Gyn/Onc Breast Cancer Flashcards
What is the number one cause of cancer in women
breast cancer
Median age of dx for breast cancer is
63 yo
Risk factors for breast cancer
early menarche
late menopause
HRT
OCP use
older age at first pregnancy, nulliparity
+FH (with or without mutation)
radiation exposure
central obesity
moderate ETOH use
personal hx of breast cancer
high dietary fat intake
Breast cancer is usually found in what location on the breast
primarily in the upper outer quadrant
Breast cancer can be classified by
histologic type and hormone responsiveness
hormone responsiveness significantly impacts treatment and prognosis
histologic type usually does not affect treatment
In breast cancer you have a better prognosis if the
hormone receptors are present
Breast cancer:
Histologic types
Noninvasive types: Ductal carcinoma in situ, Lobular carcinoma in situ
Invasive types: Infiltrating ductal carcinoma, invasive lobular
Paget carcinoma (associated with infiltrating ductal carcinoma or ductal carcinoma in situ)
Inflammatory carcinoma (commonly confused with mastitis)
Breast cancer:
Hormone responsiveness
HER2/neu (human epidermal growth factor receptor 2 - too much = rapid growth)
Estrogen receptors
Progesterone receptors
Breast cancer genetics
BRCA 1 > BRCA 2
P53 - tumor suppressor gene also contribute
Indications for BRCA screening
breast cancer in 2+ first degree relatives
+FH of breast ca bx prior to age 50
ashkenazi jewish ancestry
Breast cancer symptoms
70% present with palpable lump
usually painless, firm/hard, poorly defined margins
Nipple d/c - if milky consider other dx
lymph node involvement = metz
Peau d’orange
Breast cancer:
Paget carcinoma specific sxs
starts as nipple itching/ burning; superficial erosions/ulcerations
often no discrete breast mass
Breast cancer:
Inflammatory carcinoma specific sx
rapidly growing, occasionally painful mass
breast enlargement
often no discrete breast mass
Breast self exams and clinical exam recommendations
USPSTF recommends against teaching breast self exams
do recommend women and men be aware of their normal and promptly report and changes from baseline
Gold standard for screening for breast cancer
Mammography - looking for abnormal densities, calcifications, irregular borders
2016 USPSTF recommendation for BCA screening
women age 40-49 shared decision making
should likely get screening if - +FH, other risk factors
Screening vs Diagnostic imaging
Screening - asymptomatic
Diagnostic - presenting with sx, mets identified from breast CA, etc
Most commonly identified abnormality on mammogram for breast cancer workup
calcifications - more likely malignant if > 0.5mm, various sizes shapes and clustered in one area
may also see abnormal densities with irregular or ill defined borders
Who gets an MRI for Breast Cancer workups?
negative mammogram but still suspicious
we want more information on new BCA dx
Breast implants
adjunct to mammogram if high risk
If the patient notes a mass but is not confirmed when in the office you should re-examine
in 2-3 months –> preferably 1-2 weeks after onset of menses (could be cyclic breast tissue changes with periods)
If there is a suspicious masses on mammography what should you do next
bx
(make sure that the mammogram is done on both sides)
FNA vs core needle bx which one is preferred and why?
core needle preferred - less prone to sampling error, can test for HER2/neu, ER,PR
Bx is done under mammography guidance when
mass is non-palpable
Most common mets sites for breast cancer
liver
lungs
brain
bone
