Breast Mass Flashcards
which breast mass presents with multiple or bilateral discomfort, worsening during premenstrual cycle, has fluctuation in size of masses, or may be asymptomatic?
Fibrocystic changes
what imaging would you use for a clinical diagnosis of fibrocystic changes?
mammography
ultrasound (used alone when patient is under 30 years old.
what is the DIAGNOSTIC testing for fibrocystic changes?
core needle biopsy (by a general surgeon)
what is the treatment for fibrocystic changes?
NSAIDS
(severe pain should be referred)
You have a patient with fibrocystic changes, what are some key points of patient education you should discuss?
avoid trauma
brassiere night and day
decrease fat intake
avoid caffeine
Vitamin E (400IU daily)
BSE
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)
Fibroadenoma
what type of imaging do we do for suspected fibroadenoma?
ultrasound
(core needle biopsy often recommended)
treatment for fibroadenoma?
referred to General Surgery
if confirmed with biopsy, no treatment required.
Excision MAY be necessary for fibroadenomas > 3-4 CM
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.
Fat Necrosis.
what is the second most common cancer in women? it is also the second leading cause of cancer death.
Female breast carcinoma.
What breast mass could peak in your 60’s, associated with nulliparous or late pregnancy, early menarche or late menopause?
female breast carcinoma
signs and sx of breast carcinoma?
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
what are some LATE signs of female breast carcinoma?
nipple retraction
axillary lymphadenopathy
fixation of mass to skin or chest wall
what lab findings are there for female breast carcinoma?
increase alkaline phosphatase (from metastases of liver or bone)
increased serum calcium (elevated with bone metastases)
what imaging will we run for breast carcinoma?
mammograph (diagnostic)
ultrasound
MRI
what is the main diagnostic test for female breast carcinoma?
core needle biopsy.
treatment for breast cancer?
Refer to GS
Stage of cancer dependent:
surgery
radiation
systemic therapy
timeframe for breast cancer recurrences?
within 2-5 years
state the mammography screening recommendations for timing and frequency?
< 40- not recommended
40-49- suggest every 2 years (decision w patient
50-74- 2 years
75>- only if expectancy greater than 10 years
is MRI and ultrasound useful with breast carcinoma detections?
yes, but only recommended for high risk and not general population
how often should female breast carcinoma patients be examined for follow up after primary therapy?
first two years, examined every 6 months.
annual thereafter.
(special attention to contralateral breast due to new malignancy in 25% of patients)
what is the average age of male breast carcinoma manifesting?
70 years old.
what previous condition would increase your incidence of male breast cancer?
prostate cancer
BRCA 2 mutations.
how will a male with breast carcinoma present?
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
