breast disorders Flashcards
where it the primary lymphatic area that breast cancer spreads to
axillary lymph nodes
also
internal mammary nodes
supraclavicular nodes (late)
fibrocystic changes cause ___lateral, ____, ____ breast pain
fibrocystic changes cause BIlateral, diffuse, cyclic breast pain
(during the luteal phase)
what are some pathologic causes of nipple discharge
intraductal papilloma
ductal ectasia (usually has pain)
carcinoma
infection
benign breast masses have ___ margines
whereas
malignant breast masses have ___ margins
benign breast masses have well-defined margines
whereas
malignant breast masses have poorly-defined margins
brachytherapy radiation
days
(less time than external beam radiation)
which noninvasive breast carcinoma does NOT become invasive if left untreated
lobular carcinoma in situ (LCIS)
benign/malignant:
hard, immobile, fixed
malignant
what do you need to do before you do an MRI
check baseline BUN and creatinine
cluster pleomorphic calcifications on mammogram
ductal carcinoma in situ (DCIS)
almost all of PTs w/ this type of breast CA have lymph node involvement
1/3 have distant mets
Inflammatory Breast Cancer (IBC)
what dye is used for MRI
IV gadolinium
very rare but aggressive breast CA
inflammatory breast cancer
what is the treatment for ductal carcinoma in situ (DCIS)
Breast Conserving Surgery (BCT) with radatian
or
mastectomy
+/- sentinel lymph node biopsy
+/- tamoxifen/arimidex (if estrogen/progesterone positive)
what are the views for a diagnostic mammogram
2 craniocaudal (CC)
+
2 mediolateral oblique (MLO)
+ more views
which diagnostic test is used to obtain samples from a larger, solid breast mass
Core-Needle Biopsy
why would you do an MRI
detect brast CA in high risk women
to stage breast cancer
benign/ malignant:
smooth, soft to firm, mobile breast masses
benign
which noninvasive breast carcinoma is treated as a malignancy b/c of it’s potential to develop into an invasive CA
ductal carcinoma in situ (DCIS)
when during the menstrual cycle is the best time to perform a breast exam
follicular
what drugs are used for chemoprevention
tamoxifen
arimidex
raloxifene
what are the views for a screening mammogram
2 craniocaudal (CC)
+
2 mediolateral oblique (MLO)
rapidly progressing pain
tender, firm, enlarged breast
warm, thickened skin
peau d’orange
erythema
inflammatory breast CA
why would you do a Fine Needle Aspiration
initial method for evaluating a mass with a LOW pretest probability of CA
to determine if a palpable lump is a simple cyst
benign/malignant:
skin changes
malignant
1st: breast pain/ burning/ puritis
then
scaly/ raw/ vesicular/ ulcerated lesion that begins on the nipple and spreads out to the areola
+/- bloody discharge
usually unilateral
paget disease of the breast
(PBD)
medications can cause ___lateral, ____, ___ breast pain
medications can cause UNIlateral, focal, NON-cyclic breast pain
which diagnostic test is the initial method for evaluating a mass with a low pretest probability of CA
Fine Needle Aspiration
chemoprevention (tamoxifen, arimidex, raloxifene) is recommended for which asymptomatic women
over 35 w/out prior hx of breast CA
BUT
are at increased risk
with hematogenous spread, where does breast cancer spread to most frequenty
lungs and liver
also
bone, ovaries, brain
radical mastectomy
entire breast, lymph nodes, pectoralis muscle
(rarely performed)
what are GI meds that cause nipple discharge
cimetidine
metoclopramide (reglan)
what are some physiologic causes of nipple discharge
meds
neurogenic stimulation
galacotorrhea from prolactinoma
what is the most appropriate treatment for stage 1 or 2 breast carcinoma
Breast Conserving Surgery (lumpectomy) with post operative radiation
which diagnostic test is NOT recommended for the eval of a breast mass
MRI
what treatment is used in
primary breast CA
metastatic breast CA
and
all patient with (+) lymph nodes
what are psych meds that cause nipple discharge
anti-psychotics
MAOIs
neuroleptics
SSRIs
TCAs
what is herceptin
drug that targets the HER2/neu protein (which is a growth promoting protein found in 20% of breast CA)
effective in early stage CA and metastic dz
used in combo w/ chemo
what areas of the body are radiated when treating breast CA
breast
chest wall
regional lymph nodes
axilla
what are opiods that cause nipple discharge
codeine
heroin
methadone
morphine
what is treatment for lobular carcinoma in situ (LCIS)
lifelong surveillance
+/- taxmoxifen/arimidex (chemoprevention)
+/- bilateral prophylactic mastectomy
neoadjuvant chemo
given before surgery to shrink size of tumor
may allow for breast conservation surgery
simple mastectomy
entire breast + nipple + areola removed
what are anti-HTN meds that cause nipple discharge
methyldopa
reserpine
verapamil
why would you do an US
inconclusive MMG results
young women
dense breast tissue
for better differentation b/w solid and cystic mass
to guide tissue core-needle biopsy
who should you consider doing genetic screening for BRCA genes?
male breast CA
Jewish ancestry + HBOC CA
triple negative breast CA diagnosed before 60
patient/ 1st-3rd degree relative CA before 50
patient/ 1st-3rd degree relative w/ invasive ovarian/ fallopian tube/ primary peritoneal CA
2+ 1st-3rd degree relatives w/ breast/prostate/pancreatic CA
adjuvant chemo
given after surgery
kills the cancer cells left behind
external beam radiation takes
5-7 weeks
what are hormone meds that cause nipple discharge
estrogen
oral contraceptives
what is a total mastectomy also called
simple mastectomy
modified radical mastectomy
entire breast + nipple + areola removed
+
axillary lymph nodes
what is the most common breast malignancy
infiltrating ductal carcinoma
the strongest risk factors for breast CA are
(2)
female gender
age
which BRCA gene has a greater risk for breast CA in men
BRCA 2
which BRCA gene has a greater risk for breast CA in women
BRCA 1
which BRCA gene has a greater risk for ovarian CA
BRCA 1
