Breast Dz Flashcards
High risk factors for breast CA (BCA)? (6)
65+yo Atypical hyperplasia (confirmed) BRCA genes Lobular CA Dense breasts Hx/FHx (early ages)
Medium risk factors for BCA? (3)
Postmeno high E2/testost
Chest radiation
Hx/FHx
Best time for exam?
Follicular phase (closer to hormonal baseline)
Key features of breast exam?
Systematic approach
Cover entire area
Mammography views:
Screening?
Diagnostic?
2 craniocaudal (CC), 2 mediolateral oblique (MLO)
CC, MLO and other
US used when? (5)
Inconclusive mammo Young W Dense breasts Better diff b/w solid or cystic mass Guiding needle bx
MRI used when? (3)
Detection in high risk pts
Staging
NOT for mass eval
Before MRI gadolinium dye used, check what?
Check baseline BUN, Cr
Contra for renal dz
Fine Needle Aspiration Bx used when?
Initial eval of mass w/ low pretest CA probability
Core Needle Bx used when?
get sample of larger/solid mass
Mastalgia is?
Types?
Benign breast dz -> pain in the breast
Cyclic:
Luteal phase bilateral, diffuse pain
Fibrocystic ∆s
Noncyclic:
Unilateral or focal
(P) 2° to meds (hormones, SSRI, spirono)
Mastalgia Management? (3)
(P) US or mammo
Non-steriod anti-inflamm
Danazol or tamoxifen if persistent
Mastitis is?
Most C in?
Most C cause?
Infection in breast
Lactating W
S. aureus
Mastitis presentation?
DDX?
hard, red, painful, swollen area
engorgement, galactocele, abscess, inflamm BCA
Mastitis Tx?
Dicloxacillin or cephalexin
Keep breastfeeding
Nipple d/c: Pathologic causes?
Presentation?
INTRADUCTAL PAPILLOMA duct ectasia (dilation), CA, infection
Spontaneous, unilat
Bloody, serous or clear
a/w mass
Nipple d/c: Physiologic causes?
Presentation?
Neurogenic stim
Meds: antihypTN, GI, hormones, opiates, psych
Bilat, multiduct
a/w stim
Benign Breast Mass characteristics? (5)
Discrete margins No skin ∆s Smooth Soft or firm Mobile
Malignant Breast Mass characteristics? (5)
Poorly defined margins (P) skin ∆s Hard Immobile Fixed
Breast Cysts characteristics? (6)
Benign U 35-50yo Fluid-filled round/oval mass ∆s w/ hormone flux Firm \+/- tender
Cyst management?
Simple: none
Complicated (<1% malig): Fine Needle Asp (FNA), imaging
Complex (1-23% malig): bx, excision
Fibroadenoma characteristics? (5)
Benign Solid, gland/fiber tissue (P) ∆ w/ preg/E2 Firm - tender
Fibroadenoma management? (4)
Core needle bx
OR If US look benign, no bx. Repeat exam and US in 3-6 mo
(P) Excision/ablation
If ↑ size, EXCISION
BCA presentation? (5)
1) Nonpalp (suspicious mammo)
2) Palp mass (most C)
3) Skin ∆s
4) D/C
5) Metastatic spread
Invasive BCA: Ductal?
Most C breast malig (80%)
U palp mass or mammogram abnormality
Invasive BCA: Lobular?
More likely bilateral
No microcalcifications
U palp mass or mammo abn
Paget’s Disease of the Breast (PDB) characteristics? (7)
Rare
Scaly, raw, vesicular, ulcerated lesion,
Starts on nipple, spread to areola
+/- bloody d/c
U unilat
(P) Pain, burn, pruritis present before dz
MOST HAVE UNDERLYING BCA (in situ or invasive)
Inflammatory BCA characteristics? (6)
Very aggressive Very rare Pain w/ rapid tender, firm enlargement, Warm, thick skin w/ erythema, orange peel Most w/ LN involvement 1/3 w/ distant metastasis
BCA surgery based on? (7)
1) Tumor size
2) Metastases
3) LN involvement
4) E2 and PR status
5) Her2 NEU status
6) Oncotype recurrent score
7) BRCA status
Breast-Conserving Surgery (BCS): Lumpectomy is?
Used when?
Removal of portion w/ or w/o axillary node bx
For Stage I or II
w/ Postop radiation
Mastectomy types? (3)
1) Simple/Total: entire
2) Modified Radical: entire + axillary LNs
3) Radical: entire + ax LNs + pect mm
Radiation types? (3)
1) External beam (5-7 wks)
2) Brachytherapy (wires in tumor)
3) To breast, chest, region LN, axilla
Chemo used when? (5)
Primary and metastatic BCA, Almost all w/ + lymph nodes, High onco score (+E2/LN-) Neoadjuvant (before surgery) Adjuvant (after surgery)
Endocrine therapy used when?
Types? (2)
Receptor Status = E2 and PR
Supplement to chemo/radiation
E2+ more responsive than E2-
SERM: Tamoxifen x 5yrs
Aromatase Inhib: Arimidex
Her2/NEU Overexpression?
Tx used when/how?
1 in 5
CA grows faster and reoccur
Effective in early stages, metast dx
Herceptin target Her2 protein
Herceptin + chemo
Metastasis: Lymphatic spread
Axillary -> internal mammary -> supraclavicular (too late)
Metastasis: Hematogenous
Lungs/liver -> bone, ovaries, brain
BRCA genes are?
BRCA+ mgmt?
tumor suppressors
watch, chemoprophy or surgical prophy
BRCA 1 risks?
44-78% BCA by 70
24-40% ovarian CA by 70
BRCA 2 risks?
33-54% BCA by 70
8-18% ovarian by 70
6% male CBA
BCA f/u?
Hx/PE Q 3-6 mo x 5yrs, then annually
Initial mammo @ 6 mo post radio
Annual mammo if remaining breast
Chemoprevention?
Recommended for at risk 35+ w/o prior BCA dx
