  • Unclear or rapid growth - surgery; asx - monitor (Core needle bx OR repeat US & breast exam in 3-6 mo)
59
Q

T/F: Simple fibroadenomas are benign; do not increase risk of breast cancer

A

T

60
Q

fibroadenomas may be confused with a ____, a fibroepithelial tumor that clinically resembles fibroadenomas and has a small chance of becoming malignant

A

Phyllodes tumor

61
Q
  • MCC of cancer in women other than nonmelanoma skin cancers
  • MCC cancer (after skin CA) in all ethnic groups - highest incidence among white pts
  • 2nd MCC CA death in women (#1 lung CA)
A

breast cancer

Incidence and mortality slowly decreasing due to improved screening and treatment

62
Q

chances of developing breast CA increases with?

A

age

Avg age - 60-61 years
Main cause of death in women 40-59

63
Q

Risk of developing invasive breast cancer in a lifetime?

A

1 in 8

lifetime risk for female pts

64
Q

Over ?% of women who develop breast CA do not have significant identifiable risks

A

50

65
Q

RF severity of +FHx of breast cancer?

A
  • 1 first degree relative (mother/sister) - 2x risk
  • 2 first degree relatives - nearly 3x risk
  • Younger age of family at dx = higher risk
  • However - only 15-20% of pts with breast CA report (+) family hx
66
Q

what specific genetic mutation is a RF for breast CA?

A
  • BRCA1 and BRCA 2 - 5% of breast cancers
  • Autosomal dominant
67
Q

which genetic mutation has significantly increased lifetime risk by age 70?

A
  • BRCA 1 - breast CA 57%; ovarian CA 40%
  • Cumulative risk by age 70 for BRCA 2 - breast CA 49%; ovarian CA 18%
  • Men with BRCA 1/BRCA 2 also at higher risk
68
Q

RF for breast cancer? greatest RF?

A
  1. FHx
  2. genetic mutations
  3. age
  4. Nulliparity
  5. First full term pregnancy after age 30
  6. Early menarche (before age 12) - Late menarche - decreased risk
  7. Late natural menopause (after age 50) - Early or artificial menopause - decreased risk
  8. Postmenopausal combination HRT
  9. Hx of uterine cancer
  10. Greatest RF - personal h/o breast cancer - Increased risk in both same and in contralateral breast
69
Q

initial eval and labs of breast CA

A
  • Most dx after abnormal mammogram, instead of discovery of a breast mass - >90% dx by mammogram
  • Initial eval - CBE and assessment of lesion, bilateral mammo (if not already done) and breast US if indicated
  • Initial labs - CBC, LFTs, alkaline phosphatase
70
Q
  • painless breast mass
  • Usually hard, fixed, irregular margins, nonmobile
  • in the upper outer quadrant
  • regional LNs
  • possible initial findings: Axillary mass or swelling of arm; Bone pain or back pain; wt loss
  • less common: pain, nipple discharge, erosion, retraction, enlargement/shrinking, itching, redness, generalized hardness

dx?
concerning findings? (3)

A
  • Breast Cancer
  • Change in breast size/contour; Nipple or skin retraction; Edema or erythema
71
Q

possible palpations of regional LN for breast CA?
which is MC?

A
  • axillary, pectoral, supraclavicular, infraclavicular, subscapular, epitrochlear and lateral chain
  • Axillary nodes - >85% of breast lymph drainage
72
Q

description of high sus for breast CA vs not but frequently present?

A
  • Firm nodes or nodes >5 mm - highly suspicious
  • 1-2 mobile, nontender, not overly firm - frequently present, not suspicious
73
Q

Microscopic metastases in ?% of pts with clinically negative nodes

A

40

74
Q

LNs found in these 2 locations have strong possibility of distant metastases

breast CA

A

+ supraclavicular or infraclavicular nodes

75
Q

what type of carcinoma may only see small (1-2 mm) nipple erosions

A

Paget’s carcinoma

76
Q

Appearance Changes suggestive of advanced cancer

A
  1. Edema
  2. Redness
  3. Nodularity
  4. Ulceration of skin
  5. Fixation to chest wall
  6. Enlargement or shrinkage of breast
  7. Retraction of breast
77
Q

Findings suggestive of advanced cancer

A
  1. LAD - Marked axillary LAD; Supraclavicular or infraclavicular LAD
  2. Edema of ipsilateral arm
  3. Large primary tumor (>5 cm)
78
Q
  1. Eczematoid eruption and ulceration
    - Arises from nipple - can spread to areola
  2. 1% of all breast cancers
  3. Often mistaken for dermatitis or infection
  4. Associated with underlying carcinoma
  5. pain, itching or burning of breast along with superficial erosion or ulceration
    - May see bloody nipple discharge, retracted nipple

dx?
w/u?
tx?

A
  1. Paget’s Disease of the Breast
  2. full-thickness bx
  3. Mastectomy is traditional therapy; excision of nipple, areola and local mass; in situ dz do not need axillary eval - only if palpable mass, invasive cancer or mastectomy
79
Q

Diffuse, brawny edema of skin with erysipeloid border
Blocked dermal lymphatics by tumor emboli → lymphedema, hyperemia
“Peau d’orange” (orange peel skin) possible
Usually no palpable underlying mass
aggressive but rare - Nearly 35% have metastasis at dx

dx?
w/u?
mgmt?

A
  • Inflammatory Carcinoma
  • If suspected mastitis does not respond (1-2 wks) to abx - bx needed
  • multiple rounds of chemo, followed by surgery and radiation
80
Q

Breast imaging modality of choice
May detect CA 2 yrs before CA is palpable
False +/- possible - however correct in about 90% of cases
General sensitivity 70-90%, specificity >90%

which type of imaging?

A

mammo

81
Q

w/u for Breast CA

A
  1. mammo
  2. US and MRI not recommended for general population - consider adding if very high risk
  3. Up to 15% of CA detected on CBE not seen on mammogram - Bx should still be done if dominant or suspicious mass
    - Biopsy - definitive dx - MC lesions are benign on bx when thought to be CA (30%)
  4. Cytology - helpful on some occasions - cyst fluid, nipple discharge
  5. Labs - CBC, LFTs, beta-HCG, alkaline phosphatase
  6. imaging - limit for high pretest probability of distant metastasis
82
Q

types of bx done for breast CA

A
  • FNA - simple; can’t distinguish invasive or noninvasive
  • Core needle - more definitive dx, less chance of inadequate samples, determine invasive from noninvasive
  • Open surgical - if core needle bx cannot be done
83
Q

screenings for breast CA

A
  1. CBE - not a replacement for imaging
  2. Genetic testing - high risk families, genetic counseling needed before and after
84
Q

General consensus for mammogram screenings

A

at least once every 2 years among women 50-74

  • ACS/ACOG/ACR - Q 1 yr starting 40-45, may transition to Q2 yrs at 55
  • USPSTF/WHO/AAFP - Q 2 yrs ages 50-75
  • If 75+ - continue screening if estimated 10 years life expectancy
85
Q

> 95% of breast CA are what part of the breast?

A

epithelial components

  • Ductal - large or intermediate sized ducts
  • Lobular - epithelium of terminal ducts of lobules
86
Q

2 subtype of breast CA

A

invasive or be carcinoma-in-situ (CIS)

  • Most arise from intermediate ducts and are invasive
  • Ductal CIS - associated invasive cancers present in 1-3%
  • Lobular CIS - 25-30% will develop invasive ductal cancer later
87
Q

Most cancers have what type of hormone receptor site?

A
  • 80% - ER + and/or PR +
  • 23% - HER2 + (human epidermal growth factor receptor 2)
  • 13% - no hormone receptors
88
Q
  • which hormone receptors metastasize to bone, soft tissue, and genital organs?
  • which one metastasizes to liver, lung and brain?
A
  • ER/PR/HER2 + - metastasize to bone, soft tissue, genital organs
  • No Receptors - metastasize to liver, lung, brain
89
Q

en bloc removal of breast, pectoral muscles, axillary lymph nodes
Rarely indicated or performed currently

which type of surgery

A

Radical Mastectomy

90
Q

what is the modified radical mastectomy?

A
  • removal of breast and underlying pectoralis major fascia with evaluation of select axillary nodes
  • Better cosmetic and functional result than radical mastectomy
  • No difference in survival or disease free rates
91
Q

what is breast conservation therapy?
what stage of CA is indicated?

A

excision of tumor mass with negative margin, axillary evaluation and postoperative irradiation
Includes segmental mastectomy, partial mastectomy, quadrantectomy
For stage I and II and certain stage III cancers
Gaining increasing acceptance

92
Q

adjuvant tx If positive for ER/PR/HER2?
If negative for those receptors?

A

hormonal therapy indicated

  • Regardless of age, menopausal status, LN involvement or tumor size
  • Historically - 5 y of tamoxifen; Increased risk of endometrial Ca and VTE
  • Recently - aromatase inhibitors (anastrozole) thought to be equally or more effective

If negative for ER/PR/HER2 - may consider adjuvant; pembrolizumab (Keytruda)

93
Q

which adjuvant tx reduces occult metastases?

A

systemic chemotherapy - Polychemotherapy for 3-6 months or 4-6 cycles

94
Q
  • which med binds to estrogen receptors; block estrogen in some (not all) tissues?
  • Which ones are MC used for breast CA?
A
  • Selective Estrogen Receptor Modulators - SERMs
  • tamoxifen (Nolvadex), raloxifene (Evista)
  • May be used for chemoprevention of breast CA in some high-risk women
  • May be used off-label to treat other estrogen-sensitive neoplasms
95
Q

which SERM blocks in breasts; mimics in uterus, bone?
which one blocks breasts, uterus; mimics in bone?

A
  • tamoxifen
  • raloxifene - Less potent estrogen blockade - smaller reduction in new cancer; Less estrogenic SE (endometrial CA, VTE)
96
Q

SERM SE

A
  1. Common - hot flashes, nausea, muscle aches and cramps, hair thinning, headache, paresthesias
  2. Estrogenic - increased risk of thrombosis, fatty liver, endometrial cancer
    - Improves bone density and lipid profiles
  3. Impaired cognition
  4. False thyroid function studies
97
Q

DDI SERMs

A
  • Not for use with other hormone-modulating anti-CA therapy
  • SSRIs, cimetidine can reduce efficacy
  • Avoid with QT-prolonging agents
98
Q
  • Used for breast CA
  • inhibit aromatase (enzyme that produces estrogen)
  • May be slightly more effective at reducing recurrence of breast CA
  • May be less effective than tamoxifen at initial chemoprevention
  • used alone, combo with GnRH blockers, or before/following SERMs
  • used off-label to treat other estrogen-sensitive CA or reduce risk of breast CA in high-risk postmenopausal pts

what med?

A

Aromatase Inhibitors - anastrazole (Arimidex), exemestane (Aromasin), letrozole (Femara)

letrozole also used for ovulation induction

99
Q

SE of Aromatase Inhibitor? CI?

A
  • Common - hot flashes, GI upset, muscle weakness, joint pain, HA, worsened IHD
  • Hypercholesterolemia
  • Insomnia, impaired cognition, fatigue, mood changes
  • Thinning hair
  • CI: established pregnancy
100
Q

DDI aromatase inhibitor

A
  • Caution with, or do not use with, other hormone-modulating anti-CA therapy
  • May increase serum concentration of methadone or L-methadone
  • Do not use with estrogen or immunomodulating drugs
101
Q

3 other antibeoplastics

A
  1. Fulvestrant (Faslodex), elacestrant (Orserdu)
  2. GnRH agonists/antagonists
  3. Pembrolizumab (Keytruda)
102
Q
  • used for metastatic breast cancer and ER or PR+, HER- cancers
  • SERD - attach to and cause destruction of estrogen receptors
  • does not mimic effects of estrogen

which antineoplastic?

A

Fulvestrant (Faslodex), elacestrant (Orserdu)

103
Q

f/u for breast CA?
median time to recurrence?

A
  • PE Q 4 mo x 2 yrs, then Q 6 mo x 3 yrs, then yearly; Mammo 6 mo after radiation, then yearly; Routine laboratory tests
  • 4 years
104
Q

what type of breast CA has a higher chance of recurrence

A

Hormone receptor negative cancers

Women's health (15 decks)

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