Diseases of the Breast Flashcards
Mammography
Not a substitute for tissue dx
Regular screening at 40 (earlier if family hx) but not before 20 (too dense) or lactation
Core biopsy can be done guided by mamo or U/S
Fibroadenoma
Young women (teens/early 20s)
Firm, rubbery, movable mass
FNA or U/S dx
Removal is optional
Giant juvenile fibroadenoma
Seen in young adolescents
Very rapid growth
Removal needed to prevent deformity/ distortion of breast
Cystosarcoma phyllodes
Seen in late 20s
Grow over many years
Become very large replacing and distorting breast
Not invading or becoming fixed
Most are benign but have potential for malignant sarcoma
Core or incisional biopsy (FNA not sufficient)
Removal mandatory
Fibrocystic Disease
Seen in 30-40 (goes away w/ menopause)
Bilat tenderness related to cycle-worse last 2wks
Multiple lumps that come and go (cysts) and follow cycle
No dominant cyst (if so, r/o tumor)
Aspiration- if clear then finished; if persists after multiple aspirations-biopsy
If bloody fluid-cytology
Intraductal papilloma
20-40s
Bloody nipple discharge (most common cause)
Mammogram to r/o other lesions
Galactogram may dx & guide resection
Breast abscess
Seen only in lactating women (if not, cancer until proven otherwise
I&D needed w/ biopsy of abscess wall
Breast cancer
Suspect in any woman w/ palpable mass
Suspicion goes up w/ age
Indicators: ill defined fixed mass; retraction of skin; orange peel skin; nipple retraction; eczematoid lesions of areola; palpable axillary nodes
Radiology: irregular area of increased density w/ microcalcifications
Breast cancer during pregnancy
If early, regular tx, just no radiation
No chemo during 1st trimester
Termination not necessary
Treatment of resectable breast cancer
Lumpectomy plus axillary sampling w/ postop radiation
Modified radical mastectomy w/ axillary sampling
Infiltrating ductal carcinoma
Standard form of breast cancer
Inflammatory variant has much worse prognosis
Lobular, medullary, and mucinous have better prognosis
Lobular has higher incidence of bilaterality but not enough to justify bilat mastectomy
Ductal carcinoma in situ
Cannot metastisize, but high incidence of recurrence if only local excision
Total simple mastectomy recommended for multicentric lesions
Multicentric disease often gets sentinel node biopsy due to possible missed disease
Lumpectomy followed by radiation if lesion confined to 1 quarter of breast
Inoperable cancer of the breast
Chemo and maybe radiation- sometimes becomes operable
Operability determined by local extent
Adjuvant systemic therapy
Should follow in virtually all, esp if axillary nodes positive
Chemo in most cases
Hormone therapy if receptor positive
Premenopausal get tamoxifen; postmenopausal get anastrozole
