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Clin Med - Repro > Lecture 12 - Breast Disorder > Flashcards

Lecture 12 - Breast Disorder Flashcards

1
Q

Where are the majority of breast cancers?

A

upper outer quadrant

axillary tail

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2
Q

When is the best time to perform clinical breast exam?

A

during follicular phase (one week after menses)

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3
Q

Mastalgia

A

breast pain

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4
Q

Cyclic mastalgia

A 
related to menstrual cycle 
luteal phase (day 14 - 28)
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5
Q

What conditions can cause cyclic mastalgia?

A

luteal phase of menses
OCPs
fibrocytic breast disease

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6
Q

What is the treatment for mastalgia?

A

reassurance (assuming exam is normal and pain is cyclic)

support bra or sports bra; weight reduction

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7
Q

Mastitis

A 
infection of breast tissue -- mainly with lactating women 
breast pain 
swelling 
warmth 
redness

pathogen: MC staph aureus

tx:
if sxs >12-24 hours
dicloxacillin 500mg PO QUID x 10-14 days

if no improvement, r/o breast abscess with US
-consider inflammatory breast cancer

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8
Q

What are the sxs of mastitis?

A 
women 
breast pain 
swelling 
warmth 
redness
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9
Q

What is the MC pathogen of mastitis?

A

Staph Aureus

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10
Q

What is the treatment for mastitis?

A

if sxs >12-24hr
Dicloxacillin 500 mg PO QID x 10-14 d

if no improvement, r/o breast abscess with US
-consider inflammatory breast cancer

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11
Q

Nipple discharge affects ____% of women in their reproductive years

A

50-80%

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12
Q

Bilateral nipple discharge vs unilateral nipple discharge

A

bilateral is more commonly benign

unilateral is more commonly malignant

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13
Q

What characteristics of nipple discharge suggest benign?

A

bilaterally
multiductal
milky

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14
Q

What characteristics of nipple discharge suggest malignant?

A 
spontaneous
unilateral
uniductal
blood, straw colored, or clear stains clothes 
persistent
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15
Q

What labs should you order on a pt with nipple discharge?

A

TSH
Prolactin
B-hCG

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16
Q

If you think the nipple discharge is related to OCPs, how long after changing the OCPs should you re-evaluate?

A

3 cycles

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17
Q

What percentage of breast masses are benign?

A

80-85%

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18
Q

What is the most common presenting sx in pts dx’d with breast cancer?

A

breast mass

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19
Q

What is the biggest risk factor for the development of breast cancer?

A

age

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20
Q

Nipple retraction

A

tumor is pulling on ligaments –this is different than nipple eversion

21
Q

CNB

A

core needle biopsy

  • larger tissue specimen
  • image-guided (US)
  • local anesthesia
22
Q

Punch biopsy

A

differentiate benign vs malignant skin changes (Paget’s disease)

23
Q

What is the first line imaging choice in women <30 and pregnant women with focal breast sxs?

A

US

24
Q

Who gets MRIs for breast masses?

A

reserved for women of high-risk

good for implants

25
Q

BIRADS

A

breast imaging reporting and data system

0-6
gives likelihood of malignancy and recommendation for follow up/biopsy

26
Q

If a pt <30 comes in complaining of a breast lump and you don’t find anything, what do you do next?

A

repeat exam in 2-3 months

27
Q

What are cysts influenced by?

A

hormonal fluctuations

occur during lobular development, menses, and lobular involution

28
Q

Simple vs complex cyst?

A

simple - fluid only, benign

complex - fluid + solid components
- small risk of malignancy

29
Q

What is the management of a simple cyst vs. complex cyst?

A

simple:
aspirate cyst (FNA)
observe 2-3 months (cycles)

Complex:
must be biopsied - image guided CNB
surgical intervention based on pathology

30
Q

Fibrocystic breast disease

A

MC benign breast condition

associated with imbalance of progesterone and estrogen

sxs: bilateral cyclic pain, breast swelling, palpable mass and heaviness; “lumpy breasts”

premenopausal women affected 20-40 years

dx:
US
FNA + pathology evaluation

dx mammogram for women >30 y

31
Q

Management of fribrocystic breast disease?

A 
low fat diet 
avoid caffeine, coffee, soda, chocolate, EtOH 
manage contraception and HRT 
supportive bra 
medication as needed
32
Q

Fibroadenoma

A

benign solid tumors containing glandular + fibrous tissue
-proliferative - breast masses that you can define on exam - less likely to occur during menopause d/t decrease in hormones

increase in size during pregnancy/estrogen therapy
usually regresses after menopause

33
Q

What age women get fibroadenomas?

A

reproductive age women

34
Q

What do you feel on PE for fibroadenoma?

A

well-defined mobile mass

35
Q

How do you dx fibroadenoma?

A

US
mammogram
CNB or excision

36
Q

What is the management for fibroadenoma?

A

short term f/u with repeat sono/breast exam
expectantly manage
surfical excision

37
Q

What is the leading cause of death in women 40-49?

A

breast cancer

38
Q

What is the MC breast cancer?

A

ductal carcinoma makes up 80% of breast cancers

39
Q

Hyperplasia with atypia

A

DCIS - ductal carcinoma in situ
LCIS - lobular carcinoma in situ

not cancer but predisposes to cancer

40
Q

What are the risk factors of breast cancers?

A 
Advanced age 
family hx 
personal hx 
early menarche 
late menopause 
late first pregnancy
HRT
radiation
41
Q

BRACA

A

breast cancer susceptibility gene –tumor suppressors

carriers have 45-65% chance of breast cancer by 70

42
Q

What are they typical clinical features of breast cancer?

A

most often single, non-tender, firm, immobile mass

45% in upper outer quadrant

43
Q

Inflammatory breast cancer

A 
dermal lymphatic invasion of tumor cells 
actue onset (sx <6 months) of erythema, edema, and peau d'orange appearance

ddx: mastitis

44
Q

Paget’s disease of the breast

A

ductal carcinoma presenting as eczematous lesion of the nipple

45
Q

Breast conserving therapy

A

lumpectomy

depends on size of mass vs size of breast

46
Q

Look over breast cancer treatment and screening

A

NOT DONE

47
Q

What are the ACS guidelines for breast cancer screening?

A

offer mammograms at age 40-44
recommend annual screening 45-55
continue screening as long as life expectancy >10 years

48
Q

What medical management is used to decrease RECURRENCE of breast CA coming back?

A

Adjuvant hormone therapy

SERM - selective estrogen receptor modulator 
-anti estrogen 
-Tamoxifen 
-AI
treated for 5-10 years

Clin Med - Repro (18 decks)

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