Exam 1 - Breast Disorders Flashcards
What are some reasons that you would order a breast ultrasound?
- Inconclusive MMG results
- Evaluate breast of young women
- Dense breast tissue
- Better differentiation between a solid and cystic mass
- Guiding tissue core-needle biopsies
Why would you order a fine-needle aspiration of the breast?
Useful in determining if a palpable lump is a simple cyst
Why would you order a core-needle biopsy of the breast?
Used to obtain samples from larger, solid breast masses
When does cyclical mastalgia occur and what is it due to?
Occurs during the luteal phase of the menstrual cycle due to fibrocystic changes
What clinical presentation is associated with cyclical mastalgia?
Bilateral and diffuse breast pain
What is a possible cause of noncyclical mastalgia?
Medication
What clinical presentation is associated with noncyclical mastalgia?
Unilateral or focal breast pain
What is the first-line treatment for mastalgia?
- If normal findings on exam and imaging, reassurance
- Physical support (underwire bra, sports bra)
- Analgesics (acetaminophen or NSAIDs)
In what population does mastitis most often occur in?
What bacteria is it most commonly caused by?
Most often occurs in lactating women.
Staphylococcus aureus
How does mastitis typically present?
Hard, red, tender, swollen area of one breast with possible fever
What is the treatment for mastitis?
What patient education should you include?
Dicloxicillin or cephalexin
Continue breastfeeding
What characteristics more commonly indicate a benign breast mass?
- Discrete margins
- No skin changes
- Smooth
- Soft to firm
- Mobile
What characteristics more commonly indicate a malignant breast mass?
- Poorly defined margins
- May have skin changes
- Hard
- Immobile/fixed
What characteristics are associated with a benign breast cyst?
- Fluid-filled round or ovoid mass
- Smooth, mobile mass with possible tenderness
- May possibly be firm due to fluid
In what age group is there a peak incidence of breast cysts?
35-50 years of age
What is the management for a simple breast cyst?
No intervention necessary, but obtain FNA if symptomatic
What is the management for a complex breast cyst?
Biopsy and possible surgical excision as up to 23% risk of malignancy
In what age group is there a peak incidence of breast fibroadenomas?
15-35 years of age
What characteristics are associated with a benign breast fibroadenoma?
- Firm and nontender
- Well-defined and mobile
- Can increase in size during pregnancy and with estrogen use
What is the management for a breast fibroadenoma?
- Core needle biopsy
- If increases in size, excision to rule out malignant change
What are some characteristics of pathologic nipple discharge?
- Spontaneous
- Unilateral
- Single duct
- Bloody
- Association with mass
What is the most common cause of pathologic nipple discharge?
Intraductal papilloma
What are some characteristics of physiologic nipple discharge?
- Usually bilateral
- Multiple ducts
- Association with stimulation
What are some possible causes of physiologic nipple discharge?
- Medications
- Neurogenic stimulation
- Galactorrhea
What are the two strongest risk factors for breast cancer?
- Female gender
- Advancing age
What are some general risk factors for breast cancer?
- Advancing age and female gender
- BRCA 1 and 2 genetic mutations
- Hx of DCIS (ductal carcinoma in situ)
- First birth >30 years old or nulliparity
- FH of breast or ovarian cancer
- Early menarche
- Late menopause
- High BMI
- Postmenopausal hormone therapy
Women can have up to a 72% risk of developing breast cancer if they have what gene mutations?
Men with what gene mutation have a higher risk for breast cancer?
Women: BRCA 1, BRCA 2, or both
Men: BRCA 2
What are management options if a patient is positive for BRCA gene mutation?
- Increased surveillance
- Chemoprevention (tamoxifen in females > 35 yo)
- Surgical prevention (prophylactic mastectomy)
While varying medical associations have different recommendations on CBEs, what do they all agree on?
Breast awareness
For an average risk women, what is the recommendation for breast cancer screening with mammogram?
- Consider at 40-49 years of age
- Screen in all women 50 years or older
- Stop screening at age 75
***Screen every 1-2 years
How is breast cancer classified?
- Anatomical origin (lobular or ductal)
- Hormone receptivity (presence of absence of estronge and progesterone receptor expression)
- HER2 expression
What are some clinical presentations associated with breast cancer?
- Palpable mass (most common)
- Skin changes (dimpling, nipple retraction/inversion, orange peel appearance)
- Nipple discharge
What are the two types of Noninvasive Breast Carcinomas?
- Lobular (LCIS)
- Ductal (DCIS)
What mammography finding is suggestive of DCIS?
Clustered pleomorphic calcifications
What is the treatment for DCIS?
- Treat as a malignancy as has potential to develop into invasive cancer
- Breast-conserving surgery with radiation vs. mastectomy
- Hormone therapy if ER/PR positive
What is the treatment for LCIS?
No treatment recommended in most women as not a true cancer
What is the most common breast malignancy?
Infiltrating Ductal Carcinoma (IDC)
Which type of invasive breast carcinoma is more often bilateral?
Infiltrating Lobular Carcinoma (ILC)
What characteristics are typically associated with Paget Disease of the Breast (PDB)?
- Scaly, raw, vesicular or ulcerated lesion that begins on the nipple and spreads to the areola
- Usually unilateral
- Pain, burning, and/or pruritis may present before clinically apparent disease
What is a very aggressive form of breast cancer that can present similarly to mastitis?
Inflammatory Breast Cancer (IBC)
What characteristics are associated with Inflammatory Breast Cancer?
- Pain with rapidly progressing, tender, firm, enlarged breast
- Skin is warm, thickened, red, orange peel appearance
- Almost all with lymph node involvement
Where are the most common sites of hematogenous spread of metastatic breast cancer?
Lung and liver
What is the most common site of lymphatic spread of metastatic breast cancer?
Axillary lymph nodes
What is the general management for breast cancer?
- Surgery
- Radiation
- Chemotherapy
- Endocrine therapy
Which type of treatment is almost always used for breast cancer, especially after surgery?
Radiation
When is chemotherapy used for breast cancer treatment?
- Used in primary and metastatic breast cancers and in almost all patients with positive lymph nodes
- Used for high Oncotype DX recurrence scores
What is the difference between Neoadjuvant and Adjuvant therapy?
Neoadjuvant - given before surgery to shrink size of tumor
Adjuvant - after surgery, kills cancer cells left behind
What type of breast cancers are responsive to hormone therapy?
ER positive and PR positive breast cancers
What type of hormone therapy is recommended for breast cancer if the patient is pre-menopausal?
SERM (Tamoxifen)
What type of hormone therapy is recommended for breast cancer if the patient is post-menopausal?
Aromatase inhibitor (Arimidex)
What is HER2 and what medication is used to target it in breast cancer treatment?
A growth-promoting protein.
Herceptin targets HER2 protein.
What is the recommendation for prescribing chemoprevention (Tamoxifen, Arimidex) for breast cancer?
Asymptomatic women who are 35 years or older without a prior history of breast cancer who are at an increased risk for breast cancer.
