Breast Mass Flashcards
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
Fibrocystic condition AKA “Fibrocystic Changes”
Most common age for Fibrocystic condition AKA “Fibrocystic Changes” is what?
30-50
True/False
Fibrocystic condition AKA “Fibrocystic Changes” of the breast is uncommon
False
Most frequent lesion of the breast
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
Fibrocystic condition AKA “Fibrocystic Changes”
Imaging considerations
Fibrocystic condition AKA “Fibrocystic Changes”
(a) Mammography
(b) Ultrasound
—1) Used alone when patient is under 30 years old
Core needle biopsy
1) All suspicious lesions should be ….
biopsied by a General Surgeon
Treatment for
Fibrocystic condition AKA “Fibrocystic Changes”
a) NSAIDS
b) More severe pain should be referred to primary care for further evaluation.
c) Patient education
Patient education points for Fibrocystic breasts
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
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
Fibroadenoma
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
Fibroadenoma
Imaging considerations for fibroadenoma
Ultrasound
1) Core needle biopsy often recommended
Treatment considerations for fibroadenoma
(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
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
Fat necrosis
Fat necrosis
The safest course is to obtain a….
biopsy
-Frequently entire mass must be excised to exclude carcinoma
What lumpy bumpy is common after segmental resection, radiation therapy, or flap reconstruction after mastectomy?
-Also common after MVA or assaults’.
Fat necrosis
Female breast carcinoma Incidence
(a) One in _____ American women
(b) ______ most common cancer in women
(c) ______ leading cause of cancer death
a) one in eight
b) Second
c) Second
Risk factors for Female breast carcinoma
1) Most significant risk factor?
2) What genetic factors?
3) Reproductive history?
4) Menstrual history?
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)
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.
Mammography screening
Recommendations on timing and frequency vary by agency.
a) Age under 40?
b) Age 40-49
c) 50-74
d) 75 and older
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
What other Imaging may be useful to those who are at high risk for breast cancer?
MRI and ultrasound
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
Breast self-examination
Early symptoms of Breast cancer
1) __% of patients present with a (usually) painless lump
2) About __% of these are discovered by the patient
1) 70%
2) 90%
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
Female breast carcinoma
Laboratory findings for breast carcinoma
(a) Increase alkaline phosphatase
—-Liver or bone metastases cause elevation
(b) Increase serum calcium
—-Elevated with bone metastases
What diagnostic tests are indicated for suspected breast cancer?
Core needle biopsy
Treatment for breast cancer
(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
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.
20-25
Breast cancer
what is most reliable indicator of prognosis?
Stage of cancer
True/False
Breast cancer
More aggressive are associated with worse outcomes in younger women
True
_______ gene mutations are common in men with breast cancer
BRCA 2
Male breast cancer
Average age of occurrence is ______________
70
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
Male Breast Cancer
Prognosis male breast cancer
(a) 5 year survival
1) Node negative disease – __%
2) Node positive disease – __%
1) 88%
2) 69%
