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Block 9 - Reproductive and Endocrine Disease > FPC - Breast Health (Demore) > Flashcards

FPC - Breast Health (Demore) Flashcards

1
Q

True or False: In general, breast pain is usually not associated with cancer, but rather with benign tumors.

A

True

Typically, breast pain indicates benign lesions/tumors of the breast.

Cancerous tumors don’t tend to cause pain.

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2
Q

A 56-year-old female patient presents to her general practitioner complaining of mastodynia (breast pain) and a thick, white discharge from the nipple. What condition does this patient have and which component of the breast is involved?

A

Mammary Duct Ectasia (periductal mastitis)

Involves the mammary ducts

MDE typically occurs as inflammation, breast pain, and white secretion from the nipple in post-menopausal women.

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3
Q

What is lobular carcinoma in situ (LCIS) and how many of these women will go on to develop malignancy in both breasts?

A

LCIS is carcinoma of the lobules of the breast.

40% of women will develop malignancy in either breast

LCIS increases the risk of development of breast cancer

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4
Q

What is ductal carcinoma in situ (DCIS) and if left untreated, what is the risk that this will invade other tissues?

A

DCIS is a malignant neoplasm of the ductal epithelium of the breast.

If left untreated, DCIS increases risk of malignancy by 50-60%. For this reason, DCIS is considered to be “pre-malignant.”

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5
Q

How is invasive ductal carcinoma treated?

A

Breast conversion therapy OR mastectomy and sentinel lymph node biopsy

Axillary lymph node dissection can also be done depending on spread of cancer.

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6
Q

Which invasive carcinoma, ductal or lobular, has an increased risk of bilaterality, multicentricity, and multifocality?

A

Lobular

Invasive lobular carcinoma easily invades the tissues much more than ductal carcinoma and has multiple sites of origin.

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7
Q

What are Rotter’s nodes and why are they important nodes to assess in breast cancer patients?

A

Rotter’s Nodes are located between the pec major and pec minor muscles.

These are common sites of recurrance of cancer in cancer patients. They should be routinely checked to ensure that cancer has not returned.

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8
Q

You are on your radiology rotation and are examining a patient’s mammogram results. You notice microcalcifications in the breast tissue, but your attending does not seem to be concerned about them. A biopsy is ordered just to be safe, but what condition does the attending think this patient has?

A

Sclerosing Adenosis

Benign type of fibroadenoma that causes presence of microcalcifications in the breast tissue.

Usually does not increase cancer risk, but biopsy done to ensure no cancerous cells are present.

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9
Q

A 45-year-old woman with a 3 cm mass in the right breast undergoes a tissue biopsy of the lesion. When asked about her past history, the patient said that she suffered a traumatic injury to her right breast within the past few months. Physical examination also noted dimpling and retraction of the skin of the breast. What type of cells would you expect to find in the tissue biopsy? What disease process is occurring in this patient?

A

Macrophages with lots of fat droplets in them AND foreign-body giant cells

Patient has Fat necrosis

Traumatic injury to the breast causes inflammation, which leads to fibrosis and mass formation.

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10
Q

What is Paget’s Disease in relation to the breast? Is this usually invasive or in situ?

A

DCIS of the nipple

Typically does not invade, but may have underlying cells with metastatic potential

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11
Q

What is a radial scar and is it associated with an increased risk of cancer or no change in cancer risk?

A

Radial scar is a benign stellate, irregular mass seen on a mammogram

The mass is fibroelastic tissue suffounded by glandular elements.

This increases risk of developing cancer, so the mass should be surgically removed

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12
Q

What is the standard pharmacotherapeutic treatment for LCIS?

A

Tamoxifen

Patients can also undergo bilateral prophylactic mastectomy

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13
Q

How are breast tumors staged?

A

TNM System

  • Tumor size
  • Lymph Node involvement
  • Metastasis

Don’t forget to also take into account hormone receptor involvement: Her2/neu, ER, PR, or triple negative

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14
Q

What is the standard surgical treatment for breast cancer lymph node removal?

A

Removal of level I and II lymph nodes

If level II lymph nodes involved, remove level III nodes as well.

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15
Q

What two treatment options are available for patients with Paget’s disease of the breast?

A

Central lumpectomy or total mastectomy

Remember that Paget’s disease of the breast is a DCIS of the nipple that typically does not spread. Removal of the tumor should be all that is needed to prevent malignancy, but removal of the entire breast can be done.

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16
Q

A 35-year-old female patient presents to your office after feeling a lump during her self-breast exam. During the interview, she tells you that she has noticed that the breast with the mass seems to have gotten smaller. On physical examination, you notice dimpling of the skin of the breast and a darker tint to the skin (seen below). What term describes the physical appearance of the breast skin?

A

Peau d’Orange

aka orange skin

Dimpling and orange-red tint of the skin of the breast looks like an orange peel.

Typically indicates tumor of the breast: tumor pulls on suspensory ligaments of Cooper, causing dimpling.

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17
Q

True or False: Women with early menarche, late menopause, and nulliparity are at an increased risk of developing breast cancer.

A

True

Increased estrogen levels tend to increase the risk of breast cancer. This can be the cause of early menarche, menopause, and obesity.

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18
Q

What is the primary artery that supplies blood to the medial and central breast, and why is it important to consider when doing a mastectomy?

A

Perforating branches of internal mammary artery

These branches supply blood to the skin of the breast. Care must be taken when dissecting breast tissue to preserve the arterial supply to the skin. This prevents skin necrosis from happening.

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19
Q

What are some common over-the-counter ways to alleviate breast pain?

A
  • Limit caffeine for 2-3 months to see if pain subsides
  • Stop smoking
  • Take vitamin B6 and E
  • Take primrose oil - prostaglandin inhibitor
  • Take omega 3 fatty acids
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20
Q

A 25-year-old female patient has been referred to you after her general practitioner noticed a mass on physical examination of the breast. A mammogram is done and the image reveals a highly fibrous breast with an area that appears to be a lump. Because of her age and mammogram, you believe the lump to be a benign fibroadenoma. However, you realize that there is one other disease that should be in your differential diagnosis. What is it?

A

Cystosarcoma Phyllodes

Very uncommon malignant tumor that does not metastasize to the nodes.

To differentiate between the two, the mass must be removed and examined.

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21
Q

What are the 3 gene mutations involved in breast cancer genetic syndromes?

A

pTEN, p53, and BRCA

22
Q

What two methods are used to diagnose a fibroadenoma?

A

Ultrasound and biopsy

23
Q

Which BRCA mutation, BRCA-1 or BRCA-2, is associated with the highest life-time risk of developing breast cancer? Which type is most common in males?

A

BRCA-1 has an 85% risk of getting breast cancer, whereas BRCA-2 has a 70% risk

BRCA-2 is more common in males with hereditary breast cancer.

24
Q

What are the risk factors for developing fibrocystic breast change?

A
  • Early menarche or late menopause
  • Small breast size
  • Normal or low body weight
  • Breast pain
  • History of spontaneous abortions
25
Q

What are suspensory ligaments of Cooper?

A

Bands of pec major fascia that attach to the breast tissue

Tumors can place pressure on these ligaments, causing dimpling of the skin of the breast (peau d’orange)

26
Q

What are some risk factors for developing breast cancer?

A
  • BRCA gene mutation
  • 2 or more relatives with bilateral or pre-menopausal breast cancer
  • History of DCIS or LCIS
27
Q

Your 30-year-old female patient has returned after 3 months of limiting her caffeine intake and taking primrose oil to try to get rid of her breast pain. She reports that she still has breast pain. What is the main prescription that you can give to your patient to limit breast pain, and what are the common side effects?

A

Danazol

Danazol is a weak androgen that can cause hirsutism, amenorrhea, acne, weight gain, and liver toxicity

Other treatment methods: oral contraceptives, tamoxifen, bromocriptine

28
Q

Of the 4 types of invasive ductal carcinoma, which type generally has the worst prognosis?

A

Cirrhotic: this type leads to liver cirrhosis, making prognosis worst out of the 4

4 Types:

  1. Medullary
  2. Tubular - most favorable prognosis
  3. Mucinous - most favorable prognosis
  4. Cirrhotic - worst prognosis
29
Q

Which pattern of DCIS is the most aggressive type and has the highest risk of microinvasion and recurrence?

A

Comedo pattern

The other patterns of DCIS are: solid, cribriform, and papillary

30
Q

What is the treatment for cystosarcoma phyllodes?

A

Wide, local excision with 1cm margins

31
Q

What is the incidence of breast cancer in women?

A

1 in 7 women will get some form of breast cancer

32
Q

What is the most common benign breast tumor in adolescents and young women?

A

Fibroadenoma

33
Q

A 44-year-old female patient has been admitted to the hospital after undergoing an appendectomy. After her surgery, she complains that her usual breast pain has gotten worse than usual. During a physical exam of her breast, you note erythema, edema, and a peau d’orange appearance of the skin with invasion of the tissue. On palpation, you notice a firm mass. What is your differential diagnosis for this patient? How would you confirm?

A

Differential diagnosis: mastitis, breast abscess, inflammatory breast cancer

Confirm with ultrasound, mammography, and biopsy

More than likely, the patient has inflammatory breast cancer, which involves invasion of the skin. This typically has a high mortality rate.

34
Q

Why is the fascia between the breast tissue and pec major muscle important to consider in breast cancer patients?

A

Lymphatics of the breast enter into the fascia

This layer of fascia must be removed with the breast tissue and lymph nodes to prevent further spread of the cancerous cells.

35
Q

What is the difference between fibrocystic breast change and fibrocystic breast disease?

A
  • Change = no or minimal symptoms
  • Disease - moderate to severe symptoms
36
Q

Which type of invasive breast cancer, ductal or lobular, is easier to detect?

A

Invasive ductal

Ductal masses can usually be palpated, but lobular masses tend to be more spread out within the breast, making them difficult to feel.

37
Q

In younger, pre-menopausal patients with mammary duct ectasia (periductal mastitis), what is a common complication that can arise?

A

Infection secondary to blocked mammary ducts

Generally, pre-menopausal patients do not have the white discharge from the nipple that post-menopausal women have. Instead, the glands become blocked, which favors growth of infectious bacteria.

38
Q

How is inflammatory breast cancer treated? What is the median survival rate for patients with this disease?

A

Shrink the tumor with chemotheraphy, try to excise the tumor with good margins, then do radiation therapy

Median survival is 3 years

Because this tumor involves the skin, it is difficult to get clean margins. Chemo shrinks the tumor to try and limit this.

39
Q

What are the indications to remove a benign fibroadenoma?

A
  • Patient prefers it be removed
  • Rapid growth in short time period
  • If >4cm or painful
40
Q

A 50-year-old female is returning to your office today to discuss the results of her breast biopsy. Her mammogram showed extensive infiltration of the breast tissue bilaterally, and biopsy results indicated an invasive cancer that had spread throughout the breast and lymph nodes. What type of cancer does she have? What treatment would you recommend to this patient?

A

Invasive lobular carcinoma

Treatment: breast conservation therapy OR mastectomy and sentinel lymph node removal, with or without removal of axillary lymph node

Clues that indicate this is lobular: bilateral, highly invasive, extensive infiltration

41
Q

A patient with suspected breast cancer undergoes a biopsy of the the lymph nodes of the breast, supraclavicular nodes, and cervical lymph nodes. All three nodes show cancerous cells. What stage of breast cancer is most likely involved in this patient?

A

Metastatic (Stage IV)

When cancerous cells that originated in the breast are present in the cervical lymph nodes, this is indicative of metastasis.

Cancer is considered to be stage 3 if neoplastic cells found in supraclavicular nodes, but not cervical nodes.

42
Q

Compared to DCIS, how is LCIS different in texture and inclusions within the tumor?

A

LCIS cannot be palpated and does not typically have calcifications

Remember that DCIS consists of carcinoma cells encased in calcifications. These masses can usually be felt.

43
Q

What is the standard treatment for DCIS and when should mastectomy be considered?

A

Standard treatment: excision within 2mm margins AND radiation

Mastectomy should be considered if mass is multicentric or covers a large area of the breast

44
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

Least common: invasive lobular

45
Q

What are the 4 borders of the breast?

A
  • Medial - sternocleidomastoid
  • Lateral - mid-axillary line
  • Inferior - 6th rib at midclavicular line
  • Superior - clavicle
46
Q

Where are the 3 different levels of lymph nodes of the breast located?

A
  • Level I - between pec minor and latissimus dorsi
  • Level II - under pec minor
  • Level III - medial to pec minor
47
Q

By what percentage does screening decrease mortality due to breast cancer?

A

25%

This is due to early detection. When cancers are caught at earlier stages, there is an increased risk of survival.

48
Q

What are the 3 layers of the breast (excluding skin and superficial fascia) from superficial to deep?

A
  1. Breast tissue
  2. Fascia
  3. Pec major muscle
49
Q

What percentage of women with negative mammograms/ultrasounds will still have bresat cancer?

A

10%

10% of patients with breast cancer will have a clear mammogram and ultrasound. This is the downside to screening methods that are currently in place.

50
Q

According to the Gail Risk Assessment, patients with high risk of developing breast cancer will have a lifetime risk of at least what percent?

A

20%

Patients with greater than 20% lifetime risk should get yearly mammograms and cancer screening.

Block 9 - Reproductive and Endocrine Disease (22 decks)

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