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Breasts Flashcards

1
Q

What are the three methods of CBE?

A

circular, wedge, vertical strip

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2
Q

The benign conditions

A

fibrocystic breasts, fibroadenoma, nipple discharge, fat necrosis, breast abcesses

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3
Q

What is the most frequent lesion of the breast?

A

fibrocyst

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4
Q

What age range is a fibrocystic breast common?

A

30-50

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5
Q

What two substances are related to fibrocysts?

A

estrogen and alcohol

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6
Q

Describe the physical findings of a simple breast cyst

A

fluid filled round or oval, derived from the terminal duct lobular unit, presents as a single or multiple mass, may fluctuate in size, number and mag of sx (pain depending on cycle)

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7
Q

What will fibrocystic breasts increase your risk for?

A

Breast cancer

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8
Q

Symptoms of fibrocystic breast?

A

painful, often multiple, usually bilateral masses, rapid fluctuation of size, pain increases during premenstrual phase, serous discharge

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9
Q

What does bloody nipple discharge indicate?

A

cancer

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10
Q

What is diagnostic test for fibrocystic breast?

A

U/S not mammogram, FNA if indicated

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11
Q

Treatment of fibrocystic breast

A

watch for alarming signs, avoid trauma, wear supportive bra, Danazol (100-200 mg po BID for pain), oil of evening primrose, tamoxifen, low fat diet

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12
Q

What is the most common in women ~20 years after puberty?

A

fibroadenoma, but earlier in african americans

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13
Q

How much does your risk of cancer increase with fibroadenomas?

A

1.5-2 times

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14
Q

Characteristics of fibroadenoma?

A

round or ovoid, rubbery, discrete, movable, nontender mass, 1-5 cm

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15
Q

What is the treatment of fibroadenoma?

A

FNA to r/o other etiologies, cryoablation

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16
Q

What is phyllodes tumor?

A

a type of fibroadenoma, can be bening or malignant, should remove, sometimes mastectomy

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17
Q

Why is it important to take care of phyllodes tumors ASAP?

A

can metastasize to the lung

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18
Q

The most common causes of nipple discharge?

A

duct ectasia, intraductal papilloma, carcinoma

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19
Q

Types of discharge?

A

serous, bloody, green or brown

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20
Q

What can of fluid will occur with intraductal papilloma?

A

serous

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21
Q

What type of discharge is associated with premenopause?

A

green or brown

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22
Q

What is associated with milky discharge?

A

hyperprolactinemia, pregnancy

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23
Q

What is associated with purulent discharge?

A

subareolar abcess

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24
Q

What should be done when pt has nipple discharge?

A

watch and reexamine every 3-4 months if benign, check TSH/prolactin levels, d/c any OCP or antipsychotics, remove tumor or abcess

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25
How should discharge be examined?
ductoscopy
26
What is a rare lesion of the breast that is accompanied by skin or nipple retraction?
fat necrosis
27
What is indistinguishable from carcinoma on imaging?
fat necrosis
28
What is the most likely cause of fat necrosis?
trauma
29
When is it common to see fat necrosis?
pt after segmental resection, radiation therapy, flap reconstruction after mastectomy
30
When do breast abscesses develop?
when mastitis or cellulitis does not respond to abx, during nursing
31
What is the most common organism in breast abscesses?
staph aureus
32
What should be done if abscess found in non-lactating breast?
this is very rare so inflammatory carcinoma must be explored, will recur after I&D so excise laciferous duct
33
How to treat abscess?
needle aspiration and drainage, surgical drainage, if pus thick use 17-19 gauge needle to dilute, reexamine every 2-3 days, can use U/S to visualize cavity, abx
34
What kind of abx do you use for abscesses?
10-14 days, dicloxacillin 500 mg QID or cephalexin 500 mg QID, if beta lactam hypersensitive- clindamycin 300-450 TID, if MRSA- Bactrim 1-2 tabs BID/ clindamycin 300-450 TID, if severe- Vanco 15-20 mg/kg BID-TID
35
What is the average age of Breast cancer
61
36
how many women develop breast cancer?
1 in 8
37
What are risk factors of developing breast cancer?
early menarche, late menopause, ashkenazi jew, delayed child bearing, positive fam hx, genetic, personal hx
38
What are the early findings of breast cancer?
single, nontender, firm mass, ill defined margins
39
What are the later findings of breast cancer?
skin or nipple retraction, axillary lymphadenopathy, breast enlargement, erythema, edema, pain, fixation of mass to skin or chest wall
40
what is ductal carcinoma in situ?
heterogeneous group of neoplastic lesions confined to the breast ducts and lobules that differ in histologic appearance and biological potential
41
What is the goal of therapy in ductal carcinoma in situ?
prevent occurence of invasive br ca
42
What appears as microcalcifications on mammogram?
ductal carcinoma in situ
43
what is a microinvasive carcinoma?
stromal invasion by tumor cells invading basement membrane, measures more than 1mm, present w/ DCIS
44
What is the prognosis of microinvasive cancer?
good, 97-100% survival rate
45
What is atypical ductal hyperplasia?
proliferation of uniform epithelial cells with monomorphic round nuclei filling part, but not all of involved duct, include both ductal and lobular hyperplasia
46
What is the risk of subsequent breast cancer?
3.7-5.3 relative risk
47
what is lobular carcinoma in situ?
noninvasive lesion that arises from the lobules and terminal ducts of breasts, usually incidental finding
48
How does LCIS differ from DCIS?
regards to radiologic features, morphology, biologic behavior and anatomic distribution in the breast
49
What is BRCA 1?
on chromosome 17, ca develops in 85%, pts recommended to have double mastectomy
50
What is BRCA 2?
chomosome 13, CA develops in 1%, more likely to develop cancer in other breast if has developed in one already, so bilateral mastectomy is recommended
51
When should mammograms be performed?
after 50 yo up to 74 then evaluate life expectancy, every two years
52
What are the two general categories of br ca?
soft tissue masses, and clustered microcalcifications
53
How frequent are microcalcifications?
they are seen in about 60% of Ca detected by mammogram, associated with 1/3 of invasive carcinomas
54
What labs should you do for br ca?
ESR, ALP, Ca, CEA and CA 15-3 or CA 27-29
55
What imaging should be done for br ca?
mammogram, U/S, CT, bone scan
56
Biopsy info
all suspicous lesions- 60% are benign, FNA cytology- aspirated with minimal risks and less expensive, core biopsy, open biopsy
57
Other testing for Br Ca?
estrogen receptor, progesterone receptor, HER-2/neu overexpression, if ER and PR are positive- better prognosis
58
What are s/sx of paget's disease of the breast?
itching, burning of nipple, superficial erosion or ulceration that is eczema-like on nipple and areola w/ copious clear yellowish exudate
59
Why is paget's disease usually not diagnosed right away?
it is confused with dermatitis or bacterial infection
60
How is paget's disease diagnosed?
detailed hx, nipple scrape cytology or full thickness wedge or punch biopsy of the nipple, bilateral mammography
61
What's the hallmark of paget's
malignany, intraepithelial adenocarcinoma cells occurring singly or in small groups within the epidermis of the nipple
62
How is paget's disease treated?
stage according to underlying mass, simple mastectomy, folllow guidlines for br ca, prognosis dependent on if palpable mass was present and if there was LN involvement
63
What is the most common breast cancer in males?
invasive ductal carcinomas, hormone receptor-positive
64
How does male breast cancer present?
painless, firm mass that is usually subareolar with nipple involvement ranging between 40-50%, less than 1% is bilateral
65
What type of biopsy should be preformed for male breast cancer?
core needle biopsy, not FNA because it won't provide enough sample
66
What is affective for 5 year survival in male cancer?
tamoxifen

Clinical medicine (19 decks)

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