BREAST MASS-FEMALE BREAST CARCINOMA

Question 1

Incidence of a female with breast carcinoma

Answer 1

(a) One in eight American women
(b) Second most common cancer in women
(c) Second leading cause of cancer death

Question 2

Risk factors of a female with breast carcinoma

Age

Answer 2

1) Most significant risk factor

2) Risk rises rapidly until early 60s, peaks in 70s, then declines

Question 3

Risk factors of a female with breast carcinoma

Family history of breast or ovarian cancer

Answer 3

1) Parent, sibling, or child

2) Especially bilateral breast cancer or premenopausal

Question 4

Risk factors of a female with breast carcinoma

Genetics

Answer 4

BRCA 1, BRCA 2, and other mutations

Question 5

Risk factors of a female with breast carcinoma

Reproductive history

Answer 5

Nulliparous or late first pregnancy (after age 30)

Question 6

Risk factors of a female with breast carcinoma

Menstrual history

Answer 6

1) Early menarche (under age 12)

2) Late menopause (after age 55)

Question 7

Risk factors of a female with breast carcinoma

Previous medical history

Answer 7

1) Endometrial cancer
2) Fibrocystic changes
3) Cancer in the other breast

Question 8

Most reliable means of detecting breast cancer before a mass can be palpate

Answer 8

(a) Mammography screening

Question 9

(T/F)MRI and ultrasound may be useful to those who are at high risk

Answer 9

True

Question 10

Breast self-examination tidbits

Answer 10

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

Question 11

Signs and symptoms

of a female with breast carcinoma

Answer 11

(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

Question 12

Physical exam

of a female with breast carcinoma

Answer 12

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.

Question 13

Differential diagnosis

of a female with breast carcinoma

Answer 13

(a) In descending order of frequency:
1) Fibrocystic condition
2) Fibroadenoma
3) Intraductal papilloma
4) Lipoma
5) Fat necrosis

Question 14

Laboratory findings of a female with breast carcinoma

Answer 14

(a) Alkaline phosphatase
1) Liver or bone metastases cause elevation
(b) Serum calcium
1) Elevated with bone metastases

Question 15

Imaging of a female with breast carcinoma

Answer 15

(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%

Question 16

Diagnostic tests of a female with breast carcinoma

Answer 16

(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

Question 17

Treatment of a female with breast carcinoma

Answer 17

(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

Question 18

Prognosis of a female with breast carcinoma

Answer 18

(a) Stage of cancer is most reliable indicator of prognosis

(b) More aggressive are associated with worse outcomes in younger women

Question 19

Follow Up of a female with breast carcinoma

Answer 19

(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