Breast Disorders Flashcards
Diagnostic or screening mammography?
- two craniocaudal views
- two mediolateral oblique views
screening
what differentiates screening mammography from diagnostic mammography?
additional views
implants are radiolucent or radiopaque?
radiopaque
2 reasons for timely evaluation with mammography
r/o CA
relieve anxiety
which imaging modality?
inconclusive MMG results breasts of young women dense breast tissue
US
what imaging modality can differentiate between a solid and cystic mass?
US
what type of contrast is used for breast MRI? What labs should be checked?
gladolinium, BUN/Cr
What type of bx?
determine if lump is simple cyst or not
FNA
what type of bx?
used to obtain samples from larger, solid breast mass
core needle bx
Which mastalgia type?
pain fluctuates w. menstrual cycle
Fibrocystic changes
cyclical
Which mastalgia type?
pain felt in breast, but originates elsewhere
extra-mammary
Mastalgia tx in addition to reassurance…
physical support
acetaminophen/NSAIDs
Mastitis is MC in what population?
lactating women
Patient presents with:
hard, red, tender swollen area of one breast
Fever
mastitis
Mastitis is MC caused by what pathogen…
staph aureus
Mastitis is dx via…
clinical presentation
2 drugs to tx mastitis
dicloxicillin
cephalexin
Can patients continue breast feeding with mastitis?
yes
an area of fluctuance on the breast with erythema and tenderness is suggestive of…
breast abscess
breast abscess is treated via…
I&D
Patient presents with:
-smooth, mobile mass
+/- tenderness
well defined on palation
breast cyst
breast cyst is common between what ages?
35 and 50
simple breast cysts often need no intervention. But, if sxs present, what should be done?
FNA
Complex cysts render increasted risk of malignancy. What should be done?
Bx +/- excision
Patient presents with…
- well-defined, mobile mass
- firm, nontender
- increased size w. estrogen and pregnancy
fibroadenoma
this is a benign, solid tumor that contains glandular and fibrous tissue.
common in ages 15-35
fibroadenoma
what is first line mgmt for fibroadenoma?
core needle bx
if fibroadenoma increases in size, what is indicated?
excision to r/o malignant change
this is a fibroepithelial tumor that can be classified as benign, borderline, or malignant
phyllodes tumor
spontaneous, unilateral single duct nipple d/c is considered _____ discharge
pathologic
What is a common cause of pathologic nipple d/c?
intraductal papilloma
bilateral, multiple duct d/c associated with stimulation…
physiologic d/c
what is a common cause of physiologic d/c?
galactorrhea (via prolactinoma)
Psychotropic agents can cause…
nipple d/c
2nd leading cause of CA death among women…
breast CA
2 biggest RFs for breast CA
gender, advancing age
women with _______ can have up to a 72% risk of developing breast CA in their lifetime…
BRCA 1 or BRCA 2
men with _____ mutation have higher risk of breast Ca
BRCA 2
Best time to perform breast exam is during the ____ phase of the menstrual cycle
follicular
which organization recommends against CBE?
ACS
which organization recommends CBE every 1-3 years, or annually if ? 40?
national comprehensive cancer network
which organization suggests clinicians offer CBE with informed, shared decisionmaking?
ACOG
screening for average risk women should occur via ______ if between ages…
mammogram 40-49
All women should receive mammogram screening at what age?
50+
mammogram screening can stop at what age?
75
frequency of mammography?
1-2 years
Breast cancer classifications by anatomical origin?
lobular/ductal
breast cancer classification by hormone receptivity
estrogen/progesterone receptor expression
what growth factor receptor is part of breast cancer classification?
human epidermal growth factor receptor 2 (HER2)
MC clinical presentation of breast CA…
palpable mass
patient presents with the below, which is concerning for…
skin changes (dimplish, nipple retraction, peau d’orange, etc)
nipple d/c
breast CA
Lobular and ductal lesions that have not yet penetrated the basement membrane…
in situ breast carcinomas
does DCIS have potential to invade and progress as cancer?
yes
on mammography you see clustered pleomorphic calcifications… this is suggestive of…
DCIS
describe physical exam findings for DCIS
WNL
can LCIS become invasive cancer if untreated?
no
does LCIS have any specific findings on mammogram or US?
no, usually incidental
The below describes treatment for…
Breast conserving surgery (BCT) with radiation vs. mastectomy sentinel lymph node biopsy Adjuvant (hormone) therapy if estrogen (ER) and progesterone (PR) positive Tamoxifen , Arimidex
DCIS
does LCIS require treatment?
not in most women
does LCIS require treatment?
not in most women
What is the MC breast malignancy accounting for 80%?
infiltrating ductal carcinoma (IDC)
This type of carcinoma MC presents as palpable mass or mamographic abnormality
IDC
Which type of breast cancer?
bilateral
hormone receptor positive
Infiltrating lobular carcinoma
A patient presents with:
-Unilateral scaly, raw, vesicular or ulcerated lesion
begins on nipple, spread to areola
+/- bloody d/c
paget disease of the breast
describe the prodrome of paget disease of the breast…
pain, burning, pruritus
What type of breast CA?
- aggressive
- rare
inflammatory breast CA
A patient presents with:
- pain, tender, firm, enlarged breast
- rapid progression
- LAD
inflammatory breast CA
what are the skin changes commonly found with inflammatory breast CA? (3)
peau d’orange, erythema, warm
mets are common with IBC… T or F?
true
lymphatic mets spread to…
axillary lymph nodes
hematogenous mets commonly spread to…
lung, liver
4 tx options for breast CA…
surgery, radiation, chemo, endocrine tx
What surgical tx?
part of breast containing CA removed.
lumpectomy
What surgical tx?
entire breast, nipple, areola removed
simple/total mastectomy
What surgical tx?
entire breast, nipple, areola removed plus axillary lymph nodes
modified radical mastectomy
What surgical tx?
entire breast, nipple, areola removed plus axillary lymph nodes and pectoralis muscle
radical mastectomy
How common is radiation for breast ca?
almost always used
External beam radiation occurs for what duration?
4-7 weeks
what type of radiation?
seeds or wires placed in or near the
tumor for shorter time frame (days)
brachytherapy
What therapy is indicated for:
-primary, metastatic breast CA with lymph node involvement
chemo
what is given before surgery to shrink tumor size?
neoadjuvant
What is given after surgery to kill remaining CA cells?
adjuvant
What two types of breast cancer are responsive to hormone therapy?
ER and PR (+)
What two drugs can be given as supplement to chemo and radiation for ER/PR (+) breast cancers?
tamoxifen (premenopausal)
Anastrazole (postmenopausal)`
how long does HT last for breast cancer tx?
5-10 years
What monoclonal Ab can be used for HER2 breast cancers?
herceptin
