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Women's Health Exam 1 > Breast Disorders > Flashcards

Breast Disorders Flashcards

1
Q

Diagnostic testing for breast

A

Mammography (MMG)
US
MRI
FNA vs. Core-needle biopsy

Others: 
 Stereotactic core needle biopsy
 Vacuum-assisted core biopsy
 MRI guided biopsy
 Surgical biopsy
 Incisional biopsy vs. excisional biopsy
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2
Q

Screening MMG views

A 
two craniocaudal (CC)
two mediolateral oblique (MLO)
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3
Q

Diagnostic MMG views

A

CC
MLO
+ more views (spot compression, cleavage view)

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4
Q

MMG w/ implants

A

notify mammographer

implant pushed back to allow for visualization of breast tissue

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5
Q

Breast density

A

fat vs. breast tissue (more dense)

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6
Q

US use

A 
 inconclusive MMG results
 breasts of young women
 dense breast tissue
 better differentiation between a solid and cystic mass
 guiding tissue core-needle biopsies
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7
Q

MRI use

A

 Detecting breast cancer in high-risk women
 Staging disease in women with breast cancer

Not recommended to evaluate breast mass

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8
Q

Dye used in MRI of breast

A

IV gadolinium (check BUN/Cr)

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9
Q

Test for mass w/ low pretest probability of CA

A

FNA

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10
Q

FNA

A

determines if palpable lump is a simple cyst

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11
Q

Core-needle bx

A

obtain samples from larger, solid breast masses

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12
Q

BI-RAD scores

A

want to see 1-2

0 - need more imaging

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13
Q

Determines solid vs. cystic mass

A

US

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14
Q

Breast diseases

A

MASTALGIA MASTITIS/BREAST ABSCESS BREAST CYST FIBROADENOMA

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15
Q

Mastalgia sx

A

“breast pain”

Cyclic pain: luteal phase, bilateral, diffuse (fibrocystic changes)

Noncyclic pain: unilateral/focal, may be due to meds (hormonal contraceptives, HRT, SSRI’s, spironolactone); large, pendulous breast may cause ligamentous pain

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16
Q

Drugs leading to noncyclic mastalgia

A

Hormonal contraceptives
HRT
SSRI
SPironolactone

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17
Q

Most common in lactating women

A

mastitis

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18
Q

Presentation of mastitis

A

hard, red, tender, swollen area of one breast + fever

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19
Q

Most common cause of mastitis

A

Staph aureus

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20
Q

Ddx of mastitits

A

galactocele
abscess
INFLAMMATORY BREAST CANCER

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21
Q

Tx for mastitis

A

Dicloxicillin or
Cephalexin

Pt edu: continue breastfeeding!

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22
Q

Tx of breast abscess

A

I&D

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23
Q

No mass palpated, focal pain, <30

A

US

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24
Q

no mass palpated, focal pain, >30 YO

A

US and MMG!

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25
Q

Benign breast mass character

A 
 Discrete margins 
 No skin changes 
 Smooth
 Soft to firm
 Mobile
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26
Q

Malignant breast mass character

A 
 Poorly defined margins 
 May have skin changes 
 Hard
 Immobile
 Fixed
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27
Q

Peak incidence of breast cyst

A

35-50 YO; influenced by hormonal fluctuation

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28
Q

Features of breast cyst

A

 Smooth, mobile mass, +/- tender
 May be firm due to being tense with fluid
 Often well defined on palpation
- Cluster of cysts may palpate as an ill-defined mass
 May not be palpable

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29
Q

Tx for breast cyst

A

simple cyst: no intervention (FNA if symptomatic, if recurs: repeat imagin)

Complicated cyst (<1% . malignancy): FNA or f/u imaging q 6 mo x 2 yrs

Complex cyst (1-23% risk of malignancy): bx, possible surgical excision

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30
Q

Fibroadenoma: what is it?

A

benign, SOLID tumors containing glandular and fibrous tissu

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31
Q

Peak age for fibroadenoma

A

15-35 YO

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32
Q

Features of fibroadenoma

A

well defined, mobile mass
firm and nontender
can increase in size during pregnancy and w/ estrogen use

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33
Q

Tx of fibroadenoma

A

Core needle bx (confirm dx)

OR if benign features on US, 3-6 mo repeat CBE and US

+/- surgical excision or cryoablation

If increases in size: excision mandated to r/o malignant change (rapid growth, consider phyllodes tumor)

34
Q

Rapid growth of fibroadenoma

A

Phyllodes tumor (grows VERY fast)

35
Q

Signs of pathological d/c

A

spontaneous, unilateral, single duct

Blood, serous, clear or associated w/ mass

36
Q

Possible causes of patho d/c

A

intraductal papilloma!!!
duct ectasia (usually + pain)
carcinoma
infection

37
Q

Physiologic d’c

A

bilateral, multiple ducts, w/ stimulation

38
Q

Possible causes of physiological d/c

A

meds
neurogenic stimulation
galactorrhea (prolactinoma)

39
Q

Most common cause of patho d/c

A

intraductal papilloma (55%): benign but can harbor carcinoma

40
Q

Duct ectasia: what is it?

A

enlargement of duct

41
Q

Breast CA in #1 cause of CA death in

A

Hispanics (2nd most in everyone else)

42
Q

% of women w/ breast CA over lifetime

A

1 in 8 (12%)

43
Q

Strongest risk factors for breast CA

A

Female gender

Age (65+)

44
Q

Genetics behind breast CA

A

BRCA 1 and BRCA2 (tumor suppressor genes – mutations in these genes linked to breast and ovarian CA)

45
Q

BRCA (+)

A

increased surveillance
chemoprevention (tamoxifen in females >35 YO)
surgical prevention

Negative BRCA does not r/o breast CA

46
Q

Gene w/ larger risk of breast and ovarian cancer

A

BRCA1

47
Q

Greater risk of male breast cancer

A

BRCA2 (7-8%)

48
Q

Screening for breast CA

A

“breast awareness” (formerly SBEs – alot of false +)
Clinical breast exams (CBE)
- best time = follicular phase of menstrual cycle
Screening MMG

49
Q

Recommendations for MMG

A

consider 40-49 YO
Screen everyone 50+ YO
Stop screening @ 75YO
Frequency: q 1-2 Years

50
Q

Presentation of breast CA

A

 Nonpalpable suspicious lesion on mammogram
 Palpable mass (most common)
 Skin Changes (dimpling, nipple retraction or inversion, erythema, edema, peau d ’orange)
 Nipple Discharge
 Metastatic spread (i.e. to lungs, bone, brain, liver and lymph nodes

51
Q

Most common sx of breast CA

A

palpable mass

52
Q

Noninvasive (in situ) carcinoma

A

Lesions with malignant cells that have not penetrated the basement membrane of the mammary ducts or lobules

53
Q

Types of noninvasive in situ

A

Locular (LCIS)

Ductal (DCIS)

54
Q

DCIS

A

Treated as a malignancy because DCIS has potential to develop into invasive cancer

55
Q

PE of DCIS

A

MMG: clustered pleomorphic calcifications
PE: WNL (occasional palpable mass, most non-palpable)
Multifocal or multi-centric

56
Q

does NOT become invasive CA

A

LCIS (incidental finding)

57
Q

increased risk of invasive carcinoma in opposite breast

A

LCIS

58
Q

DCIS tx

A

 Breast-conserving surgery (BCT) with radiation vs. mastectomy
 +/- sentinel lymph node biopsy
 Adjuvant (hormone) therapy if estrogen (ER) and progesterone (PR) positive
- Tamoxifen, Arimidex

59
Q

LCIS Tx

A 
 Not a true cancer; no tx rec’d in most women
 Lifelong close surveillance 
 Chemoprevention
- Tamoxifen, Arimidex
 Bilateral prophylactic mastectomy
60
Q

Most common invasive breast carcinoma

A

infiltrating DUCTAL carcinoma (80%)

61
Q

Presentation of ductal carcinoma

A

palpable mass

MMG abnormality

62
Q

More likely bilateral invasive breast carcinoma

A

infiltrating lobular carcinoma

63
Q

Hormone positive invasive CA

A

lobular

64
Q

Features of Paget Disease of the Breast (PDB)

A

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

  • +/- bloody discharge
  • Usually unilateral
  • Pain, burning, &/or pruritis may present before clinically apparent disease
65
Q

Inflammatory Breast Cancer (IBC) sx

A

VERY AGGRESSIVE
Pain, tender, firm, enlarged
skin is warm, thick, peau d’orange, erythema

almost all w/ lymph node invovement; 1/3 distant metastasis

66
Q

Spread of Breast CA

A

lymphatic spread: axillary, supraclavicular, internal mammary nodes

Hematogenous: lung, liver first; bone, ovaries, brain

67
Q

Most common lymph spread of breast CA

A

axillary lymph nodes

68
Q

Tx of breast CA

A

surgery (breast conserving surgery (BCS): lumpectomy); or mastectomy)
Radiation
Chemo
Endocrine therapy

69
Q

Surgical management of breast CA

A 
Based on multiple components: 
 Tumor size
 Lymph node involvement
 Metastases
 Estrogen (ER+/-) and progesterone (PR+/-) status  HER2 status
 Oncotype recurrence score
 Oncotype dx test is used in ER + and LN - patients 
 BRCA status
70
Q

Lumpectomy

A

 Part of the breast containing the cancer is removed
 With or without selective sampling of axillary nodes (axillary sentinel lymph node biopsy)
 Multiple clinical trials have shown that BCS with post- operative radiation therapy is the appropriate treatment for Stage I or II breast carcinoma
 Decreased morbidity
 Comparable survival & recurrence rates to more invasive procedures

71
Q

Masectomy types

A

simple (total): entire breast including nipple/areola

Modified radical: above + axillary lymph nodes

Radical: breast, lymph nodes, pectoralix mm. (rarely performed)

72
Q

Radiation types

A 
external beam (5-7 weeks)
brachytherapy = seeds or wires placed in or near the tumor for shorter time frame
73
Q

Palliative for metastatic disease

A

Radiation

74
Q

When is chemo used?

A

primary and metastatic breast CA and in almost all patient w/ (+) lymph nodes!

75
Q

When to give chemo?

A

before or after surgery:
Neoadjuvant: before surgery to shrink size of tumor; may allow for conservation surgery
Adjuvant: after surgery, kills CA cells left behind

76
Q

HT for breast CA

A

SERM: Tamoxifen x 5 years
Aromotase inhibitors: arimidex
Supplement to chemo + radiation

77
Q

HER2/neu

A

human epidermal growth factor receptor 2

  • growth promoting protein
  • 1 in 5 w/ breast cancer
  • CA cells have increased HER2/neu
  • Herceptin targets HER2/neu
  • effective in early stage CA, metastatic disease
  • herceptin + chemo
78
Q

used in early stage, metastatic disease

A

Herceptin (HER2)

79
Q

Who should get breast cancer prevention

A

asymptomatic 35+ w/ prior dx of breast CA who are at increased risk for disease

80
Q

Who should get breast cancer prevention

A

asymptomatic 35+ w/ prior dx of breast CA who are at increased risk for disease

81
Q

Prevention meds

A

Tamoxifen

Arimidex, Raloxifene

Women's Health Exam 1 (5 decks)

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