Gyn Onc Flashcards
What is the lifetime risk of breast ca?
1 in 8 (12%)
What is an example of a non-proliferative breast mass?
Breast cyst
What is an example of a proliferative breast mass without atypia?
Fibroadenoma, intraductal papilloma
What is an example of a proliferative breast mass with atypia?
Atypical ductal hyperplasia, atypical lobular hyperplasia (4x risk of breast cancer in either breast)
What is the work up of a breast mass?
- Mammogram (if positive…)
- Ultrasound (if a mass…)
- Aspiration (if bloody or mass fails to resolve…)
- Excision/biopsy
What are the criteria for a breast biopsy/excision?
- Suspicious solid palpable mass
- Non palpable suspicious mammo findings
- Aspiration with bloody fluid or persistent mass
- Bloody nipple discharge or ulceration
What are some skin findings that warrant evaluation for inflammatory breast cancer?
Thickening, edema, peau d’ orange, erythema, nipple excoriations, skin ulcerations
How do you manage BIRADS 1-3 with clinical inflammatory breast findings?
Punch biopsy of skin
How do you manage BIRADS 4-5 with clinical inflammatory breast findings?
Punch biopsy of skin
Core needle biopsy
What is the management of atypical ductal hyperplasia, lobular carcinoma in situ?
Annual MRI if > 30yo
Clinical breast exam q 12 mo
Breast self awareness
Riks reduction (Tamoxifen)
What are some positives associated with ER/PR+ breast ca?
Better response to hormonal therapy (80% vs 10%)
Slower growing tumors, well-differentiated
What are the effects of Tamoxifen on breast, bone, uterus?
x breast
+ bone
+ uterus
What specific changes can Tamoxifen cause in the uterus?
Tamoxifen results in a spectrum of uterine abnormalities including benign alterations such as endometrial polyps, endometrial hyperplasia, endometrial cystic atrophy, adenomyosis, and uterine fibroid growth as well as malignant transformation into endometrial carcinoma and uterine sarcoma
What is the recommended uterine surveillance in patients who take Tamoxifen?
Per ACOG - none, unless symptomatic! However, this is controversial, as many providers do screen with EMB or US.
What are the effects of Raloxifene on breast, bone, uterus?
x breast
++ bone
x uterus
What are the effects of Anastraozole (AI) on breast, bone, uterus?
x breast via blocking peripheral conversion (but doesn’t block ovaries in pre-menopausal women)
x bone
x uterus
Used pre or post menopause?
- Tamoxifen (SERM)
- Raloxifene (SERM)
- Anastrazole (AI)
- Tamoxifene: both
- Raloxifene: post
- Anastrazole: both
How does Herceptin work?
Targeted monoclonal antibody therapy (trastuzumab) targeting Human Epidermal growth hormone Receptor+ cancer
Can be used pre- and post-menopause
What is the most common cause of bloody nipple discharge?
Benign intraductal papilloma
What is the most common cause of a solid breast mass?
Fibroadenoma
What cancer is associated with Paget’s disease of the breast?
Underlying intraductal and invasive breast carcinoma
What is the false positive rate of a mammogram?
10%
What are some indications for breast MRI?
- BRCA 1/2
- 1st deg relative wtih BRCA 1/2, pt not tested
- Lifetime risk breast ca > 20% (assessments)
- Chest radiation at 10-30yo
- Genetic syndromes such as Cowden
What defines Stage 1A cervical cancers (1A1, 1A2)?
1A1 = < 3mm depth of invasion
1A2 = 3-5mm depth of invasion
What defines Stage 1B cervical cancers (1B1, 1B2, 1B3)?
1B1 = 5mm-2cm greatest dimension
1B2 = 2-4cm greatest dimension
1B3 = >4cm greatest dimensiion
What defines Stage 2 cervical cancers (2A, 2B)?
2A = upper 2/3 vagina
2B = parametrial involvement
What defines Stage 3 cervical cancers (3A, 3B, 3C)?
3A = lower 1/3 vagina
3B = sidewall and/or hydronephrosis
3C = (a) pelvic, (b) para-aortic lymph nodes
What defines Stage 4 cervical cancers (4A, 4B)?
4A = Spread to adjacent pelvic organs (bladder, rectum)
4B = Spread to distant organs