GYN Oncology, Breast Flashcards
What are the categories of benign breast lesions?
- Nonproliferative
- Proliferative
- Atypical hyperplasia
What is an example of a nonproliferative benign breast lesion?
Breast cyst
What is an example of a proliferative benign breast lesion?
Fibroadenoma
Intraductal papilloma
What is an example of atypical hyperplasia benign breast lesion?
Atypical ductal hyperplasia
Atypical lobular hyperplasia
What is a breast cyst?
benign fluid filled sac in the breast
What is a fibroadenoma?
Benign tumor of the breast composed of glandular and stromal connective tissue
What is a intraductal papilloma?
Benign breast lesion that consists of wart like lump that develops in 1 or more milk ducts
What is atypical ductal hyperplasia?
Atypical ductal hyperplasia is a premalignant proliferative breast lesion with high risk of ductal carcinoma in situ or invasive breast cancer
What is atypical lobular hyperplasia?
Atypical lobular hyperplasia is a premalignant proliferative breast lesion with high risk invasive breast cancer
What is BIRADS category 0?
Incomplete, additional testing needed
What is BIRADS category 1?
Negative, 0% likelihood of cancer, routine imaging
What is BIRADS category 2?
Benign, 0% likelihood of cancer, routine imaging
What is BIRADS category 3?
Probably benign, 0-2% likelihood of cancer, 6 month follow up
What is BIRADS category 4?
Suspicious
4A= low, >0%<10%
4B= >10%<50%
4C= >50%<95%
Tissue diagnosis
What is BIRADS category 5?
Highly suggestive of malignancy
>95% likelihood of cancer
Tissue diagnosis
What is the lifetime risk of breast cancer?
12%
Are breast self exams recommended?
Not in average risk women due to risk of false positives
What is the breast screening protocol by ACOG?
Screening from age 40-75 either annual or biennial
Clinical breast exam >40y/o
What is the breast screening protocol by American Cancer Society?
Annual screening from 40-54
Biennial screening 55- until 10 years before anticipate death
Clinical breast exam not recommended
What should you known about women with dense breast?
Mammogram less sensitive
Dense breast confer increased cancer risk
What is lobular carcinoma a marker for?
Future malignancy
How do you determine what imaging to perform for the workup of a breast mass?
<30y/o= ultrasound
>30y/o = mammogram
When is it appropriate to aspirate a breast mass?
Only if its cystic
When should you do an excision or biopsy for a breast mass?
- Suspicious solid palpable breast mass
- Non-palpable suspicious mammogram finding
- Aspiration with bloody fluid or mass that fails to resolve
- Mass associated with bloody nipple discharge or ulceration
What is the management for atypical hyperplasia/lobular carcinoma in situ?
Mammogram annually if over 30
Clinical breast exam q6-12 months
Breast self awareness
Risk reduction recommended with tamoxifen
In a patient with nipple discharge, when should you be concerned for underlying pathology?
Spontaneous discharge
Persistent discharge
Expressed on exam
single duct
Clear/serous or bloody
What kind of symptoms do you see with inflammatory breast cancer?
Skin thickening
Edema
peau dā orange
persistent erythema
nipple excoriations
skin ulcerations
What is positive receptor status in breast cancer associated with?
Better response to hormonal therapy
Tumors more often well differentiated and slower growing
What are the adjuvant therapies for breast cancer?
- Tamoxifen
- Raloxifene
- Aromatase inhibitors
- Herceptin
What kind of Breast cancer patients can you use tamoxifen in?
ER+/Unknown
Pre or post menopausal
What kind of Breast cancer patients can you use raloxifene in?
ER+
Postmenopausal
What kind of Breast cancer patients can you use aromatase inhibitors in?
ER+/Unknown
Postmenopausal
What kind of Breast cancer patients can you use Herceptin in?
Her2/Neu+
Pre or post menopausal
What is the risk of tamoxifen therapy?
VTE
What is the risk of raloxifene therapy?
VTE
What is the risk of aromatase inhibitor therapy?
Bone loss
What is the most common cause of bloody nipple discharge?
Benign intraductal papilloma
What is the most common cause for a solid breast mass?
Fibroadenoma
What is Paget disease of the breast associated with?
Underlying intraductal or invasive carcinoma of the breast
When is breast MRI indicated?
- BRCA 1,2 mutation
- First degree relative of BRCA 1,2
- Lifetime risk of breast cancer is >20%
- Chest radiation between 10-30y/o
