Breast Examination Dr. Wootton Flashcards
Most common location of breast cancer
+ most comon routes
Upper outer quadrant = Tail of Spins
+ Lymph node and internal mammary nodes
Estrogen on breast
Progesteron on the breast
E: adipose growth and lactiferous ducts
P: stimulate lobular growth and aveolar budding
Risk factors for breast cancer (personal to body)
- Age
- PMH
- Atypical hyperplasia
- 1st degree relative with breast or ovarian cancer
- Early menarche (under 12yo)
- High breast tissue density (mammogram works not as good)
- Late menopause (over 55yo)
- No pregnancies
Risks for breast cancer (more)
- Never breast fed
- Long term oral contraceptives
- Postmenopause obesity
- Alcohol
- High socioeconomic status
- Jewish
- Tall height
DX tests to order for breast exam
- Mammogram
- US
- MRI
- Fine needle aspiration
- Core biopsy (always for palpable mass)
Mammogram works how
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
Abnormal mammogram finding is what
Spikulated calcificaition
BI-RADS are what
Assessment catagory for how a mammogram looks
- 0 = you need more imaging , did not get everythign you need to see
- 1 = good
- 2 = benign , not to worry only keep up with routine screening
- 3 = could be benign only look at more frequent for changes (every6mo)
- 4,5,6 = suspicious for cancer
US is used how
Young breast so under 40yo or others with dense breast tissue
= inconclusive mammogram (solid vs cystic)
= guide core needle biopsy
US solid vs cysts looks like
Cyst = completely black Solid = grey / black
MRI is used when
- Suspicious breast with Mammogram
- Post cnacer diagnostic
- High risk like BRCA carries
Fine Needle Aspiration Biopsy is used for what, gauge size
- Determine solid vs cystic (clear = no further evaluation, bloody = send to cytology + do mammogram /US)
- If cyst reoccurs or never resolved = biopsy
- 22-24 gauge
Core needle biopsy is what and needs what and gauge size
- Need local anesthesia, can be done also in office
- Get tissue from solid masses
- 3-6 samples about 2 cm long
- 14-16 gauge
Mastalgia is what, cyslic vs noncyclic vs extramammary
Breast pain
- Cyclic : with period
- Noncyclic : tumors, mastitis, cysts, antidepressants, antihtn
- Extramammary : trauma, shingles, fibromyalgia
Benign Breast Disease : Mastalgia TX
- Danazol : gives hair, deep voice, intracranial P, weight gain, high blood sugar
- SERMS tamoxifen : can cause endometrial hyperplasia and DVT
- Oral contraceptives, Depo Provera
4 . Proper bra fitting, weight reduction, exercise, low caffeine, Vit E, Primrose oil **
Benign Breast Disease : Nipple Discharge
- Could at timesbe cancer or endocrine problem (hyperprolactinemia, hypothyroidism)
- Look at color, how it looks
Nipple discharge in ductal ectasia or fibrocystic changes
Nonspontaneous, nonbloody, bilateral discharge
Bloody nipple discharge in indicative of
Intraductal carcinoma or invasive ductal carcinoma, unless proven to be benign intraductal papilloma
How to evaluate bloody nipple discharge
Breast ductography and requires ductal excision
Concerns on breast for malignancy
- Larger then 2cm
- Immobile + poor margins + firm
- Skin dimpling, retraction or color changes
- Bloody discharge
- LAD on same side
3 catagories or benign breast massas
- Non-proliferative
- Proliferative without atypia
- Proliferative with atypia
Non-proliferative breast mass
- What is it
- Prevalence
- Fibrocystic changes (many changes), places that dilate and form cysts, can rupture and scar or get inflammed
- In 70% in normal women
Nonproliferative breast mass 4 types
- Adenoiss lobular growth (increased glands)
- Lactational adenomas (hormonal response)
- Fibroadenomas (most common beign tumor in female breast, early 20yo, solid + mobile + rubbery, 2-4cm)
- Galactocele
Galactocele
- What and when
- Risk
- Tx
- Cystic dilation of duct with milky fluid , near lactation time
- Can get infected —> acute mastitis
- Fine needle aspiration
Galactocele looks like what in radiology
Black circle with white fluid seen laying on botton half
Proliferative without atypia
- Found in imaging
= Papillomas (intraductal growths, 30-50yo, serous or seroanguinous discharge)** - Comlex sclerosing lesions
- Sclerosing adenosis , epithelial hyperplasia
Proliferative lesions with atypia
- Types
- TX
- Lobular carcinoma = not precursor only risk for breast cancer
- Ductal carcioma = ducts with atyicl cells increased risk of invasive or reacurring DCIS
- Excision + SERMS
Race and age in risk of breast cancer
Black = under 45yo White = over 50yo
1st degree relative risk of breast cancer
BRCA1 and BRCA 2 risks
- 1.5 higher chance
- 72%
- 69%
Breas cancer risk tool
Gail Model Breast cancer risk
= less good with 2nd degree relative
= fasly elevate if you have benign biopsies
Location most common to least common of breast cancer
- Ductal : 70%-80% (50yo, spread to nodes)
- Lobular : usually bilateral
- Nipple : Pagets disease (superficial skin lesions)
- Inflammatory Breast Cancer (looks like cellulitis, swelling, redness induration under skin), eldetrly woman
5 year survival in local, regional, metastaic
- 99% local
- 86% regional
- 27% metastatic
Breast cancer staging in TX course
- Having E or P receptors present is good (tx is responding)
- Her2/neu : worse prognosis
- Luptectomy + radiation = mastectomy are equal in outcome
Adjunctive therapy used in all stages of breast cancer to reduce risk or reocurrance or death
- Chemo = kills cells
- H. Therapy (Tamoxifen): in premenopausal women, ——I E
- Aromatase inhibitors (Arimedex, Femara) : postmenopausal women , ——I E
- Herceptin (TRASTUZUMAB) : ——I proteins from her2/neu (HF, resp probs, allergic rx = bad side effects)
Benign mass usually feels like what
Tender
34yo with lump comes in
- Imaging you should do
- Recommendation that is different then a 57yo post menopausal
- US (denser breast since under 40yo) + Fine needle aspiration or core needle biopsy since palpable
- Mammogram + US, FNA + CNB also
