breast disorders trigger Flashcards
what happens to breast epithelial cells after menstruation
they undergo programmed cell death at the END of luteal phase
when are fatty tissues almost completely replaced by breast parenchyma
In late pregnancy
psychiatric medications and nervous system medications cause what SE
galactorrhea
Anabolic steroids/Androgens are associated with what condition
gynecomastia
gynecomastia nipple retraction is suggestive of what diagnosis
cancer:(
any of the following = cx:
Asymmetry
Enlargement not beneath the areola
Unusual firmness
Nipple retraction
Bleeding or discharge
MC during 2nd/3rd week of puerperium
mastitis
CI if breastfeeding an infant thats <1month old or if there is a hx of G6PD, jaundice, or prematurity
bactrim for mastitis.
must use a different abx
where do non-puerperal peripheral breast abscesses arise from? how do you treat it?
skin infections (tx w I&D and same abx as mastitis)
this is d/t Keratin-plugged milk ducts behind the nipple.
how would you treat this.
non-puerperal subareolar breast abscess
- simple I&D (40% reoccurence)
- subareolar duct excision and complete removal of sinus tracts
- biopsy.
what would suggest karyotyping for klinefelters syndrome
suspicious gynecomastia
Subareolar duct excision and removal of sinus tracts is used for what diagnosis
subareolar breast abscess
what is the etiology of fat necrosis and how do you diagnose it?
etiology - trauma, radiation or surgery
dx: US or mammogram. i think you can use watchful waiting though.
Drinking alcohol while 18-22 is the main risk for what dx
fibrocystic breast changes
s/s may be worsened w the use of caffiene in what dx?
fibrocystic breast changes
a 27 year old patient presents with cyclic breast pain that is worse just prior to menstruation. She reports multiple small bumps found in her breasts. what diagnostic will be used in this patient to assess dx?
US. mammograms are not indicated in pts <30!
what are some treatment options for fibrocystic breast changes
- CAM (primrose oil/vit E)
- NSAIDS/tylenol
- may consider drainage of large cysts
- severe pain - danazol, tamoxifen (limited by SE)
- refractory severe cases = surgery.
MC in young women within 20 years of puberty
fibroadenoma
patient presents with complaints of left breast mass. on exam you see a 3cm mass that is firm, nontender, and relatively mobile. US shows well-defined solid mass with benign features. what is your diagnosis?
fibroadenoma
nulliparity, early menarche, and late onset menopause are all risks for what dx
breast cancer
Nulliparity
First full term pregnancy after 30
Early menarche (b4 12)
Late natural menopause (after 50)
Postmenopausal combinattion HRT
Hx of uterine cx
PERSONAL HX of Breast Cx
when do you order CBC, LFTs and ALP in this lecture
in initial evaluation of breast cancer
eczematous eruption arising from the nipple with ulceration spreading to the areola. may be painful, itchy or burning
pagets carcinoma
orange peel skin is assocaited with what diagnosis
inflammatory breast carcinoma
blocked dermal lymphatics by a tumor emboli leading to lymphedema and hyperemia. Leads to diffuse brawny edema of skin with erysipeloid border.
what diagnosis
inflammatory carcinoma (orange peel skin)
this type of cancer tends to metastasize to the liver, lungs, and brain
no estrogen or progesterone or HER receptors.
this type of cancer tends to metastasize to the bone, soft tissue and genital organs
ER+
PR+
HER2+
what types of breast cancer are treated w tamoxifen (TOC) or aromatase inhibitors
ER/PR/HER2+ cancer
tamoxifen for 5 yrs is TOC
when is pembrolizumab used?
ER/PR/HER2 negative breast cancers
this medication blocks estrogen receptors in the breast and uterus but mimics them in the bones
raloxifene
tamoxifen = blocks in breast, minics in bones and uterus
this medication blocks estrogen receptors in the breast but mimics it in the uterus and bone
tamoxifen
raloxifene blocks breast &uterus but mimics in bone
which SERM has less SE
raloxifene
cimetidine can reduce the efficacy of this drug. this drug should also be avoided with other QT prolonging drugs
SERMS (raloxifene and tamoxifene)
what are the 3 aromatase inhibitors
anastrazole
exemestane
letrozole
these medications are used for metastatic breast cancer and ER or PR+, HER - cancers
fulvestrant
elacestrant
does not mimic estrogen, instead attatches to and causes destruction of estrogen receptors
does not mimic estrogen, instead attatches to and causes destruction of estrogen receptors
fulvestrant
elacestrant
what is the follow up regimen for breast cancer after tx
what is the most specific feature of breast cx to show up on a mammogram
spiculated focal mass
If a patient has a breast density of 43 what category does that put her in?
scattered fibroglandular densities
Predominantly fatty (0-25% dense)
Scattered fibroglandular densities (26-50% dense)
Heterogeneously dense (51-75% dense)
Dense (76% or greater dense)
which BI-RADS score indicates screening recommendations of: Diagnostic mammo/US every 6 months x1 year, then annually for x2 years.
BI-RADS 3
BI-RADS scale
- 0 = not enough info, poor scan
- 1 = negative, just routine f/u. (Q1-2 years)
- 2 = benign, just routine f/u (Q1-2 years)
- 3 = tiny chance of cancer, f/u (Q6 mo)
- 4ABC = wide range, could be cancer
- 5 = very sus!
- 6 = yea you have cancer
