Clin: Normal/Abnormal Breast - Wooton Flashcards
what hormone is responsible for growth of adipose tissue and lactiferous ducts?
estrogen
what hormone is responsible for stimulation of lobular growth and alveolar budding?
progesterone
what is polythelia?
extra nipples
what is polymastia?
accessory breast
what are the two most common breast complaints?
- breast pain
- mass
what are the main risk factors for breast cancer?
- hx of atypical hyperplasia
- high breast tissue density
- early menarche, late menopause
- no term pregnancies
what are the BI-RADS categories?
1: negative
2: benign
3: probably benign
4: suspicious (>2 but <95% likelihood of malignancy)
when would you use an ultrasound on breast tissue?
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
when would you use an MRI for breast tissue?
- 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
when would you perform FNAB on breast tissue?
- to determine solid versus cystic mass
NOTE: if cyst reappears or does not resolve with aspiration-dx mammogram/US -> perform biopsy
when would you perform a core needle biopsy?
to get tissue from larger solid masses for diagnosis
- 3-6 samples about 2 cm long are obtained
breast pain not associated with menstrual cyce
- includes tumors, mastitis, cysts
- can be associated with some medications (antidepressants, antihypertensives, hormonal meds)
noncyclic mastalgia
benign breast disease caused by chest wall trauma, shingles, fibromyalgia
extramammary mastalgia
what is the only FDA approved tx for mastalgia?
danazol
- unpleasant SA’s: menstrual irregularities, benign intracranial HTN, alters blood sugar, deepens voice, unusual hair growth
what can help with symptom relief of mastalgia?
properly fitting bra, weight reduction, exercise, decrease caffeine intake and vitamin E supplementations, evening of primrose oil
milky discharge common with childbearing, but may indicate hyperprolactinemia or hypothyroidism or medication related (oral contraceptives or psychotropics)
- usually benign
nipple discharge
what is always considered cancer until proven otherwise?
bloody nipple discharge
- concern for intraductal carcinoma or invasive ductal carcinoma
- could be benign intraductal papilloma
- evaluated with breast ductography, requires ductal excision
when are breast masses a concern for malignancy?
- greater than 2cm
- immobility
- poorly defined margins
- firmness
- skin dimpling/retraction/color changes
- bloody nipple discharge
- ipsilateral lymphadenopathy
what are the three categories of benign breast masses?
- non-proliferative (RR of developing cancer=1)
- proliferative without atypia (RR = 1.5-2)
- proliferative with atypia (RR = 8-10)
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
non-proliferative breast mass
what is the most common benign tumor in female breast?
fibroadenoma
- usually late teens - early 20’s
- solid, rubbery, mobile and typically solitary
- typically 2-4cm in size
cystic dilation of duct filled with milky fluid
- occurs near time of lactation
- secondary infection may produce acute mastitis
- typically can be needle aspirated
galactocele
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
proliferative WITHOUT atypia
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
proliferative lesions WITH atypia
what is the most common malignancy in women besides skin cancer?
breast cancer
- second leading cause of cancer related deaths in US
what is the lifetime risk of developing breast cancer? lifetime risk of dying from breast cancer?
1: 8
1: 28
about half of early onset breast cancers, 90% of hereditary ovarian cancers
BRCA1
about 35% of early onset breast cancer, much lower risk of ovarian cancer
BRCA2
why does being overweight increase your risk of developing breast cancer?
increased conversion of androstenedione to estrone
70-80% of all breast cancers
- most common in women in their 50’s
- spread to regional lymph nodes
ductal breast cancer
5-15% of breast cancers
- more likely to be multifocal or bilateral
lobular
Pagets disease presents as superficial skin lesion
- 3% of breast cancers
- looks like mastitis
nipple cancer
1-4% of breast cancers
- swelling and redness of underlying skin and induration of surrounding tissues
inflammatory breast cancer
what stage:
total mastectomy or breast conservation therapy (includes lumpectomy and breast irradiation)
stage 0
what stage:
total mastectomy or breast conservation therapy
- sentinel node biopsy/axillary lymph node dissection
stage I
what stage:
modified radical mastectomy or breast conservation therapy
- tx: chemo and tamoxifen
stage II
what stage:
modified radical mastectomy or breast conservation therapy
- axillary lymph node dissection
- tx: chemo, radiation, tamoxifen
stage III
what stage:
surgery for local control
- tx: chemo, hormonal agents
stage IV
what is used in addition to staging to determine prognosis?
receptor status: estrogen, progesterone
what is considered a worse prognosis and is found in 20-30% of invasive cancers?
HER2/neu (oncogene)
what therapy is used in all stages, and reduces risk of reoccurrence by 1/3 and reduces risk of death by 30%?
medical therapy
what is the increased risk seen with tamoxifen?
increased risk endometrial cancer
- is an estrogen antagonist, reduced risk of cancer in the contralateral breast as well
what therapy prevents production of estrogen in postmenopausal women?
aromatase inhibitors (Arimedex, Femara)
what therapy acts on protein made by HER2/nue
- side effects include HEART FAILURE, respiratory problems, serious allergic reactions
trastuzumab (Herceptin)
think she likes this one
what is the treatment follow up after breast cancer?
first 2 years after dx: every 3-6 months
- annually after first 2 years
- most reoccurrences will happen within first 5 years after tx
