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EndoRepro 2 Exam 1 > Clin: Normal/Abnormal Breast - Wooton > Flashcards

Clin: Normal/Abnormal Breast - Wooton Flashcards

1
Q

what hormone is responsible for growth of adipose tissue and lactiferous ducts?

A

estrogen

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2
Q

what hormone is responsible for stimulation of lobular growth and alveolar budding?

A

progesterone

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3
Q

what is polythelia?

A

extra nipples

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4
Q

what is polymastia?

A

accessory breast

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5
Q

what are the two most common breast complaints?

A
  • breast pain

- mass

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6
Q

what are the main risk factors for breast cancer?

A
  • hx of atypical hyperplasia
  • high breast tissue density
  • early menarche, late menopause
  • no term pregnancies
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7
Q

what are the BI-RADS categories?

A

1: negative
2: benign
3: probably benign
4: suspicious (>2 but <95% likelihood of malignancy)

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8
Q

when would you use an ultrasound on breast tissue?

A

best for evaluating young women (<40) and others with dense breast tissue
- allows you to differentiate between cystic versus solid lesions as well as show solid tissue within or adjacent to a cyst that may be malignant

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9
Q

when would you use an MRI for breast tissue?

A
  • useful adjunct to dx mammography in suspicious masses
  • used post cancer dx for further evaluation
  • women at high risk for breast cancer like BRCA carriers
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10
Q

when would you perform FNAB on breast tissue?

A
  • to determine solid versus cystic mass

NOTE: if cyst reappears or does not resolve with aspiration-dx mammogram/US -> perform biopsy

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11
Q

when would you perform a core needle biopsy?

A

to get tissue from larger solid masses for diagnosis

- 3-6 samples about 2 cm long are obtained

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12
Q

breast pain not associated with menstrual cyce

  • includes tumors, mastitis, cysts
  • can be associated with some medications (antidepressants, antihypertensives, hormonal meds)
A

noncyclic mastalgia

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13
Q

benign breast disease caused by chest wall trauma, shingles, fibromyalgia

A

extramammary mastalgia

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14
Q

what is the only FDA approved tx for mastalgia?

A

danazol
- unpleasant SA’s: menstrual irregularities, benign intracranial HTN, alters blood sugar, deepens voice, unusual hair growth

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15
Q

what can help with symptom relief of mastalgia?

A

properly fitting bra, weight reduction, exercise, decrease caffeine intake and vitamin E supplementations, evening of primrose oil

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16
Q

milky discharge common with childbearing, but may indicate hyperprolactinemia or hypothyroidism or medication related (oral contraceptives or psychotropics)
- usually benign

A

nipple discharge

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17
Q

what is always considered cancer until proven otherwise?

A

bloody nipple discharge

  • concern for intraductal carcinoma or invasive ductal carcinoma
  • could be benign intraductal papilloma
  • evaluated with breast ductography, requires ductal excision
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18
Q

when are breast masses a concern for malignancy?

A
  • greater than 2cm
  • immobility
  • poorly defined margins
  • firmness
  • skin dimpling/retraction/color changes
  • bloody nipple discharge
  • ipsilateral lymphadenopathy
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19
Q

what are the three categories of benign breast masses?

A
  1. non-proliferative (RR of developing cancer=1)
  2. proliferative without atypia (RR = 1.5-2)
  3. proliferative with atypia (RR = 8-10)
20
Q

fibrocystic changes in 50% of women

  • lobules of breast dilate and form cysts -> cysts rupture and result in scarring and inflammation
  • adenosis-lobular growth with increased number of gland
  • lactational adenomas d/t hormonal response
A

non-proliferative breast mass

21
Q

what is the most common benign tumor in female breast?

A

fibroadenoma

  • usually late teens - early 20’s
  • solid, rubbery, mobile and typically solitary
  • typically 2-4cm in size
22
Q

cystic dilation of duct filled with milky fluid

  • occurs near time of lactation
  • secondary infection may produce acute mastitis
  • typically can be needle aspirated
A

galactocele

23
Q

usually NOT palpable, usually found on imaging

  • epithelial hyperplasia, overgrowth of cells that line ducts
  • sclerosing adenosis: increasing fibrosis within breast lobules
  • complex sclerosing lesions (radial scar) - tubules trapped in a dense stroma surrounded by radiating arms of epithelium
  • papillomas
A

proliferative WITHOUT atypia

24
Q

when malignant cells replace the normal epithelium lining the ducts or lobules (CIS)

  • LCIS: not a precursor to breast cancer but risk factor
  • DCIS: ducts are filled with atypical epithelial cells and women are increased risk for developing invasive disease or reoccurrence of DCIS
  • both treated with excision and then followed by tx with selective estrogen receptor modulators
A

proliferative lesions WITH atypia

25
Q

what is the most common malignancy in women besides skin cancer?

A

breast cancer

- second leading cause of cancer related deaths in US

26
Q

what is the lifetime risk of developing breast cancer? lifetime risk of dying from breast cancer?

A

1: 8
1: 28

27
Q

about half of early onset breast cancers, 90% of hereditary ovarian cancers

A

BRCA1

28
Q

about 35% of early onset breast cancer, much lower risk of ovarian cancer

A

BRCA2

29
Q

why does being overweight increase your risk of developing breast cancer?

A

increased conversion of androstenedione to estrone

30
Q

70-80% of all breast cancers

  • most common in women in their 50’s
  • spread to regional lymph nodes
A

ductal breast cancer

31
Q

5-15% of breast cancers

- more likely to be multifocal or bilateral

A

lobular

32
Q

Pagets disease presents as superficial skin lesion

  • 3% of breast cancers
  • looks like mastitis
A

nipple cancer

33
Q

1-4% of breast cancers

- swelling and redness of underlying skin and induration of surrounding tissues

A

inflammatory breast cancer

34
Q

what stage:

total mastectomy or breast conservation therapy (includes lumpectomy and breast irradiation)

A

stage 0

35
Q

what stage:
total mastectomy or breast conservation therapy
- sentinel node biopsy/axillary lymph node dissection

A

stage I

36
Q

what stage:
modified radical mastectomy or breast conservation therapy
- tx: chemo and tamoxifen

A

stage II

37
Q

what stage:
modified radical mastectomy or breast conservation therapy
- axillary lymph node dissection
- tx: chemo, radiation, tamoxifen

A

stage III

38
Q

what stage:
surgery for local control
- tx: chemo, hormonal agents

A

stage IV

39
Q

what is used in addition to staging to determine prognosis?

A

receptor status: estrogen, progesterone

40
Q

what is considered a worse prognosis and is found in 20-30% of invasive cancers?

A

HER2/neu (oncogene)

41
Q

what therapy is used in all stages, and reduces risk of reoccurrence by 1/3 and reduces risk of death by 30%?

A

medical therapy

42
Q

what is the increased risk seen with tamoxifen?

A

increased risk endometrial cancer

- is an estrogen antagonist, reduced risk of cancer in the contralateral breast as well

43
Q

what therapy prevents production of estrogen in postmenopausal women?

A

aromatase inhibitors (Arimedex, Femara)

44
Q

what therapy acts on protein made by HER2/nue

- side effects include HEART FAILURE, respiratory problems, serious allergic reactions

A

trastuzumab (Herceptin)

think she likes this one

45
Q

what is the treatment follow up after breast cancer?

A

first 2 years after dx: every 3-6 months

  • annually after first 2 years
  • most reoccurrences will happen within first 5 years after tx

EndoRepro 2 Exam 1 (25 decks)

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