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ENRP Exam 1 > Breast Examination Dr. Wootton > Flashcards

Breast Examination Dr. Wootton Flashcards

1
Q

Most common location of breast cancer

+ most comon routes

A

Upper outer quadrant = Tail of Spins

+ Lymph node and internal mammary nodes

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2
Q

Estrogen on breast

Progesteron on the breast

A

E: adipose growth and lactiferous ducts
P: stimulate lobular growth and aveolar budding

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3
Q

Risk factors for breast cancer (personal to body)

A
  1. Age
  2. PMH
  3. Atypical hyperplasia
  4. 1st degree relative with breast or ovarian cancer
  5. Early menarche (under 12yo)
  6. High breast tissue density (mammogram works not as good)
  7. Late menopause (over 55yo)
  8. No pregnancies
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4
Q

Risks for breast cancer (more)

A
  1. Never breast fed
  2. Long term oral contraceptives
  3. Postmenopause obesity
  4. Alcohol
  5. High socioeconomic status
  6. Jewish
  7. Tall height
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5
Q

DX tests to order for breast exam

A
  1. Mammogram
  2. US
  3. MRI
  4. Fine needle aspiration
  5. Core biopsy (always for palpable mass)
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6
Q

Mammogram works how

A

Detects lesions 2 years before palpable, less then 1cm can be detected
= 40yo and older Females
= Screening : 4 images (2 craniocaudal, 2 mediolateral), digital enhancement or radiograph
= Diagnostic : screen with US and compare with other breast also

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7
Q

Abnormal mammogram finding is what

A

Spikulated calcificaition

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8
Q

BI-RADS are what

A

Assessment catagory for how a mammogram looks

  1. 0 = you need more imaging , did not get everythign you need to see
  2. 1 = good
  3. 2 = benign , not to worry only keep up with routine screening
  4. 3 = could be benign only look at more frequent for changes (every6mo)
  5. 4,5,6 = suspicious for cancer
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9
Q

US is used how

A

Young breast so under 40yo or others with dense breast tissue
= inconclusive mammogram (solid vs cystic)
= guide core needle biopsy

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10
Q

US solid vs cysts looks like

A 
Cyst = completely black 
Solid = grey / black
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11
Q

MRI is used when

A
  1. Suspicious breast with Mammogram
  2. Post cnacer diagnostic
  3. High risk like BRCA carries
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12
Q

Fine Needle Aspiration Biopsy is used for what, gauge size

A
  1. Determine solid vs cystic (clear = no further evaluation, bloody = send to cytology + do mammogram /US)
  2. If cyst reoccurs or never resolved = biopsy
  3. 22-24 gauge
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13
Q

Core needle biopsy is what and needs what and gauge size

A
  1. Need local anesthesia, can be done also in office
  2. Get tissue from solid masses
  3. 3-6 samples about 2 cm long
  4. 14-16 gauge
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14
Q

Mastalgia is what, cyslic vs noncyclic vs extramammary

A

Breast pain

  1. Cyclic : with period
  2. Noncyclic : tumors, mastitis, cysts, antidepressants, antihtn
  3. Extramammary : trauma, shingles, fibromyalgia
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15
Q

Benign Breast Disease : Mastalgia TX

A
  1. Danazol : gives hair, deep voice, intracranial P, weight gain, high blood sugar
  2. SERMS tamoxifen : can cause endometrial hyperplasia and DVT
  3. Oral contraceptives, Depo Provera
    4 . Proper bra fitting, weight reduction, exercise, low caffeine, Vit E, Primrose oil **
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16
Q

Benign Breast Disease : Nipple Discharge

A
  1. Could at timesbe cancer or endocrine problem (hyperprolactinemia, hypothyroidism)
  2. Look at color, how it looks
17
Q

Nipple discharge in ductal ectasia or fibrocystic changes

A

Nonspontaneous, nonbloody, bilateral discharge

18
Q

Bloody nipple discharge in indicative of

A

Intraductal carcinoma or invasive ductal carcinoma, unless proven to be benign intraductal papilloma

19
Q

How to evaluate bloody nipple discharge

A

Breast ductography and requires ductal excision

20
Q

Concerns on breast for malignancy

A
  1. Larger then 2cm
  2. Immobile + poor margins + firm
  3. Skin dimpling, retraction or color changes
  4. Bloody discharge
  5. LAD on same side
21
Q

3 catagories or benign breast massas

A
  1. Non-proliferative
  2. Proliferative without atypia
  3. Proliferative with atypia
22
Q

Non-proliferative breast mass

  1. What is it
  2. Prevalence
A
  1. Fibrocystic changes (many changes), places that dilate and form cysts, can rupture and scar or get inflammed
  2. In 70% in normal women
23
Q

Nonproliferative breast mass 4 types

A
  1. Adenoiss lobular growth (increased glands)
  2. Lactational adenomas (hormonal response)
  3. Fibroadenomas (most common beign tumor in female breast, early 20yo, solid + mobile + rubbery, 2-4cm)
  4. Galactocele
24
Q

Galactocele

  1. What and when
  2. Risk
  3. Tx
A
  1. Cystic dilation of duct with milky fluid , near lactation time
  2. Can get infected —> acute mastitis
  3. Fine needle aspiration
25
Q

Galactocele looks like what in radiology

A

Black circle with white fluid seen laying on botton half

26
Q

Proliferative without atypia

A
  1. Found in imaging
    = Papillomas (intraductal growths, 30-50yo, serous or seroanguinous discharge)**
  2. Comlex sclerosing lesions
  3. Sclerosing adenosis , epithelial hyperplasia
27
Q

Proliferative lesions with atypia

  1. Types
  2. TX
A
  1. Lobular carcinoma = not precursor only risk for breast cancer
  2. Ductal carcioma = ducts with atyicl cells increased risk of invasive or reacurring DCIS
  3. Excision + SERMS
28
Q

Race and age in risk of breast cancer

A 
Black = under 45yo
White = over 50yo
29
Q

1st degree relative risk of breast cancer

BRCA1 and BRCA 2 risks

A
  1. 1.5 higher chance
  2. 72%
  3. 69%
30
Q

Breas cancer risk tool

A

Gail Model Breast cancer risk
= less good with 2nd degree relative
= fasly elevate if you have benign biopsies

31
Q

Location most common to least common of breast cancer

A
  1. Ductal : 70%-80% (50yo, spread to nodes)
  2. Lobular : usually bilateral
  3. Nipple : Pagets disease (superficial skin lesions)
  4. Inflammatory Breast Cancer (looks like cellulitis, swelling, redness induration under skin), eldetrly woman
32
Q

5 year survival in local, regional, metastaic

A
  1. 99% local
  2. 86% regional
  3. 27% metastatic
33
Q

Breast cancer staging in TX course

A
  1. Having E or P receptors present is good (tx is responding)
  2. Her2/neu : worse prognosis
  3. Luptectomy + radiation = mastectomy are equal in outcome
34
Q

Adjunctive therapy used in all stages of breast cancer to reduce risk or reocurrance or death

A
  1. Chemo = kills cells
  2. H. Therapy (Tamoxifen): in premenopausal women, ——I E
  3. Aromatase inhibitors (Arimedex, Femara) : postmenopausal women , ——I E
  4. Herceptin (TRASTUZUMAB) : ——I proteins from her2/neu (HF, resp probs, allergic rx = bad side effects)
35
Q

Benign mass usually feels like what

A

Tender

36
Q

34yo with lump comes in

  1. Imaging you should do
  2. Recommendation that is different then a 57yo post menopausal
A
  1. US (denser breast since under 40yo) + Fine needle aspiration or core needle biopsy since palpable
  2. Mammogram + US, FNA + CNB also

ENRP Exam 1 (13 decks)

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