Breast Mass/CA

Question 1

Causes of Breast MAsses

Answer 1

• fibrocystic changes/cysts
• fibroadenoma
• intraductal papilloma
• fat necrosis
• abscess
• malignancy

Question 2

evaluation if younger than 30 years

Answer 2

-charachteristics of a cyst: monitor x 1-2 menstural cycles or aspirate

Question 3

if younger than 30, breat mass persists or more suspicious?

Answer 3

-US

Question 4

if US neg in woman under 30>

Answer 4

observe q 3-6 mnth, considered mammogram

Question 5

if simple cyst

Answer 5

-reassure, observe or aspirate

Question 6

if complex cyst?

Answer 6

mammogram

Question 7

if solid mass?

Answer 7

mammogram:
C3- short ter f/u w/ imaging
C4/5-bx

Question 8

if age > 30 yo?

Answer 8

unilateral dx mammo and US

Question 9

if >40 yo?

Answer 9

can get bilateral mammo

Question 10

Breast Ca

Answer 10

most common female malignancy and the second leading cause of death from CA in women

Question 11

RF for BCA?

Answer 11

most women have no identifiable RF-

being women, increasing age

-BRCA1 AND 2, associated w. 5-10% of the pts, but only seen in 1% of the population

Question 12

associated rf for BCA?

Answer 12

nulliparity, early menarche, late menopause, long-term estrogen or radiation exposure, delayed childbearing

Question 13

what about relatives w/ BCA?

Answer 13

women w/ first degree relatives are at increased risk, especially if the CA was premenopausal or bilateral

Question 14

relation to endometrial ca?

Answer 14

Breast CA incrases the risk of endometrial and vice versa

Question 15

what is the most common type of breast ca?

Answer 15

ductal carcinoma (50-80%); the rest are lobular carcinomas

Question 16

what may presidpose one to breast ca?

Answer 16

lobular CIS and atypical ductal hyperplasia

Question 17

what is Paget’s dz?

Answer 17

ductal carcinoma presenting as an excematous lesion of the nipple

Question 18

what is a feature of invasive lobular carcinomas and 2/3 of ductal carcinomas?

Answer 18

estrogen-receptor positive

Question 19

what are the CF of breast ca?

Answer 19

presents as a single, nontender, firm, immobile mass

-45% occur in the upper outer quadrant, 25% under the nipple and areola

Question 20

what type can be detected early, but w/ no palpable mass?

Answer 20

early carcinoma

Question 21

what are rarer presentations of breast ca?

Answer 21

include nipple discharge or retraction,

• dimpling,
• breast enlargement or shrinkage,
• skin thickening or peau d’orange skin,
• eczematous changes, breast pain,
• fixed mass,
• axillary node enlargement, ulceration
• arm edema
• palpable supraclavicular nodes

Question 22

dx of BCA

Answer 22

• combo of PE, mammo, and fine-needle/stereotactic core needle bx
• US and excisional bx may be indicated
• bx need to undergo estrogen and progesterone receptor analysis and histologic analysis

Question 23

tx of BCA

Answer 23

-stage before tx
o Breast conservation therapy (lumpectomy), modified radical mastectomy, and partial mastectomy have equivalent survival rates when surgery is followed by radiation therapy
o Adjuvant chemotherapy and/or hormonal manipulation benefit some women
o Tamoxifen is used to treat women with estrogen receptor-positive disease and postmenopausal women