Lecture 5: Normal and Abnormal Breast Exam Flashcards

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1
Q

How do estrogen and progesterone affect the growth of the breast tissue?

A
  • Estrogen is responsible for growth of adispose tissue and lactiferous ducts
  • Progesterone is responsible for stimulation of lobular growth and alveolar budding
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2
Q

What are some of the risk factors for breast cancer?

A
  • High breast tissue density
  • Early menarche (age <12)
  • Late cessation of menses (age >55)
  • No term pregnancies
  • Never breastfed
  • Recent and long-term use of OC’s
  • Postmenopausal obesity
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3
Q

A palpable mass of the breast will almost always get what type of evaluation?

A

Biopsy (FNA/core/excisional)

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4
Q

Mammograms are best in women of what age; how often?

A

40 years and older; annually

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5
Q

What type of breast imaging allows for differentiation between cystic vs. solid lesions as well as visualizing solid tissue within or adjacent to a cyst that may be malignant?

A

Ultrasonography

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6
Q

When is ultrasonography useful in examination of the breast?

A
  • Useful in evaluating inconclusive mammogram findings
  • Best for evaluating young women (<40) and others w/ dense breast tissue
  • Allows to differentiate between cystic vs. solid lesions as well as show solid tissue within or adjacent to a cyst that may be malignant
  • Used for guidance when performing core needle biopsies
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7
Q

When is MRI useful for evaluating the breasts?

A
  • As adjunct to diagnostic mammography in suspicious masses
  • Post-cancer diagnosis for further evaluation of staging
  • Used w/ implants
  • Women at high risk for breast cancer like BRCA carriers
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8
Q

Which technique is useful in determining if a breast mass is solid vs. cystic?

A

Fine needle aspiration biopsy

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9
Q

What is the next best step if fine needle aspiration of a breast mass contains bloody vs. clear fluid?

A
  • Clear fluid needs no further evaluation
  • Bloody fluid sent for cytology and pt neds a diagnostic mammogram/ultrasound
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10
Q

What is the next best step if a breast cyst reappears or does not resolve with aspiration?

A

Perform diagnostic mammogram/ultrasound and perform biopsy

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11
Q

What is core needle biopsy of the breast used for; how many samples taken?

A
  • Used to get tissue from larger solid masses for diagnosis
  • 3-6 samples about 2cm long are obtained
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12
Q

What are the 3 categories of benign mastlagia (breast pain)?

A
  • Cyclic = starts at luteal phase of menstrual cycle and ends after onset of menses
  • Noncyclic = tumors, mastitis, cysts; can be assoc. w/ some meds (anti-depressants/hypertensives, hormonal meds (OCP’s))
  • Extramammary = chest wall trauma, shingles, fibromyalgia
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13
Q

What is the only FDA approved treatment for benign mastalgia (breast pain) and what are the AE’s?

A
  • Danazol
  • AE’s = menstrual irregularities, benign intracranial HTN, alters blood sugar, deepens voice, unusual hair growth and weight gain
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14
Q

What are some recommendations for symptom relief of benign mastalgia?

A
  • Properly fitting bra
  • Weight reduction
  • Exercise
  • caffeine intake
  • Vit E supplementation and evening of primrose oil
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15
Q

Non-spontaneous, non-bloody (can be clear, green or yellow) and bilateral nipple discharge is most consistent with what?

A

Fibrocystic changes or ductal ectasia

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16
Q

Bloody nipple discharge is considered what?

A

CANCER until proven otherwise!

17
Q

Which benign process of the breast can produce bloody nipple discharge?

A

Intraductal papilloma

18
Q

How is bloody nipple discharge evaluated clinically?

A

Breast ductography and requires ductal excision

19
Q

What are some characteristics of a breast mass that would be a concern for malignancy?

A
  • >2 cm in size
  • Immobility w/ poorly defined margins
  • Firmness
  • Skin dimpling/retraction/color changes
  • Bloody nipple discharge
  • IPSILATERAL lymphadenopathy
20
Q

What is the most common benign tumor in female breast; when does it arise?

A
  • Fibroadenoma = solid, rubbery, mobile and typically solitary
  • Usually in late teens and early 20’s
21
Q

Which type of benign breast mass is an intraductal growth typically seen in women 30-50 y/o and causes serous or serosanguinous discharge?

A

Papillomas

22
Q

How are LCIS and DCIS of the breast treated?

A

Both w/ excision and then followed with SERM tx

23
Q

Which ethnicity has greater risk of breast cancer?

A

Caucasian women

24
Q

70-80% of all breast cancers are what type?

A

Ductal

25
Q

Which type of breast cancer is more likely to be multifocal and/or bilateral?

A

Lobular

26
Q

Using the Gail Model-Breast Cancer risk tool, which women are considered high risk and how should they be managed?

A
  • Women w/ 5-year risk of 1.7% or more
  • Counseled on prophylactic therapy (chemoprevention, mastectomy, oophorectomy)
27
Q

What should be used in addition to staging for the treatment of breast cancer?

A

Receptor status - estrogen and progesterone (positive finding)

28
Q

Which 2 surgical options for breast cancer have equivalent outcomes?

A
  • Lumpectomy w/ radiation
  • Mastectomy
29
Q

Which drug can be used for Her2/neu-positive breast cancers; but what are the AE’s?

A
  • Trastuzumab
  • AE’s: heart failure, respiratory problems, serious allergic rxns
30
Q

What is the recommended timeline for treatment follow-up for breast cancer; when do the majority of reoccurrences happen?

A
  • During the first 2 years after diagnosis = every 3-6 months
  • Annually after first2 years
  • Most reoccurrences happen within first 5 years after tx