Breast Examination Dr. Wootton

Question 1

Most common location of breast cancer

+ most comon routes

Answer 1

Upper outer quadrant = Tail of Spins

+ Lymph node and internal mammary nodes

Question 2

Estrogen on breast

Progesteron on the breast

Answer 2

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

Question 3

Risk factors for breast cancer (personal to body)

Answer 3

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

Question 4

Risks for breast cancer (more)

Answer 4

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

Question 5

DX tests to order for breast exam

Answer 5

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

Question 6

Mammogram works how

Answer 6

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

Question 7

Abnormal mammogram finding is what

Answer 7

Spikulated calcificaition

Question 8

BI-RADS are what

Answer 8

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

Question 9

US is used how

Answer 9

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

Question 10

US solid vs cysts looks like

Answer 10

Cyst = completely black 
Solid = grey / black

Question 11

MRI is used when

Answer 11

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

Question 12

Fine Needle Aspiration Biopsy is used for what, gauge size

Answer 12

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

Question 13

Core needle biopsy is what and needs what and gauge size

Answer 13

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

Question 14

Mastalgia is what, cyslic vs noncyclic vs extramammary

Answer 14

Breast pain

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

Question 15

Benign Breast Disease : Mastalgia TX

Answer 15

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 **

Question 16

Benign Breast Disease : Nipple Discharge

Answer 16

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

Question 17

Nipple discharge in ductal ectasia or fibrocystic changes

Answer 17

Nonspontaneous, nonbloody, bilateral discharge

Question 18

Bloody nipple discharge in indicative of

Answer 18

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

Question 19

How to evaluate bloody nipple discharge

Answer 19

Breast ductography and requires ductal excision

Question 20

Concerns on breast for malignancy

Answer 20

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

Question 21

3 catagories or benign breast massas

Answer 21

1. Non-proliferative
2. Proliferative without atypia
3. Proliferative with atypia

Question 22

Non-proliferative breast mass

1. What is it
2. Prevalence

Answer 22

1. Fibrocystic changes (many changes), places that dilate and form cysts, can rupture and scar or get inflammed
2. In 70% in normal women

Question 23

Nonproliferative breast mass 4 types

Answer 23

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

Question 24

Galactocele

1. What and when
2. Risk
3. Tx

Answer 24

1. Cystic dilation of duct with milky fluid , near lactation time
2. Can get infected —> acute mastitis
3. Fine needle aspiration

Question 25

Galactocele looks like what in radiology

Answer 25

Black circle with white fluid seen laying on botton half

Question 26

Proliferative without atypia

Answer 26

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

Question 27

Proliferative lesions with atypia 1. Types 2. TX

Answer 27

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

Question 28

Race and age in risk of breast cancer

Answer 28

``` Black = under 45yo White = over 50yo ```

Question 29

1st degree relative risk of breast cancer | BRCA1 and BRCA 2 risks

Answer 29

1. 1.5 higher chance 2. 72% 3. 69%

Question 30

Breas cancer risk tool

Answer 30

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

Question 31

Location most common to least common of breast cancer

Answer 31

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

Question 32

5 year survival in local, regional, metastaic

Answer 32

1. 99% local 2. 86% regional 3. 27% metastatic

Question 33

Breast cancer staging in TX course

Answer 33

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

Question 34

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

Answer 34

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)

Question 35

Benign mass usually feels like what

Answer 35

Tender

Question 36

34yo with lump comes in 1. Imaging you should do 2. Recommendation that is different then a 57yo post menopausal

Answer 36

1. US (denser breast since under 40yo) + Fine needle aspiration or core needle biopsy since palpable 2. Mammogram + US, FNA + CNB also