Breast Disorders Flashcards
What are the factors that increase the risk of breast cancer the most?
age, family history of premenopausal, personal history
What is BIRADS 0? Which BIRADS values require follow-up or biopsy?
needs additional evaluation
(1 is normal, 2 is benign, up to 5 highly suggestive of malignancy)
BIRADS 3 requires follow-up (and biopsy if patient desires pregnancy, is a candidate for transplant, or has other suspicious lesions) BIRADS 4-5 (suspicious) requires biopsy
Which form of DCIS has the highest malignant potential?
comedo
T/F: LCIS has almost NO risk of axillary metastasis.
True
Sclerosing adenosis may look similar to ___________ histopathologically.
invasive tubular carcinoma
What imaging is used in pregnant patients that develop a suspicious nodule?
ultrasound
Sclerosing adenosis, apocrine change, cysts, fibrosis, and hyperplasia are all examples of
fibrocystic disease of the breast
What dietary measures may be recommended in fibrocystic breast disease?
elimination of caffeine from the diet and supplemental vitamin E
Cystosarcoma phyllodes is AKA
giant cell fibroadenoma
Firm, rubbery, nontender, freely movable lesion that is 14cm in diameter:
cystosarcoma phyllodes. May or may not have ulceration of overlying skin. Treatment is wide excision with generous margins
Breast tumors with a high Ki67 have a (better/worse) prognosis.
Worse! Correlates with S-phase fraction = higher proliferative component.
What does Paget’s disease of the breast look like?
chronic eczematoid lesion of the nipple
What is the arterial supply and venous drainage of the breast?
Arterial supply: internal mammary and lateral thoracic
Venous drainage: axillary and internal mammary veins
What is the gold standard for treating diffuse and multicentric DCIS?
simple mastectomy
Describe the level of lymph nodes and their relation to the pec minor muscle.
Which are sampled as a staging procedure?
level 1: lateral
level 2: posterior
level 3: medial
Levels 1 (with/w/o Level 2) are sampled as a staging procedure
Lumpectomy with axillary node sampling and post op radiation can only be performed if the tumor is less than __ cm in diameter.
<5
Which patients should not have radiation therapy to the breasts and thus should have mastectomies (vs lumpectomies with rad)?
connective tissue disease, prior radiation to the chest or breasts
(tumors that are multicentric or with poor margins are not good lumpectomy candidates either)
TRAM flaps are not as successful in which kinds of patients?
obese, smokers
What are contraindications for reconstruction of breasts following tumor removal?
primary lesions involving the chest wall, extensive local or regional disease, or stage III or IV cancer
What is Stage I breast cancer?
T1NoMo (tumor 2 cm or less in greatest dimension)
What is Stage II breast cancer?
Stage 2a
1) T1N1Mo (tumor 2 but 5 cm)
What is Stage III breast cancer?
Stage 3a
1) T1n2mo (fixed, matted axillary nodes)
2) t2n2mo
3) t3n1mo
4) t3n2mo
Stage 3b
1) T4anyNmo (tumor of any size with direct extension to chest wall (not pec major) or skin
What is stage 4 breast cancer?
anyTanyNm1 (distant mets INCLUDING supraclavicular nodes!!!)
Patients who have had lumpectomy with radiation should undergo mammography of the affected breast how frequently?
every 6 months for 2 years, followed by yearly mammograms
After mastectomy, women have a ___% chance of cancer developing in the remaining breast.
15
An inflammatory lesion means that the breast cancer is stage
III
T/F: In stage IV breast cancer, palliation with radiation and chemo is given, and no surgical procedure is performed unless the primary tumor is painful or infected.
True
In stage III breast cancer, patients receive chemo (before/after) modified radical mastectomy.
both!!! (along with radiation post-op)
What is the treatment of inflammatory breast cancer? What does histopath show?
histopath shows cancer cells invading dermal lymphatics and vessels with a large inflammatory component. Treatmet is 4-6 cycles of chemotherapy; then modified radical mastectomy, adjuvant chemo, and radiation to chest and regional LN basins
A small 0.5 cm nodule in the suture line 5 years after modified radical mastectomy:
local recurrence until proven otherwise
T/F: Local irradiation to a pathologic fracture inhibits fracture union.
FALSE. But it does control the cancer and prevent recurrence.
The development of coma in any patient with a history of breast cancer should lead to the suspicion of
hypercalcemia (parathyroid hormone related peptide can be secreted by breast cancers; also must consider bony mets)
T/F: Estrogen and progesterone receptor status of breast cancer is usually unreliable in preganncy.
True
Lumpectomy can be performed in pregnant patients with breast cancer as long as they are in at least the ___ trimester.
3rd! Need post-op radiation…can be delayed until after delivery if in 3rd trimester, but otherwise should have mastectomy
Gynecomastia is treated how in adolescents?
observation; typically spontaneously regresses
T/F: A 6yo girl with a firm 1 cm unilateral breast mass should be biopsied.
observation! Excision or biopsy are contraindicated in such a patient because it would diminish or stop development of the breast by removing the breast tissue.
Gynecomastia in a 50yo man is commonly associated with medications, including _______________-. Excision is only indicated if the enlargement fails to regress with cessation of meds.
diuretics (spironolactone), estrogens, isoniazid, marijuana, digoxin, alcohol abuse
What are the borders of the axillary lymph nodes?
Axillary vein (apex), lat dorsi (lateral), pec major (medial), fifth to seventh ribs (inferior)
What is Mondor disease and how is it treated?
Superficial thrombophlebitis, affecting the thoracoepigastric vein. Treated with NSAIDs and warm compresses.
Mutation of BRCA-1 confers what risk of developing breast cancer?
60-80%
What are the microscopic findings on biopsy of Paget’s disease of the nipple?
vacuolated cells
What are common sites for metastasis of breast cancer?
Brain, bone, lungs, liver, and adrenal glands
T/F: In comparing breast conversation surgery and mastectomy, there is no difference in possible recurrence rates, but mastectomy does confer better survival.
False!
Same survival, but mastectomy confers less chance of recurrence
What drugs can be used for chemotherapy for breast cancer?
cyclophosphamide, methotrexate, fluorouracil, adriamycin
What feature of gynecomastia makes it seem more likely benign than malignant?
breast tenderness
What is the best treatment for breast cancer recurrence involving the chest wall following mastectomy?
radiation therapy (not surgery)
What is a treatment that can be used for syphilis if a patient is allergic to penicillin?
doxycycline
Lymph from the lower 25% of the vagina (below the hymen) is drained by which lymph nodes?
How about the upper 3/4 of the vagina?
superficial inguinal (then deep, then external)
upper 3/4: internal iliac
