Breast Mass

Question 1

Definition of what issue?
-Painful breast masses
–1) Often multiple and bilateral
(b) Pain often worsens during premenstrual phase of cycle
(c) Rapid fluctuation in mass size is normal
–1) Estrogen is considered a causative factor
–2) Increased risk in women who drink alcohol
(d) Most frequent lesion of the breast
(e) Most common age is 30-50
(f) Generally considered to increase the risk of subsequent not detecting breast cancer

Answer 1

Fibrocystic condition AKA “Fibrocystic Changes”

Question 2

Most common age for Fibrocystic condition AKA “Fibrocystic Changes” is what?

Answer 2

30-50

Question 3

True/False
Fibrocystic condition AKA “Fibrocystic Changes” of the breast is uncommon

Answer 3

False
Most frequent lesion of the breast

Question 4

Signs and symptoms of what issue?
(a) Breast pain or tenderness
–1) May be asymptomatic and found on accident
(b) Discomfort often worsens during premenstrual phase of cycle as cysts are enlarging
(c) Fluctuation in size of masses
(d) Multiple or bilateral
(e) Absence of enlarged or tender lymphadenopathy

Answer 4

Fibrocystic condition AKA “Fibrocystic Changes”

Question 5

Imaging considerations
Fibrocystic condition AKA “Fibrocystic Changes”

Answer 5

(a) Mammography
(b) Ultrasound
—1) Used alone when patient is under 30 years old

Question 6

Core needle biopsy
1) All suspicious lesions should be ….

Answer 6

biopsied by a General Surgeon

Question 7

Treatment for
Fibrocystic condition AKA “Fibrocystic Changes”

Answer 7

a) NSAIDS
b) More severe pain should be referred to primary care for further evaluation.
c) Patient education

Question 8

Patient education points for Fibrocystic breasts

Answer 8

1) Avoiding trauma
2) Wear supportive brassiere night and day
3) Decreasing dietary fat intake
4) Consider eliminating caffeine
5) Vitamin E, 400IU daily
6) Monthly self-breast exam just after menstruation
–a) Risk of not detecting breast cancer is higher

Question 9

Definition of what issue
(a) Common benign neoplasm occurs most frequently in young women
–1) Usually within 20 years after puberty
–2) More frequent and occurs earlier in black women
(b) Usually discovered incidentally

Answer 9

Fibroadenoma

Question 10

Signs and symptoms of what mass?
(a) Round or ovoid
(b) Rubbery
(c) Discrete
(d) Relatively movable
(e) Nontender mass 1-5 cm in diameter

Answer 10

Fibroadenoma

Question 11

Imaging considerations for fibroadenoma

Answer 11

Ultrasound
1) Core needle biopsy often recommended

Question 12

Treatment considerations for fibroadenoma

Answer 12

(a) All breast masses should be referred to General Surgery for further evaluation and work up
(b) Once confirmed by biopsy, no treatment is usually necessary
(c) Excision may be necessary for large or rapidly growing fibroadenomas
—1) Larger than 3-4 cm
—2) Rule out phyllodes tumor
—–a) A rare malignant fibroadenoma like tumor

Question 13

Definition of what issue?
(1) Lesion of the breast
—(a) Produces a mass (often accompanied by skin or nipple retraction)
(2) Usually indistinguishable from carcinoma even with imaging studies
(3) Commonly seen after fat injections to augment breast size or fill defects after breast surgery
(4) Trauma is presumed to be the cause
(5) Ecchymosis is occasionally present
(6) If untreated, the mass gradually disappears

Answer 13

Fat necrosis

Question 14

Fat necrosis
The safest course is to obtain a….

Answer 14

biopsy
-Frequently entire mass must be excised to exclude carcinoma

Question 15

What lumpy bumpy is common after segmental resection, radiation therapy, or flap reconstruction after mastectomy?
-Also common after MVA or assaults’.

Answer 15

Fat necrosis

Question 16

Female breast carcinoma Incidence
(a) One in _____ American women
(b) ______ most common cancer in women
(c) ______ leading cause of cancer death

Answer 16

a) one in eight
b) Second
c) Second

Question 17

Risk factors for Female breast carcinoma
1) Most significant risk factor?
2) What genetic factors?
3) Reproductive history?
4) Menstrual history?

Answer 17

1) Age
2) BRCA 1, BRCA 2, and other mutations
3) Nulliparous or late first pregnancy (after age 30)
4) Early menarche (under age 12) or Late menopause (after age 55)

Question 18

What is the most reliable means of detecting breast cancer before a mass can be palatable?
-Can identify slow growing cancers at least two years before they are palpable.

Answer 18

Mammography screening

Question 19

Recommendations on timing and frequency vary by agency.
a) Age under 40?
b) Age 40-49
c) 50-74
d) 75 and older

Answer 19

a) Not recommended in average risk women
b) Shared decision making with patient
—-Women who decide to initiate screening in their 40s, suggest
screening every two years
c) Recommended every two years, unless prior screenings indicate
otherwise
d) Only recommended if life expectancy is greater than 10 years

Question 20

What other Imaging may be useful to those who are at high risk for breast cancer?

Answer 20

MRI and ultrasound

Question 21

What screening tool?
1) Has not shown to improve survival
2) American Cancer Society no longer recommended
3) Patients should recognize and report any breast changes

Answer 21

Breast self-examination

Question 22

Early symptoms of Breast cancer
1) __% of patients present with a (usually) painless lump
2) About __% of these are discovered by the patient

Answer 22

1) 70%
2) 90%

Question 23

S/S of what?
Early symptoms
–70% of patients present with a (usually) painless lump
—-About 90% of these are discovered by the patient
(b) Less frequent symptoms
–Breast pain
– Nipple discharge
–Erosion, retraction, enlargement, or itching of the nipple
–Redness, generalized hardness, enlargement, or shrinking of the breast
(c) Rarely
–Axillary mass or swelling
–Back or joint pain
–Jaundice
–Weight loss

Answer 23

Female breast carcinoma

Question 24

Laboratory findings for breast carcinoma

Answer 24

(a) Increase alkaline phosphatase
—-Liver or bone metastases cause elevation
(b) Increase serum calcium
—-Elevated with bone metastases

Question 25

What diagnostic tests are indicated for suspected breast cancer?

Answer 25

Core needle biopsy

Question 26

Treatment for breast cancer

Answer 26

(a) All breast masses should be referred to General Surgery for further evaluation and work up
(b) Depends on the stage of cancer
—1) Surgical resection, with axillary node dissection
—2) Radiation
—3) Systemic therapy

Question 27

Special attention to the contralateral breast
-A new primary breast malignancy will develop in ______% of patients. If metastatic, will travel to bone, liver, lungs and brain.

Answer 27

20-25

Question 28

Breast cancer
what is most reliable indicator of prognosis?

Answer 28

Stage of cancer

Question 29

True/False
Breast cancer
More aggressive are associated with worse outcomes in younger women

Answer 29

True

Question 30

_______ gene mutations are common in men with breast cancer

Answer 30

BRCA 2

Question 31

Male breast cancer
Average age of occurrence is ______________

Answer 31

70

Question 32

S/s of what issue?
(a) Patient usually presents with a painless lump
—1) With or without nipple discharge, retraction, ulceration or erosion
(b) Physical exam
—1) Hard, ill defined, nontender mass beneath the nipple or areola
(c) Gynecomastia
—1) Current or history of Gynecomastia
(d) Staging is the same as in women

Answer 32

Male Breast Cancer

Question 33

Prognosis male breast cancer
(a) 5 year survival
1) Node negative disease – __%
2) Node positive disease – __%

Answer 33

1) 88%
2) 69%