Breast Disorders Flashcards
1
Q
where do supernumerary nipples commonly found?
A
along the milk line
2
Q
How do you approach a male patient wih gynecomastic?
A
breast and axillary exam, check the testicles as well
3
Q
If a patient between the ages 13-early adulthood has gynecomastia, what treatment should they receive?
A
observation
4
Q
what can cause gynecomastia in males over 50?
A
drop in testosterone
5
Q
What are some meds that can cause gynecomastia?
A
digoxin, thiazides, estrogens, theophylline, atypical antipsychotics
6
Q
Medical conditions that can cause gynecomastia
A
hepatic cirrhosis, renal failure, malnutrition
7
Q
inflammation at the stie of two closely opposed skin surfaces often due to moisture and maceration
A
intertrigo
8
Q
treatments for intertrigo
A
hairdryer to the area, antifungal, corticosteroid (if needed)
9
Q
Most frequent, benign condition of the breast
A
fibrocystic breast disorder
10
Q
when may a fibrocystic breast mass be the most painful? Why?
A
during premenstrual phase, due to estrogen
11
Q
this type of mass is most commonly seen in 30-50 year olds and may fluctuate in size → often multiple and bilateral
A
fibrocystic breast disorder
12
Q
45 year old patient presents with tender mass that is only painful right before starting her menstrual cycle, she says sometimes she will have multiple masses but they fluctuate in size and may even disappear, she notes occasional serous discharge with the masses
A
fibrocystic breast disorder
13
Q
Treatment for Fibrocystic Breast Disorder
A
avoid trauma, wear supportive bra, use needle for aspiration to alleviate pain, stop HRT in postmenopausal, primrose oil for pain, decrease intake of dietary fat/caffeine/chocolate
14
Q
This drug may be used in patients with severe fibrocystic breast disorder but only rarely due to virilizing SE
A
Danazol
15
Q
condition where a female develops characteristics associated with male hormones (Androgens)
A
virilization
16
Q
most common benign neoplasm of the breast
A
fibroadenoma of the breast
17
Q
Patient population most commonly seen with fibroadenomas
A
young women withing 20 years of puberty, may be younger age in black women
18
Q
Patient in mid 20s presents with round, mobile, rubbery, non-tender breast lesion measuring less than 5 cm
A
fibroadenoma
19
Q
How can you differentiate fibroadenoma from a cyst?
A
US and aspiration
20
Q
Treatment for fibroadenoma
A
none necessary → reassurance
21
Q
if you have fibroadenoma larger than 3-4 cm it should be excised to rule out
A
Phyllodes tumor
22
Q
fibroadenoma like tumor with cellular stroma that grows rapidly → can be benign or malignant
A
Phyllodes tumor
23
Q
Treatment for malignant Phyllodes tumor
A
large excition with clear borders
24
Q
do you need to perform lymph node resection with a a malignant phyllodes tumor
A
no → lesion metastasizes to the lungs and not the lymph nodes
25
milk retention cyst caused by an obstructed milk duct
galactocele
26
New mother who just stopped breast feeding presents with soft, cystic, mobile mass
galactocele
27
what is the best method to diagnose galactocele?
clinical history and aspiration
28
Treatment for galactocele
let it be → won't need excision
29
How likely is a galactocele to become cancer?
no risk
30
organism that most likely causes mastitis
Staphylococcus aureus
31
risk factors for breast abscess/mastitis
breast conservation treatment, prior breast infection, breast surgery within 30 days, lactation, trauma (bite, piercing, tattoo), lesions (eczema, intertrigo), implants, smoking, poor hygeince, diabetes, autoimmune disorder
32
If you see infection in non-lactating breast or an abscess does not respond to antibiotic and drainage you must always consider
inflammatory carcinoma
33
In high risk patient, what would you order after they recover from mastitis?
mammogram
34
Treatment for mastitis
NSAID, cool compress, Dicloxacillin or Cephalexin PO, Clindamycin
35
If you are concerned your patient with mastitis has MRSA what would you prescribe them?
PO clindamycin, timethoprim-sulfamethazole or linezolid
| IV vancoymcin
36
what is Paget Disease?
cutaneous sign of underlying breast malignancy
37
60 year old patient presents with weeping, red, crusty skin condition of the breast, especially the nipple → states she has severe nipple itchiness
Paget Disease
38
How do you diagnose Paget Disease?
needle biopsy
39
Paget Disease occurs in ____ patients with breast cancer and ____ of patients with Paget Disease have cancer
1-4%
| 50%
40
Common misdiagnosis of Paget Disease
dermatitis or bacterial infection
41
what is considered normal nipple discharge?
clear, milky, green-tinged
42
Patient presents with bloody nipple discharge, what do you do?
think cancer → mammogram or surgical evaluation
43
If patient presents complaining of nipple discharge that stains the inside of her bra, what is your first thought?
galactorrhea → evaluate thyroid and pituitary gland
44
If there is no mass and the nipple discharge is not bloody, what is your treatment of choice?
reexamine every 3-4 months for 1 year → mammogram or US
45
You have a nonpregnant patient who is not breast feeding and has milky discharge
galactorrhea
46
If you have a patient with bilateral galactorrhea what do you think is the most likely cause?
hormone
47
causes of galactorrhea
breast stimulation, trauma, stoping oral contraceptive, oophorectomy, miscarriage, abortion, some meds, increased prolactin secretion
48
Lab values you want to order if patient presents with galactorrhea
serum prolactin, TSH, B-HCG, FSH (if also has amenorrhea), MRI of pituitary
49
benign solitary lesion that grows in the epithelial linging of the breast ducts
intraductal papilloma
50
Most common cause of bloody nipple discharge in the absence of a mass
intraductal papilloma
51
Patient presents with intermittent discharge from one nipple, the discharge is sometimes serous, watery, or bloody
intraductal papilloma
52
where do 75% of intraductal papillomas present? How do they feel and size?
beneath aerola
small and soft
< 3 cm
53
Most common age range for intraductal papilloma
30-50 yo
54
Treatment for intraductal papilloma
excisional biopsy of the duct and small amount of surrounding tissue
55
If an intraductal papilloma is not excised how often do you need to check the lesion? Why?
every 3-4 months
| twofold increase in developing subsequent cancer
56
this is seens most commonly in premenopausal women and believed to be caused by local response to stagnant secretions and calcifications may be common
mammary duct ectasia
57
Patient presents with nipple discharge (multicolored, sticky), non-cyclic breast pain, nipple retraction, or subaereolar mass
mammary duct ectasia
58
Diagnostic test of choice in patient with mammary duct ectasia
mammogram and US
59
Treatment for mammary duct ectasia
spontaneously resolves, excision if persistent/recurrent
60
what percentage of new breast cancers are not seen on mammogram?
10-15%
61
which diagnostic testing method is most reliable for detecting breat cancer before a mass can be palpated?
mammogram
62
What type of mammogram will you order for a young woman with dense breast tissue?
digital
63
indications for mammogram
screening at risk women at regular intervals, eveluate each breast after curable breast cancer diagnosis is made, eveluate suspicious breast mass, search occult breast cancer in women with metastic disease in the axillary nodes, screening before cosmetic procedures, monitor breast cancer treatment, guide for diagnostic procedures
64
Ordered for asymptomatic women in the hope of detecting a cancer not clinically apparent
screening mammogram
65
what is the American Cancer Societ recommendation for breast cancer screening?
annually from 45 - 55 → every other year after 55
66
what is ACOG recommendations for screening for breast cancer?
should begin by age 50 and screen every 1-2 years → stop screening by 75
67
how are mammogram results reported?
BI RADS (breast imaging reporting and date system)
68
two most important mammogram findings suspicious for breast malignancy
masses and microcalcifications
69
What is the recommended test for determining if a breast mass is solid or cystic?
US and aspiration
70
Is US a good screening method for breast cancer?
no → primary diagnostic tool
71
Patient felt a lesion herself on self breast exam, what test do you want to order first?
US
72
This breat exam has high sensitivity but low specificity → leading to more unnecessary biopsies
MRI
73
This test is recommened in women at high risk for breast cancer, axillary lymph nodes with no mammogram findings, or a patient with Paget Disease with no mammogram findings?
MRI
74
what percent of suspected cancer lesions will be benign and what percent of benign looking lesions will be malignant?
60%
| 30%
75
Diagnostic procedure of choice for a breast lesion
large needle core biopsy
76
If you are in outpatient setting and feel suspicious lump what test can you do without anesthesia?
fine needle biopsy
77
If the patient have mammogram or clinical indication of malignancy, does a negative fine needle biopsy indicate there is nothing to worry about?
no
78
Method of choice in testing breast lesions
core needle biopsy
79
Women who are considered high risk for developing breast cancer
BRCA 1 or BRCA 2 gene in self or first degree relative, lifetime risk 20-25%, radiation to chest between ages 10-30, Li-Fraumeni syndrome or Cowden syndrome or first defree relative with one of these
80
Rate of breast cancer in American women
1 in 8
81
what has lead to the decline of breast cancer in women?
discontinue HRT
82
most significant risk factor for breast cancer
age
83
what factors increase exposure to estrogen and thus increased risk of breast cancer?
first full term pregnancy after 30, early menarche, late menopause, combined HRT after meopause
84
Risk assessment model that evaluates womans risk of developing breast cancer and recommendations
Gail 2
85
protective factors for breast cancer
breast feeding, physical activity, early surgical or chemical menopause, early pregnancy, don't drink, healthy diet
86
two main breast cancer genes
BRCA 1 and BRCA 2
87
Women with BRCA1 or 2 gene have ___ percent of getting breast cancer
40-85% → 3-7x greater risk than normal women
88
Women with BRCA1 or 2 gene have ____ percent lifetime risk of ovarian cancer
16-60%
89
Men with the BRCA2 gene are at increased risk for what two types of cancer
breast and prostate
90
classic presentation of breast cancer
hard, immovable, single dominant lesion with irregular borders → often painless
91
Symptoms a patient will complain about with breast cancer
breast pain, nipple discharge, erosion, retraction, enlarged/itching nipple, redness, hardness, enlargement/shrinking of brest, axillary mass,
92
Late symptoms of breast cancer
back pain, weight loss, bone pain, jaundice
93
Most common site of breat cancer
outer wing
94
80% of all breast cancers are
nonspecific infiltrating duct carcinoma
95
What do you use to describe a breast mass?
size, shape, location, consistency, fixed or not
96
Describe a classical malignant breast mass
single, firm, nontender, immobile, irregular borders
97
Describe suspicious lymph nodes
> 1 cm, fixed, irregular, firm, mobile
98
What is Breast Conseving Therapy?
lumpectomy + radiation
99
What type of biopsy is done to evaluate axillary lymph nodes?
sentinel lymph node biopsy
100
what are complications of full axillary node dissection?
full arm edema, seroma formation, loss of sensation, shoulder dysfunction
101
Categories for staging breast cancer
TNM → Tumor, Lymph Node Status, Metastases
102
what would indicate poor prognosis for breast cancer?
larger tumor size, more lymph node involvement, metastases
103
If a high risk patient undergoes radical mastectomy or undergoes conservative breast therapy they should also receive?
radiation
104
What are some complications of radiation?
arm edema, arm weakenss, radiation pericarditis, soft tissue necrosis
105
three ways a breast cancer tumor can spread
local infiltration, lymphatic, hematogenous
106
If a tumor infiltrates locally, where will it most likely go?
breast parenchyma → deep pectoral fascia or overlying skin
107
where is breast cancer most ilkely to spread lymphatically?
axillary lymph nodes
108
axillary node involvement is directly related to ____ but not the ____ of the tumor within the breast
size of primary tumor, location
109
Second place for lymph node metastases
internal mammary node chain
110
where is breat cancer most likely to hematogenously spread to?
lungs and liver → others are bone, pleura, adrenals, ovaries, brain
111
Factors to consider that may affect chemotherapy choices
tumor burden, general health, prior treatment and toxicities
112
Side effects of chemotherapy
nausea/vomiting, infertility/premature ovarian failure
| small risk → neutropenia, cardiomyopathy, peripheral neuropathy, leukemia
113
Standard care for patients with stage I, II, III breast cancer
surgical resection → radiation or systemic therapy
114
When doing breast augmentation, where is the preferered placement of the implant?
under the pectoralis muscle
115
capsule contraction or scarring around the breast implants occurs in what percent of patients?
15-25%
116
what percent of implants rupture in patients?
5-10%
117
If a patient is getting breast reconstruction after a mastectomy how long should they wait after the surgery to get the implants?
at least 3 month if not done at time of mastectomy
118
Can a prepubescent girl get breast augmentation - implants or reduction?
no
119
What are the 4 extra views taken by mammogram on a patient with breast implants called?
implant displacement views
120
scar tissue that has formed around implants is called ____ and cause you to not be able to perform implant displacement views on mammogram
contractures
121
Do women who get breast implants have greater risk of cancer?
no but detecting it may be harder
122
What is the diagnostic test of choice if you suspect your patient has a ruptured bresat implant?
MRI
123
Difference in saline vs silicone implant ruptures
saline implants will leaky more quickly while silicone implants will leak very slowly (years) → dangerous
