CH 5 The Breast Flashcards
Carcinomas of female breasts: general considerations/risks
cancer of breast is most common CA of women (excluding skin CAs), chances of having breast CA in lifetime is 1 in 8 women; incidence highest in white patients. Risks increased with family hx in 1st degree relative, or genetic mutation (BRCA 1 and 2), Increased in nulliparous women and women whose 1st child is after age 30, early menarche (before age 12), late menopause (after age 50)
Staging
based on TNM (tumor, node, metastisis). helps determine prognosis
initial workup of Carcinomas of female breasts
diagnosed as result of abnormal mammogram and less often because of palpable mass. initial eval should include assessment of local lesion, including bilat mammo, and breast US. initial workup should include CBC, LFTs, and alkaline phosphatase
symptoms of Carcinomas of female breasts
take extensive history, back or other bone pain may be related to metastases. systemic complaints, weight loss. Mets most frequently affects bones, liver, and lungs. Look for lymph node involvement. Usually have painless mass, but may have breast pain, nipple discharge, redness, engorgement, hardness and breast shrinkage.
signs of Carcinomas of female breasts
abnormal variations of breast size and contour, nipple retraction, slight edema, redness, retraction of skin, dimpling, palpate enlarged nodes. CA usually nontender, firm or hard lump with poorly delineated margins caused by infiltration. nipple discharge (watery, serous, or bloody).
paget’s dz of the breast
eczematoid eruption and ulceration that arises from nipple, can spread to areola, and is associated with an underlying carcinoma. will have pain and itching or burning. Diagnosed with full thickness biopsy of lesion which reveal pathognomonic intraepithelial adenocarcinoma cells or paget cells within epidermis of nipple.
Mammography
breast imaging modality of choice and the only screening method that has consistently been found to decrease mortality of breast CA. They can catch some lumps 2 years before they would be palpatable. US and MRI used only as adjunct
Cytology
cytologic examination of nipple discharge or cyst fluid can help, but rarely. still will need biopsy
Breast Biopsy
safest course is biopsy exam of all suspicious masses found on physical exam and in absence of mass, of suspicious lesions on mammo. Simplest method done by fine needle aspiration but not diagnostic. Core needle biopsy and open surgical biopsies are needed. Do biopsy first and then give pt time to adjust to possible surgery
Lab findings for Carcinomas of female breasts
elevation in alkaline phosphatase, hypercalcemia or LFTs may be indicative of distant metastatic dz.
imaging studies for breast mets
CT and PET scans good for evaluation of possible mets.
Breast CA screening
mammography annually starting at age 40 (college of obgyn says every 1-2 years from age 40-49 then annually after). Genetic testing for BRCA1 and BRCA 2 genes
Histologic types of breast CA and occurence
invasive ductal: 80-85%, medullary: 3-6%, colloid (mucinous): 3-6%, tubular: 3-6%, papillary: 3-6%, invasive lobular: 4-10%
follow up care for treatment of breast CA
after primary treatment, these patients should be followed for life. detect recurrences and second primaries. Physical exam should be done every 4 months for 1st two years, then q 6 months until year 5, then annually. Do mammo 6 months after radiation is complete, and do CXR every year
Inflammatory carcinoma
aggressive form of breast cancer that is characterized by diffuse, brawny edema of the skin of the breast with an erysipeloid border, usually without an underlying palpable mass
