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Surgery > Breast Disorders > Flashcards

Breast Disorders Flashcards

1
Q

Incidence of breast cancer

A

1 in 8

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2
Q

Breast cancer screening?

A

Screen every 2-3 years from 20-39
Initial mammogram at 40 w/ repeat every 1-2 years 40-50; all over 50 should receive annual mammogram

High risk need 2x year screening starting at 25, initial mammogram at 30, yearly starting at 40

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3
Q

Breast cancer risk factors?

A
  • One or more first-degree relatives w/ breast cancer
  • Older age = greater risk
  • Personal hx of breast cancer, ovarian cancer, endometrial cancer
  • Obesity, postmenopausal
  • Hx of fibrocystic disease
  • Single > married, white, early menarche, late menopause
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4
Q

BRCA1 or BRCA2 associated w/ ovarian cancer?

A

BRCA1

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5
Q

Risks of mammography

A

Radiation and false (-) results (7-20%)

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6
Q

Classifications of mammography abnormalities?

A

Masses, Asymmetric densities, Microcalcifications

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7
Q

BI-RADS?

A 
0 - Needs additional eval
1 - Normal
2 - Benign, routine screening
3 - Probably benign, short initial f/u
4 - Suspicious - bx
5 - Highly suggestive of malignancy
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8
Q

1 cm non-palpable suspected DCIS. Next step?

A

Magnification mammography –> stereotactic core needle bx

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9
Q

If mass highly suspicious for malignancy what might be a better test than stereotactic needle bx?

A

Needle localization and open bx as it allows complete excision

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10
Q

DCIS manifestation on mammogram?

A

Incidental microcalcifications, possibly a mass … often multifocal

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11
Q

Can DCIS be infiltrative?

A

10-20%

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12
Q

Which form of DCIS has higher malignant potential

A

Comedo pattern (30% invasive)

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13
Q

Tx of diffuse/multicentric DCIS?

A

Simple mastectomy

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14
Q

Tx of smaller DCIS?

A

Wide excision and radiotherapy w/ pathology free margins

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15
Q

Effect of radiotherapy on DCIS

A

Local recurrence falls to 22% w/ wide excision and radiation. 4% w/ simple mastectomy over 10 yr period

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16
Q

Are nodal mets common w/ DCIS?

A

No, so nodal dissection not necessary except in comedo type an axillary SLNBx may be ok

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17
Q

LCIS or DCIS presenting younger?

A

LCIS

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18
Q

LCIS or DCIS more likely to be bilateral?

A

LCIS

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19
Q

Presentation of LCIS?

A

Incidental finding w/out mass, not usually visible on mammography

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20
Q

Risk of axillary mets in LCIS?

A

Very rare

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21
Q

Tx of LCIS?

A

Close observation w/ exam and mammography every 6 mo for several years

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22
Q

Presentation of sclerosing adenosis?

A

Clustered microcalcifications that can appear similar to invasive tubular carcinoma. Routine f/u

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23
Q

Associated risk of cancer in Atypical ductal hyperplasia?

A

4-5x higher

24
Q

Dx of Atypical ductal hyperplasia

A

Needle localization and excision

25
Q

Suspected carcinoma: Work up?

A

Mammogram, US if cystic, aspiration if painful or enlarging, bx if solid (core needle or open)

26
Q

40 yo menstruating woman w/ mass. Change in work-up? 28 yo woman?

A

No, any mass 35-60 is cancer until proven otherwise. Higher incidence of benign and greater risk of radiation from mammography, US may be appropriate initial study (98% fibroadenoma)

27
Q

Woman w/ “lumpy breasts” that are tender prior to menstrual periods.

A

Fibrocystic disease and is usually bilateral.

28
Q

Causes of fibrocystic disease. Malignancy risk? Management?

A

Estrogen sensitivity or dec. progesterone activity. Low risk but w/ atypia that increases. Can aspirate cysts if sxic.

29
Q

14 cm lesion … ? Malignancy risk?

A

Phyllodes tumor (giant cell fibroadenoma). Tumor behavior and an increased number of mitoses.

30
Q

Clear nipple discharge from multiple ducts?

A

More likely to be fibrocystic disease

31
Q

MCC of bloody nipple discharge?

A

Intraductal papilloma –> requires surgical bx, mammography, possible ductogram (radiographic dye) and should be excised

32
Q

Staging DCIS

A

Mammogram, bx

33
Q

Prophylactic lumpectomy in LCIS?

A

Doesn’t make sense as LCIS inc. risk of breast cancer by ~1% each year. Bilateral mastectomy would be more likely.

34
Q

Management of LCIS?

A

Observe, Q6 mo clinical exam, annual mammography, MRI?, Tamoxifen cuts risk by 56%

35
Q

Paget’s disease of breast? Dx?

A

DCIS spreading out through nipple causing ulceration. Punch bx.

36
Q

DCIS tx? SLNBx?

A
  1. Partial mastectomy + RADIATION +/- Tamoxifen
    • Appropriate for solitary tumor < 5 cm
    • Axillary node sampling
  2. Total mastectomy +/- reconstruction + radiation

SLNBx for mastectomy only

37
Q

Favorable Histologic Types?

A

Tubular, papillary, mucinous, Paget’s, presence of estrogen receptors

38
Q

Less favorable histologic types?

A

Infiltrating ductal, infiltrating lobular, medullary, inflammatory

39
Q

Supraclavicular node positive?

A

Stage IV disease

40
Q

T staging

A 
T1 = < 2 cm
T2 = 2-5 cm
T3 = > 5 cm
T4 = any size w/ direct extension to chest wall or skin
41
Q

N staging

A 
0 = no palpable nodes
1 = mets to movable nodes
2 = fixed, matted nodes
42
Q

M staging

A 
0 = no distant mets
1 = Distant mets including supraclavicular
43
Q

Clinical Stage I … Dx

A

T1 N0 M0 –> SLNBx (Te99 injection), Lumpectomy

44
Q

Clincal Stage II

A

T2 N1 M0

45
Q

Clinical Stage III

A

T3 N1/2 M0

46
Q

Clinical Stage IV

A

Any T Any N M1

47
Q

Level I nodes

A

Lateral (axillary), Posterior (subscapular), Anterior (external mammary)

48
Q

TRAM flap?

A

Trans Rectus Abdominus Muscle … not successful in smokers or obese pts

49
Q

Stage III and IV tx

A

Staging –> Neoadjuvant (pre-surgery) chemo beneficial in Stage III

Stage IV surgery only for local control

50
Q

Inflammatory breast cancer tx

A

Neoadjuvant chemo, modified radical mastectomy, adjuvant chemo, hormonal therapy, radiation

51
Q

Development of coma input w/ hx of breast cancer

A

Hypercalcemia due to bony met and PTHrP should be highly considered

52
Q

Breast cancer in pregnancy tx

A

Stage I/II mastectomy/lumpectomy is safe w/ radiation after delivery of child if lumpectomy. Mastectomy would not require radiation

Stage III/IV needs rapid chemoradiation which may require abortion

53
Q

Breast mass in a man

A

Bilateral mammogram, mastectomy w/ post-op radiation. Typically > 60 yrs old and survival about the same, though tend to present at later stage

54
Q

Gynecomastia

A

Adolescents and 40-50 and resolves spontaneously in adolescents. Older men usually due to medications (diuretics, estrogens, isoniazid, marijuana, digoxin, alcohol

55
Q

Invasive lobular carcinoma tx

A

Total mastectomy + SLNBx

56
Q

Invasive ductal

A

Adjuvant therapy if > 1 cm, hormonal therapy

Surgery (7 decks)

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