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Foundations III-Women's Health > Breast Disorders > Flashcards

Breast Disorders Flashcards

1
Q

What are the 3 components of the breast?

A

Skin
Subcutaneous tissue
Breast tissue (epithelial elements and stromal elements)

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2
Q

Ideally, when should you perform a breast exam? What are the 2 components of the breast exam?

A

7-9 days after onset of menses

inspection & palpitation

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3
Q

What are some abnormalities that may be seen on breast inspection?

A 
Asymmetry
Skin changes
Nipple asymmetry
Nipple inversion or retraction
Nipple discharge or crusting
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4
Q

When should you order a mammogram?

A

for screening

dx- initial study for new, palpable breast mass

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5
Q

What is evaluated in BI-RADS for mammogram?

A 
Shape
Margin
Orientation
Echogenicity
Homogeneity
Attenuation
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6
Q

BI-RADS scoring?

A

0: incomplete
1: negative
2: benign
3: probably benign
4: suspicious A-C
5: highly suggestive or malignancy
6: known biopsy proven malignancy

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7
Q

FU for pts with BI-RADS 1 or 2?

A

routine FU annual screening if 40 or older

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8
Q

FU for pts with BI-RADS score or 3?

A

probably benign

FU in 6 months for repeat mammogram

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9
Q

FU for pts with BI-RADS score of 4/5

A

biopsy to determine further work up

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10
Q

What is the initial study for young, low risk women with suspected fibroadenoma? Wha can be used for screening in high risk women?

A

US

MRI

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11
Q

What is a targeted US?

A

Palpable mass evaluation

Concurrent with diagnostic mammogram

Solid vs. cystic vs. mixed

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12
Q

What other diagnostic studies may be used to evaluated breast tissue?

A

breast tomosyntesis: 3D xray

Molecular breast imaging

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13
Q

What kind of breast biopsies can you perform?

A

skin punch biopsy

FNA > simple cysts

core needle biopsy > complex masses

surgical biopsy

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14
Q

Which pts are fibroadenomas usually seen in?

A

Young women

More frequent in black women

Usually a solitary mass

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15
Q

Presentation for fibroadenoma?

A

Round or ovoid, 1-5 cm

Rubbery

Discrete

Movable

Non-tender

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16
Q

How can you dx a fibroadenoma?

A

core needle biopsy

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17
Q

Tx for fibroadenoma?

A

Excision

Conservative treatment with monitoring

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18
Q

What is a phyllodes tumor?

A

Large fibroadenoma that grows rapidly

can be benign, borderline or malignant

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19
Q

Tx for phyllodes tumor

A

excision required

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20
Q

What is the MC breast lesion?

A

fibrocystic changes

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21
Q

Fibrocystic changes are most commonly seen in women…. y/o

A

30-50

increased risk with alcohol use

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22
Q

Fibrocystic changes are…dependent

A

estrogen

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23
Q

Clinical presentation for fibrocystic changes?

A

Painful, Multiple, usually bilateral

Rapid changes in size and appearance

Nodular breast tissue
Mobile
Tender

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24
Q

How can you dx fibrocystic changes?

A

mammogram and/or US

FNA

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25
Q

Tx for fibrocystic changes

A

breast support

+/- evening primrose oil, low fat diet, avoid caffeine, Vit E

will subside with menopause

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26
Q

Risk factors for breast CA?

A

BRCA1/BRCA2 genes

Personal and/or family history ovarian, peritoneal or breast cancer

Radiotherapy to chest b/t age 10-30

Others: age, white race, postmenopausal obesity, tall stature, high estrogen levels, nulliparity, higher bone density, alcohol, smoking, DES exposure

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27
Q

Protective factors for breast CA?

A 
Breastfeeding
Higher parity
Physical activity
Oophorectomy ≤ 35 y/o
Aspirin use
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28
Q

What screening tool can you use to determine risk of breast CA for average risk women?

A

Gail model

if higher than 1.67 considered higher risk

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29
Q

USPSTF guidelines for mammogram in average risk women?

A

Age 40-49, individualize (grade C)

Every 2 years, age 50-74 (grade B)

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30
Q

ACOG guidelines for mammogram in average risk women?

A

Age 40-49, shared decision making

Recommend at age 50-74
Every 1-2 years

≥ age 75, shared decision making

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31
Q

screening guidelines for higher risk pts?

A

annual mammogram starting at 25 (or 5-10 yrs before dx of relative)

supplemental breast MRI -6 months apart

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32
Q

Genetic testing in breast CA?

A

refer to genetic counselor if possible

BRCA mutation carriers
(Blood, saliva, buccal mucosa samples)

BRCA1: 65% risk of breast cancer by age 70

BRCA2: 45% risk of breast cancer by age 70

other genes: ATM, CHEK2, PALB2

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33
Q

Who should undergo genetic testing for breast CA?

A

Any relative with BRCA 1 or 2 mutation

Breast CA before age 50

Bilateral breast cancer

Breast & ovarian CA in same woman or same family

Multiple breast CA in same family

2+ primary types of BRCA 1 or 2 related cancers in single family member

Male breast cancer

Ashkenazi Jewish ethnicity

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34
Q

What is ductal carcinoma in situ?

A

Neoplastic lesions confined to breast ducts and lobules

35
Q

What stage is DCIS?

A

always stage 0!

confined within ducts

36
Q

Px of DCIS?

A

excellent!

3% 20 yr mortality

37
Q

What is the MC type of breast CA?

A

infiltrating ductal carcinoma?

38
Q

Infiltrating ductal carcinoma arises from?

A

epithelial lining of the large or intermediate-sized ducts

39
Q

Infiltrating lobular carcinoma arises from?

A

epithelium of the terminal ducts of the lobules

40
Q

What are the molecular subtype of breast cancers?

A

Luminal A/B

HER2-enriched

Basal “triple negative)
-ER/PE/HER2 neg

41
Q

breast CA presentation

A

most due to abn. mammogram

breast/axillary mass

+/- skin changes
-erythema, thickening, dimpling

with metastasis
-back/leg pain, abn pain, nausea, jaundice, SOB

42
Q

Work up for breast CA?

A

Mammogram
-spiculated soft tissue mass**

US
-solid v. cystic, vascular supply

MRI

Bx

Liver enzymes

43
Q

What imaging should you order to eval for metastasis?

A

Bone scan / MRI
CT abdomen
Abdominal MRI or U/S or PET-CT
Chest CT / CXR

44
Q

Tx for Breast CA?

A

Surg:

  • Lumpectomy + radiation therapy (breast conservation)
  • Mastectomy
  • Modified radical mastectomy
  • breast reconstruction
45
Q

Medical therapy options for breast CA?

A

chemo + estrogen antagonists

  • Tamoxifen or Raloxifine for ER + cancers (take 5 yrs post surg)
  • Aromatase inhibitors
  • Trastuzumab: for HER-2 cancers
46
Q

Follow up after breast CA tx?

A

Every 3-6 months x 2 years, then annually

Annual mammogram and CBE indefinitely

Most recurrences are within 5 years

47
Q

Prophylactic options for BRCA 1 or 2 carriers without personal hx of CA?

A

BSO btwn 35-40 and done childbearing

intensive screening

chemoprevention with
Tamoxifen

48
Q

Which pts are most likely to get inflammatory breast CA (IBC) ?

A

black women

rare invasive breast CA, highly aggressive

49
Q

Presentation of IBC?

A

diffuse dermatologic erythema and edema (peau d’orange)

rapid presentation 
\+/- mass
Breast pain
Tender, firm, or enlarged breast
Itching of the breast
Lymph node involvement
1/3 have distant metastasis
50
Q

Pathology of IBC?

A

lymphedema caused by tumor emboli within the dermal lymphatics

51
Q

Dx of IBC?

A

**Full-thickness skin punch biopsy: Dermal lymphatic invasion by tumor cells

mammogram, lymph node US, core needle biopsy

52
Q

Tx for IBC?

A

chemo followed by mastectomy with axillary node dissection and post mastectomy radiation

poor px

53
Q

Peak incidence of Paget disease of the breast (PDB)?

A

50-60 y/o

54
Q

Presentation of PDB?

A

usually unilateral, occasional bloody DC, pain/burning and or pruritus

scaly, raw, vesicular or ulcerated lesion that begins on the nipple and spreads to the areola

55
Q

Pathology of PDB?

A

malignant, intraepithelial adenocarcinoma cells (Paget cells) occurring singly or in small groups within the epidermis of the nipple

56
Q

Dx of PDB?

A

Full thickness wedge or punch biopsy of the nipple

Bilateral mammogram

57
Q

tx of PDB?

A

Mastectomy or BCT followed by radiation

px with mass: 5 yr 20-60%
w/out mass: 5 yr 75-100%

58
Q

causes of nipple DC?

A

Usually benign

Early endocrine dysfunction – hyperprolactinemia, hypothyroidism

Meds – OCPs, tricyclics, antipsychotics

Cancer – 5-15%

59
Q

Nipple DC seen with fibrocystic changes of ductal ectasia?

A

Non-spontaneous

Non-bloody

Bilateral

Green, yellow, or brown; sticky

60
Q

Nipple DC seen with endocrine/meds?

A

Milky, bilateral, multiple ducts

61
Q

Nipple DC seen with infectious cause?

A

purulent

62
Q

What should make you worried about nipple DC?

A

Spontaneous

Bloody

Unilateral, uniductal

Associated with a mass

63
Q

Work up for nipple DC?

A

US, mammogram if >30

ductography

MRI, MR ductography

labs: HCG, PRL, renal tests, thyroid tests

64
Q

Tx for nipple DC?

A

If medication related, reassurance

Terminal ductal excision

If malignancy, appropriate cancer surgery

65
Q

Who is mastitis usually seen in?

A

primiparous nursing patient

66
Q

Organism seen in mastitis? Causes?

A

s. aureus

Can be hospital acquired infection

Disrupted flow of milk causing engorgement
Infection of the infant

67
Q

Can mastitis occur in pt who is not lactating?

A

YES

Periductal mastitis

Idiopathic granulomatous mastitis

68
Q

Presentation of mastitis?

A

Fever, Swelling, Painful, erythematous lobule in outer breast quadrant

+/- other systemic symptoms

+/- axillary lymphadenopathy

69
Q

Dx for mastitis?

A

clinical!

if refractory tx –> US

70
Q

Tx for mastitis?

A

Continue breastfeeding or use breast pump

Local heat

Breast support

Abx

Monitor for abscess

71
Q

What abx can you use for tx of mastitis?

A

Dicloxacillin 500 mg po QID

Cephalexin 500 mg po QID

Alternatively, clindamycin 300 mg po TID

72
Q

Describe a breast abscess. What causes this?

A

Localized collection of pus in the breast tissue

Secondary to untreated or refractory to treatment mastitis or cellulitis

73
Q

Risk factors for breast abscess?

A

age > 30 years
primiparity

gestational age ≥ 41 weeks

tobacco use

74
Q

Presentation of breast abscess?

A

Localized, painful inflammation
Fluctuant, tender, palpable mass
Fever, malaise

75
Q

Dx of breast abscess?

A

clinical findings & US

breast milk US

+/- blood cx

76
Q

Tx of breast abscess?

A

I&D

abx

77
Q

What is physiologic gynecomastia?

A

Benign proliferation of glandular breast tissue in males

Symmetrically distributed around areolar-nipple complex

can be tender, usually bilateral

78
Q

What can cause pathologic gynecosmatia?

A

drugs-exogenous estrogen

hypogonadism

tumors

79
Q

What drugs are assoc. with gynecomastia?

A 
Estrogens
Spironolactone
Cimetidine
Ketoconazole
Growth hormone
Gonadotropins
Antiandrogen therapies
5-alpha-reductase inhibitors

lots more!

80
Q

Presentation of gynecomastia?

A

Mass or lump behind nipple

Gradual enlargement

≤ 4 cm diameter

Tender for about 6 months then gradually resolves

81
Q

What should be included in PE for gynecomastia?

A

thyroid, abdomen, and genitalia at a minimum

82
Q

dx of gynecomastia

A

usually clinical

if pathologic: +/- HCG, testosertone, LH, DHEA, peds endo

83
Q

Tx fo physiologic gynceomastia?

A

regress spontaneously in >70%

+/- psychotherapy, surg

84
Q

Tx for pathologic gynecomastia?

A

depends on etiology

Foundations III-Women's Health (13 decks)

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