Exam 1 - Breast Disorders Flashcards by Kelsey Peiser

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

How well did you know this?

Not at all

Perfectly

Why would you order a fine-needle aspiration of the breast?

Useful in determining if a palpable lump is a simple cyst

How well did you know this?

Not at all

Perfectly

Why would you order a core-needle biopsy of the breast?

Used to obtain samples from larger, solid breast masses

How well did you know this?

Not at all

Perfectly

When does cyclical mastalgia occur and what is it due to?

Occurs during the luteal phase of the menstrual cycle due to fibrocystic changes

How well did you know this?

Not at all

Perfectly

What clinical presentation is associated with cyclical mastalgia?

Bilateral and diffuse breast pain

How well did you know this?

Not at all

Perfectly

What is a possible cause of noncyclical mastalgia?

Medication

How well did you know this?

Not at all

Perfectly

What clinical presentation is associated with noncyclical mastalgia?

Unilateral or focal breast pain

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

How does mastitis typically present?

Hard, red, tender, swollen area of one breast with possible fever

How well did you know this?

Not at all

Perfectly

What is the treatment for mastitis?

What patient education should you include?

Dicloxicillin or cephalexin

Continue breastfeeding

How well did you know this?

Not at all

Perfectly

What characteristics more commonly indicate a benign breast mass?

Discrete margins
No skin changes
Smooth
Soft to firm
Mobile

How well did you know this?

Not at all

Perfectly

What characteristics more commonly indicate a malignant breast mass?

Poorly defined margins
May have skin changes
Hard
Immobile/fixed

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

In what age group is there a peak incidence of breast cysts?

35-50 years of age

How well did you know this?

Not at all

Perfectly

What is the management for a simple breast cyst?

No intervention necessary, but obtain FNA if symptomatic

How well did you know this?

Not at all

Perfectly

What is the management for a complex breast cyst?

Biopsy and possible surgical excision as up to 23% risk of malignancy

How well did you know this?

Not at all

Perfectly

In what age group is there a peak incidence of breast fibroadenomas?

15-35 years of age

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is the management for a breast fibroadenoma?

Core needle biopsy

- If increases in size, excision to rule out malignant change

How well did you know this?

Not at all

Perfectly

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.