Ch. 3 New Palpable Mass in Right Breast Flashcards
What is the most likely dx?
Invasive breast cancer
- Postmenopausal woman with a new palpable breast mass that is non-tender, hard, ill defined, immobile, and in upper outer quadrant
- Risk factors for breast cancer:
- family hx in 1st-degree relative
- early menarche
Benign conditions in differential diagnosis of palpable breast mass (6)
Malignant Lesions in differential dx of palpable breast mass (6):
Relative Risk (RR) for breast cancer
What histologic features of fibrocystic changes are associated with increased risk for cancer?
- Most changes are benign
- Apocrine metaplasia = NO increased risk
- Ductal hyperplasia or sclerosing adenosis = 2x
- Atypical hyperplasia = 5x
What is the pathophysiology of “Peau d’Orange”?
Treatment?
When lymph drainage in the breast is compromised by a tumor, it can result in edema expanding the interfollicular dermis –> produce characteristic dimples which resemble the texture and appearance of orange peels
This finding is most commonly seen in inflammatory carcinoma
**FULL-THICKNESS, PUNCH BIOPSY OF DERMIS = ESSENTIAL FOR DEFINITIVE DX
Treatment: neoadjuvant chemo, surgery, radiation
What is the pathophysiology of nipple retraction?
Suspensory ligaments of the breast = Cooper’s ligaments
When a breast tumor infiltrates these ligaments, it can retract the skin, often at or around the nipples
Workup:
What is the triple test for a new breast mass?
- PE
- Imaging
- Tissue sampling
Each test is classified as benign (1 pt), suspicious (2 pts), or malignant (3 pts). A range from 3 to 9 can help stratify pts into groups that are likely benign to a high likelihood of malignancy.
What are the different tumor markers for breast cancer and how are they utilized?
- CA 15-3
- CA 27.29
- CEA
Not used routinely as not all pts with breast cancer have elevated levels
Poor sensitivity and specificity making them poor choices for screening tools
How to diagnose:
- Apply triple test to all new breast masses:
* Negative for estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER-2) receptors - Imaging
- <30 y/o - US
- >30 y/o - mammogram + US
- FNA cannot accurately differentiate in situ from carcinoma thus core needle biopsy is better
- Metastatic workup for clinically early stage reast cancer: CXR, liver chemistries, AP
Mgmt:
What surgical options are available for pts with Stage I and II breast cancers?
Two basic options:
Breast-conserving therapy (BCT) = lumpectomy (partial mastectomy) + sentinel lymph node biopsy (SLNB) followed by radiation therapy (to decrease risk of local recurrence)
vs.
Simple mastectomy + SLNB only
What are the boundaries in the axilla for breast dissection?
4 boundaries:
- Axillary vein (superior)
- Floor of axilla/long thoracic n. (posterior)
- Latissimus dorsi m. (lateral)
- Pectoral minor m. (medial)
What is the purpose of axillary lymph node dissection? Does it affect survival?
Used for staging of breast cancer; removing the lymph nodes per se has not been shown to improve survival
What are the options for hormonal therapy, and what is the premise behind it?
What study must be done prior to starting trastuzumab?
Cancers that are ER+ or PR+ = candidates for hormonal therapy
Since there is a high risk of CM in pts receiving trastuzumab, it is recommended that all patients receive an echo or MUGA scan to determine their EF.
Drugs:
- Tamoxifen for pre-menopausal ER+
- Anastrozole for post-menopausal ER+
- Most pts receive chemo
- Exception: small (<1 cm) tumors with favorable hormonal and molecular characteristics and SLNB negative
Why are aromatase inhibitors only effective in postmenopausal women?
AI work by inhibiting aromatase, located in fat tissue, which is responsible for making small amounts of estrogen in postmenopausal women.
AI are only effective in women with ovaries that have stopped producing estrogen, which occurs after menopause. The primary source of estrogen for these women is that which is produced in fat cells.
Chemotherapeutic regimens for breast cancer
What nerves are at risk for damage during dissection?
