Breast Mass

Question 1

which breast mass presents with multiple or bilateral discomfort, worsening during premenstrual cycle, has fluctuation in size of masses, or may be asymptomatic?

Answer 1

Fibrocystic changes

Question 2

what imaging would you use for a clinical diagnosis of fibrocystic changes?

Answer 2

mammography
ultrasound (used alone when patient is under 30 years old.

Question 3

what is the DIAGNOSTIC testing for fibrocystic changes?

Answer 3

core needle biopsy (by a general surgeon)

Question 4

what is the treatment for fibrocystic changes?

Answer 4

NSAIDS

(severe pain should be referred)

Question 5

You have a patient with fibrocystic changes, what are some key points of patient education you should discuss?

Answer 5

avoid trauma
brassiere night and day
decrease fat intake
avoid caffeine
Vitamin E (400IU daily)
BSE

Question 6

which breast mass presents as rubbery, discrete, relatively movable masses that are 1-5 cm in diameter? (HINT: occurs frequently with black women and 20 years after puberty)

Answer 6

Fibroadenoma

Question 7

what type of imaging do we do for suspected fibroadenoma?

Answer 7

ultrasound

(core needle biopsy often recommended)

Question 8

treatment for fibroadenoma?

Answer 8

referred to General Surgery
if confirmed with biopsy, no treatment required.

Excision MAY be necessary for fibroadenomas > 3-4 CM

Question 9

what breast mass is commonly seen after trauma, in indistinguishable from carcinoma even with imaging, produces a mass with skin or nipple detraction? Common after radiation therapy, segmental resection, or augmentations.

Answer 9

Fat Necrosis.

Question 10

what is the second most common cancer in women? it is also the second leading cause of cancer death.

Answer 10

Female breast carcinoma.

Question 11

What breast mass could peak in your 60’s, associated with nulliparous or late pregnancy, early menarche or late menopause?

Answer 11

female breast carcinoma

Question 12

signs and sx of breast carcinoma?

Answer 12

usually painless lump
possible discharge, erosion, itching of nipple
redness, hardness, enlargement or shrinking of breast

has a rare chance of axillary mass, jaundice, or back pain

Question 13

what are some LATE signs of female breast carcinoma?

Answer 13

nipple retraction
axillary lymphadenopathy
fixation of mass to skin or chest wall

Question 14

what lab findings are there for female breast carcinoma?

Answer 14

increase alkaline phosphatase (from metastases of liver or bone)
increased serum calcium (elevated with bone metastases)

Question 15

what imaging will we run for breast carcinoma?

Answer 15

mammograph (diagnostic)
ultrasound
MRI

Question 16

what is the main diagnostic test for female breast carcinoma?

Answer 16

core needle biopsy.

Question 17

treatment for breast cancer?

Answer 17

Refer to GS

Stage of cancer dependent:
surgery
radiation
systemic therapy

Question 18

timeframe for breast cancer recurrences?

Answer 18

within 2-5 years

Question 19

state the mammography screening recommendations for timing and frequency?

Answer 19

< 40- not recommended
40-49- suggest every 2 years (decision w patient
50-74- 2 years
75>- only if expectancy greater than 10 years

Question 20

is MRI and ultrasound useful with breast carcinoma detections?

Answer 20

yes, but only recommended for high risk and not general population

Question 21

how often should female breast carcinoma patients be examined for follow up after primary therapy?

Answer 21

first two years, examined every 6 months.
annual thereafter.

(special attention to contralateral breast due to new malignancy in 25% of patients)

Question 22

what is the average age of male breast carcinoma manifesting?

Answer 22

70 years old.

Question 23

what previous condition would increase your incidence of male breast cancer?

Answer 23

prostate cancer

BRCA 2 mutations.

Question 24

how will a male with breast carcinoma present?

Answer 24

usually with a painless lump (there may be discharge, retractions or ulcerations)

you will find a hard, ill defined, nontender mass beneath nipples
you may find the patient has gynecomastia