EXAM #1: BENIGN/MALIGNANT BREAST DISEASE Flashcards
What should you do if there is a thickening of breast tissue on breast exam?
Re-eval in 2-3 months
What should you do if there is a clinically benign mass on breast exam?
Imaging
What should you do if there is a clinically suspicious mass on breast exam?
Imaging + biopsy
If a discrete mass is found on breast exam, what should you do?
- Under 40, US
- Over 40, Mammogram
If a discrete mass is found on mammogram and is clinically suspicious, what should you do?
Core needle biopsy
What is duct ectasia?
Inflammation with dilation of subareolar ducts
How does duct ectasia typically present?
- More common in multiparous postmenopausal women
- Green-brown nipple discharge
If you can’t determine if a breast cyst is cystic or solid, what should you do?
FNA
If no fluid can be obtained on FNA of a potential breast cyst, what should you do?
Core biopsy
If mastitis is caused by MRSA, what is the proper treatment?
1) Aspirate/drain
2) TMP/SMX or Vancomycin
What is a fibroadenoma?
Tumor of fibrous tissue and glands
How does fibroadenoma present?
Well-circumscribed, mobile, marble-like mass
What is the most common benign neoplasm of the breast?
Fibroadenoma (esp. in premenopausal women)
What is a lactating adenoma?
Benign stromal tumor seen in 3rd trimester of pregnancy through the time of lactation
What drug can be used to treat lactating adenoma?
Bromcriptine
What is the most common cause of bloody nipple discharge in premenopausal women?
Itraductal papilloma
*Fibrovascular projections lined by epithelial and myoepithelial cells that bleed
What must intraducal papilloma be distinguished from?
Papillary carcinoma
How is intraductal papillloma treated?
Excision
What is atypical ductal hyperplasia?
Hyperplasia of the cells lining the ducts in the TDLU
*Considered a step toward DCIS, increases risk of breast cancer 5x
What is atypical lobular hyperplasia?
Hyperplasia of the cells lining the lobules in the TDLU
*Considered a step toward LCIS, increases risk of breast cancer 5x
What is fibrocystic change in the breast? How does this present?
Development of fibrosis and cysts in the breast that presents as a “lumpy” breast (esp. in the upper outer quadrant)
*Varies with hormonal cycle
What are the treatment options for fibrocystic breast change?
1) D/c contrceptives/hormone replacement therapy OR switch to lowest possible dose
2) D/c caffiene
3) Reassurance
What is Mondor’s Disease?
Phlebitis of the throaco-epigastic vein
What is the most common carcinoma in women by indidence?
Breast
What are the risk factors for breast cancer?
1) Female
2) Age (post-menopausal)
3) Early menarche/late menopause
4) Obesity
5) Atypical hyperplasia
6) First-degree relative with breast cancer
What assessment tool can be used to calculate risk in breast cancer?
Gail risk assessment score (1.67= high risk)
What clinical features suggest hereditary breast cancer?
1) Multiple-first degree relatives with breast cancer
2) Tumor at early age (45 y/o or pre-menopausal)
3) Multiple tumors in single patient
Also,
- Triple receptor negative under 60 y/o
- Personal history of ovarian cancer
- Family history of male breast cancer (BRCA2)
What is the most common type of breast cancer?
Invasive ductal carcinoma
What is the difference between Grade 1, 2, and 3 breast cancer?
Grade 1= well differentiated/ slow growing
Grade 2= moderate
Grade 3= poor differentiation/fast growing
What type of cancer is Tamoxifen used to treat?
ER+
What type of cancer is Trastuzumab (Herceptin) used to treat?
HER2/Neu+
What is the receptor status of most invasive breast cancer?
ER/PR+ and HER2/neu-
What is inflammatory breast cancer?
Carcinoma that invades the dermal lymphatics causing the classic “Peau d’ orange”
How is inflammatory breast cancer distinguished from acute mastitis?
No response to antibiotics
How can inflammatory breast cancer diagnosis be confirmed?
Punch biopsy
Clinically, what is important about medullary, mucinous, papillary, and tubular breast cancer?
Better prognosis that invasice ductal carcinoma
What is Paget’s Disease?
DCIS that extends to the nipple
*Presents as nipple ulceration and erythema
What is the current screening recommendation for breast cancer?
- 25-40 y/o Q1-3 year clinical breast exam
- 40+ y/o is annual breast exam and mammography
Define BI-RADS 1.
Normal
Define BI-RADS 2.
Benign finding
Define BI-RADS 3.
Probably benign–recommend short follow-up
Define BI-RADS 4.
Suspicious for malignancy
Define BI-RADS 5.
Strongly suggestive for malignancy
Define BI-RADS 6.
Imaging patient with known malignancy
What is the single most important prognositc factor in breast cancer?
Axillary lymph nodes
What is the sentinal lymph node?
First lymph node in the chain of drainage
What has sentinal lymph node biopsy prevented?
Lymphedema
What should you do if the sentinal lymph node is positive?
Axillary lymph node dissection
What is the current recommendation for surgical intervention for breast cancer?
Overall survival is equal between lumpectomy + radiation compared to radical mastectomy
*Recurrence rate is higher with lumpectomy, but can be prevented with appropriate surveillance
Is contralateral prophylaxtic mastectomy recommended for patients without BRCA mutations?
No–there is no advantage
