BREAST MASS-FEMALE BREAST CARCINOMA Flashcards
Incidence of a female with breast carcinoma
(a) One in eight American women
(b) Second most common cancer in women
(c) Second leading cause of cancer death
Risk factors of a female with breast carcinoma
Age
1) Most significant risk factor
2) Risk rises rapidly until early 60s, peaks in 70s, then declines
Risk factors of a female with breast carcinoma
Family history of breast or ovarian cancer
1) Parent, sibling, or child
2) Especially bilateral breast cancer or premenopausal
Risk factors of a female with breast carcinoma
Genetics
BRCA 1, BRCA 2, and other mutations
Risk factors of a female with breast carcinoma
Reproductive history
Nulliparous or late first pregnancy (after age 30)
Risk factors of a female with breast carcinoma
Menstrual history
1) Early menarche (under age 12)
2) Late menopause (after age 55)
Risk factors of a female with breast carcinoma
Previous medical history
1) Endometrial cancer
2) Fibrocystic changes
3) Cancer in the other breast
Most reliable means of detecting breast cancer before a mass can be palpate
(a) Mammography screening
(T/F)MRI and ultrasound may be useful to those who are at high risk
True
Breast self-examination tidbits
1) Has not shown to improve survival
2) American Cancer Society no longer recommended
3) Patients should recognize and report any breast changes.
Signs and symptoms
of a female with breast carcinoma
(a) Early symptoms
1) 70% of patients present with a (usually) painless lump
a) About 90% of these are discovered by the patient
(b) Less frequent symptoms
1) Breast pain
2) Nipple discharge
3) Erosion, retraction, enlargement, or itching of the nipple
4) Redness, generalized hardness, enlargement, or shrinking of the breast
(c) Rarely
1) Axillary mass or swelling
2) Back or joint pain
3) Jaundice
4) Weight loss
Physical exam
of a female with breast carcinoma
1) Early
a) Single, nontender, firm to hard mass with ill-defined margins;
b) Mammographic abnormalities and no palpable mass
2) Late
a) Skin or nipple retraction;
b) axillary lymphadenopathy;
c) breast enlargement, erythema, edema, pain;
d) fixation of mass to skin or chest wall.
Differential diagnosis
of a female with breast carcinoma
(a) In descending order of frequency:
1) Fibrocystic condition
2) Fibroadenoma
3) Intraductal papilloma
4) Lipoma
5) Fat necrosis
Laboratory findings of a female with breast carcinoma
(a) Alkaline phosphatase
1) Liver or bone metastases cause elevation
(b) Serum calcium
1) Elevated with bone metastases
Imaging of a female with breast carcinoma
(a) Primary lesion
1) Mammography, diagnostic
a) Essential when abnormality is only felt by patient
(b) Ultrasound
(c) MRI
1) Not for average risk patient
a) False negative rate of about 3-5%
Diagnostic tests of a female with breast carcinoma
(a) Core needle biopsy
1) Diagnostic procedure of choice in both palpable and image
detected abnormalities
2) Biopsy examination of all suspicious lesions found on physical
examination or mammography, or both
3) Can be image guided
Treatment of a female with breast carcinoma
(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
a) Breast conserving therapy (partial mastectomy)
b) Mastectomy
2) Radiation
3) Systemic therapy
a) Chemotherapy
b) Targeted therapy
c) Bisphosphonates
Prognosis of a female with breast carcinoma
(a) Stage of cancer is most reliable indicator of prognosis
(b) More aggressive are associated with worse outcomes in younger women
Follow Up of a female with breast carcinoma
(a) After primary therapy, patients should be monitored long term in order to detect
recurrences.
(b) Local and distant recurrences occur most frequently within the first 2-5 years.
1) During the first two years, most patients should be examined every 6 months
2) Annually thereafter
(c) Special attention to the contralateral breast
1) A new primary breast malignancy will develop in 20-25% of patients
