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Women's Health > Exam 1 - Breast Disorders > Flashcards

Exam 1 - Breast Disorders Flashcards

1
Q

What are some reasons that you would order a breast ultrasound?

A
  • Inconclusive MMG results
  • Evaluate breast of young women
  • Dense breast tissue
  • Better differentiation between a solid and cystic mass
  • Guiding tissue core-needle biopsies
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2
Q

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

A

Useful in determining if a palpable lump is a simple cyst

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3
Q

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

A

Used to obtain samples from larger, solid breast masses

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4
Q

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

A

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

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5
Q

What clinical presentation is associated with cyclical mastalgia?

A

Bilateral and diffuse breast pain

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6
Q

What is a possible cause of noncyclical mastalgia?

A

Medication

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7
Q

What clinical presentation is associated with noncyclical mastalgia?

A

Unilateral or focal breast pain

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8
Q

What is the first-line treatment for mastalgia?

A
  • If normal findings on exam and imaging, reassurance
  • Physical support (underwire bra, sports bra)
  • Analgesics (acetaminophen or NSAIDs)
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9
Q

In what population does mastitis most often occur in?

What bacteria is it most commonly caused by?

A

Most often occurs in lactating women.

Staphylococcus aureus

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10
Q

How does mastitis typically present?

A

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

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11
Q

What is the treatment for mastitis?

What patient education should you include?

A

Dicloxicillin or cephalexin

Continue breastfeeding

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12
Q

What characteristics more commonly indicate a benign breast mass?

A
  • Discrete margins
  • No skin changes
  • Smooth
  • Soft to firm
  • Mobile
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13
Q

What characteristics more commonly indicate a malignant breast mass?

A
  • Poorly defined margins
  • May have skin changes
  • Hard
  • Immobile/fixed
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14
Q

What characteristics are associated with a benign breast cyst?

A
  • Fluid-filled round or ovoid mass
  • Smooth, mobile mass with possible tenderness
  • May possibly be firm due to fluid
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15
Q

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

A

35-50 years of age

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16
Q

What is the management for a simple breast cyst?

A

No intervention necessary, but obtain FNA if symptomatic

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17
Q

What is the management for a complex breast cyst?

A

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

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18
Q

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

A

15-35 years of age

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19
Q

What characteristics are associated with a benign breast fibroadenoma?

A
  • Firm and nontender
  • Well-defined and mobile
  • Can increase in size during pregnancy and with estrogen use
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20
Q

What is the management for a breast fibroadenoma?

A
  • Core needle biopsy

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

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21
Q

What are some characteristics of pathologic nipple discharge?

A
  • Spontaneous
  • Unilateral
  • Single duct
  • Bloody
  • Association with mass
22
Q

What is the most common cause of pathologic nipple discharge?

A

Intraductal papilloma

23
Q

What are some characteristics of physiologic nipple discharge?

A
  • Usually bilateral
  • Multiple ducts
  • Association with stimulation
24
Q

What are some possible causes of physiologic nipple discharge?

A
  • Medications
  • Neurogenic stimulation
  • Galactorrhea
25
Q

What are the two strongest risk factors for breast cancer?

A
  • Female gender

- Advancing age

26
Q

What are some general risk factors for breast cancer?

A
  • 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
27
Q

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?

A

Women: BRCA 1, BRCA 2, or both

Men: BRCA 2

28
Q

What are management options if a patient is positive for BRCA gene mutation?

A
  • Increased surveillance
  • Chemoprevention (tamoxifen in females > 35 yo)
  • Surgical prevention (prophylactic mastectomy)
29
Q

While varying medical associations have different recommendations on CBEs, what do they all agree on?

A

Breast awareness

30
Q

For an average risk women, what is the recommendation for breast cancer screening with mammogram?

A
  • 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

31
Q

How is breast cancer classified?

A
  • Anatomical origin (lobular or ductal)
  • Hormone receptivity (presence of absence of estronge and progesterone receptor expression)
  • HER2 expression
32
Q

What are some clinical presentations associated with breast cancer?

A
  • Palpable mass (most common)
  • Skin changes (dimpling, nipple retraction/inversion, orange peel appearance)
  • Nipple discharge
33
Q

What are the two types of Noninvasive Breast Carcinomas?

A
  • Lobular (LCIS)

- Ductal (DCIS)

34
Q

What mammography finding is suggestive of DCIS?

A

Clustered pleomorphic calcifications

35
Q

What is the treatment for DCIS?

A
  • 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
36
Q

What is the treatment for LCIS?

A

No treatment recommended in most women as not a true cancer

37
Q

What is the most common breast malignancy?

A

Infiltrating Ductal Carcinoma (IDC)

38
Q

Which type of invasive breast carcinoma is more often bilateral?

A

Infiltrating Lobular Carcinoma (ILC)

39
Q

What characteristics are typically associated with Paget Disease of the Breast (PDB)?

A
  • 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
40
Q

What is a very aggressive form of breast cancer that can present similarly to mastitis?

A

Inflammatory Breast Cancer (IBC)

41
Q

What characteristics are associated with Inflammatory Breast Cancer?

A
  • Pain with rapidly progressing, tender, firm, enlarged breast
  • Skin is warm, thickened, red, orange peel appearance
  • Almost all with lymph node involvement
42
Q

Where are the most common sites of hematogenous spread of metastatic breast cancer?

A

Lung and liver

43
Q

What is the most common site of lymphatic spread of metastatic breast cancer?

A

Axillary lymph nodes

44
Q

What is the general management for breast cancer?

A
  • Surgery
  • Radiation
  • Chemotherapy
  • Endocrine therapy
45
Q

Which type of treatment is almost always used for breast cancer, especially after surgery?

A

Radiation

46
Q

When is chemotherapy used for breast cancer treatment?

A
  • Used in primary and metastatic breast cancers and in almost all patients with positive lymph nodes
  • Used for high Oncotype DX recurrence scores
47
Q

What is the difference between Neoadjuvant and Adjuvant therapy?

A

Neoadjuvant - given before surgery to shrink size of tumor

Adjuvant - after surgery, kills cancer cells left behind

48
Q

What type of breast cancers are responsive to hormone therapy?

A

ER positive and PR positive breast cancers

49
Q

What type of hormone therapy is recommended for breast cancer if the patient is pre-menopausal?

A

SERM (Tamoxifen)

50
Q

What type of hormone therapy is recommended for breast cancer if the patient is post-menopausal?

A

Aromatase inhibitor (Arimidex)

51
Q

What is HER2 and what medication is used to target it in breast cancer treatment?

A

A growth-promoting protein.

Herceptin targets HER2 protein.

52
Q

What is the recommendation for prescribing chemoprevention (Tamoxifen, Arimidex) for breast cancer?

A

Asymptomatic women who are 35 years or older without a prior history of breast cancer who are at an increased risk for breast cancer.

Women's Health (5 decks)

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