[CLMD] The normal and abnormal breast [Wootton] Flashcards
Normal anatomy of the breast
The breast is considered a modified ________gland
The breast is considered a modified SEBACEOUS gland
Most breast cancers occur where?
Upper outer qudrants
Which are the most common routes for metastasis of breast cancer?
Ipsilateral lymph node
Internal mammary nodes
GENERALLY what is a big worry that we have about breast cancer?
There is a HIGH concentration of lymph nodes that surround the breast. This makes it easy for one cancerous cell to spread quickly
What are 4 examples of congenital anomalies of the breast?
- Absence of the breast
- Accessory breast tissue along the milk line
- Extra nipples (polythelia)
- Accessory breast (polymastia)
What is the milk line?
2 most common breast complaints?
Breast pain
Mass
What are notable risk factors for breast cancer?
- Age
- Personal hx of breast cancer or atypical hyperplasia
- High breast tissue density
- First degree relatives w/ breast cancer or ovarian cancer
- Early menarche
- Late cessation of menses
- No term pregnancies
What is included in the physical exam of the breasts?
Evaluate both breasts
Complete exam including axilla and chest wall
What are diagnostic breast exams to perform?
Mammogram
Ultrasound
MRI
Fine needle aspiration
Core biopsy
Palpable masses almost always get a _______
Palpable masses almost always get a BIOPSY
What age is best suited for mammograms?
Women over 40
Ultrasonography is ideal as an imaging study in breast tissue for women aged…
YOUNGER than 40
When would you order an MRI for your patient?
Diagnostic in SUSPICIOUS MASSES
Too expensive to use as a screening method.
Use for women at high risk for breast cancer, like BRCA carriers
What is fine needle aspiration biopsy useful for?
Determining solid versus cystic masses
Describe what happens for follow up with fine needle aspiration with
Clear fluid
Bloody fluid
Clear fluid = needs no further evaluation
Bloody fluid = sent for cytology and patient needs diagnostic mammogram/US
What is a core needle biopsy used for?
LARGE NEEDLE
Used to get tissue from larger solid masses for diagnosis
What is the word for breast pain?
Mastalgia
What is the difference between cyclic and noncyclic MASTALGIA?
Cyclic mastalgia = coordinated w/ menstrual cycle
Noncyclic mastalgia = NOT associated with menstrual cycle
What is extramammary mastalgia?
Breast pain that derives from…
Chest wall trauma
Shingles
Fibromyalgia
What is the only FDA approved treatment for mastalgia?
Danazol
Why isn’t danazol prescribed much?
Unpleasant side effects:
Menstrual irregularities, benign intracranial hypertension, alters blood sugar, deepens voice, unusual hair growth, weight gain
Nipple discharge could indicate three things. What are they?
- Benign
- Endocrine disorder
- Cancer
___________ is considered cancer until proven otherwise
BLOODY NIPPLE DISCHARGE is considered cancer until proven otherwise
What are the signs for concern regarding breast masses?
Greater than 2cm in size
Immobility
Poorly defined margins
Firmness
Skim dimpling
Bloody nipple discharge
Ipsilateral lymphadenopathy
Fibroadenoma
Benign or metastatic?
Benign
Fibroadenomas
Frequency?
Age group?
Most common benign tumor in female breast
Late teens, early 20s
Fibroadenomas
Describe the mass:
Size:
Solid, rubbery, mobile and solitary
2-4cm in size, can reach up to 15cm in diameter
What is a galactocele?
Cystic dilation of duct filled w/ mikly fluid
Papillomas
What type of growth?
Age?
Can cause?
Intraductal growths
30-50yrs
Serous/serosanguinous discharge
What is
LCIS?
Lobular carcinoma in situ
–> risk factor for developing breast cancer
What is
DCIS?
Ductal carcinoma in situ
Ducts are filled with atypical epithelial cells and woman are increased risk for developing invasive disease or reoccurrence of DCIS
How are LCIS and DCIS treated?
Excision
then follow up with SERMs
What are the two genes that are high risk factors for developing breast cancer?
BRCA1
BRCA2
What is the model is used to evaluate cancer risk?
Gail Model
70-80% of all breast cancers are _______
70-80% of all breast cancers are ductal
What is the oncogene that gives a worse prognosis for breast cancer?
HER2/NEU
