MDT's Part 1 Flashcards
What are some general considerations for fibrocystic conditions (fibrocystic changes)?
- Painful breast mass (often multiple/bilateral)
- Pain worse during menstrual phase cycle
- Rapid fluctuation of size normal
- Most frequent lesion of breast
- Most common age 30-50
What are some signs of fibrocystic conditions?
- Breast pain/tenderness
- Discomfort worsens during premenstrual phase
- Fluctuation of mass size
- Multiple or bilateral masses
- Absence of lymphadenopathy
Imaging for fibrocystic conditions?
- Mammography
- Ultrasound (used alone if Pt <30)
What is the diagnostic testing of fibrocystic conditions?
- Core Needle Biopsy
- All suspicious lesions should be biopsied by Gen Surg
Treatment for fibrocystic conditions?
- NSAIDS
- Avoid trauma
- Wear supportive bra day/night
- Decrease dietary fat
- Caffeine elimination
- Vitamin E 400IU
- Monthly self-exam
- More severe pain should be referred to primary care for eval*
What is fibroadenoma?
- Common benign neoplasm occurring most frequently in young, black women
- Usually within 20 yrs of puberty
- Usually discovered incidentally
Signs/symptoms of fibroadenoma?
- Round/ovoid
- Rubbery
- Discrete
- Relatively moveable
- Nontender/nonpainful mass 1-5cm in diameter
Imaging for fibroadenoma?
- Ultrasound
- Core needle biopsy recommended
Treatment for fibroadenoma?
- All breast masses referred to Gen Surg for eval
- Once confirmed, no treatment usually necessary
- Excision may be necessary for large (3-4cm) masses
- Rule out phyllodes tumor
What is phyllodes tumor?
Rare malignant fibroadenoma like tumor
What is fat necrosis of the breast?
- Lesion of the breast
- Often accompanied by skin or nipple retraction
- Usually indistinguishable from carcinoma even on imaging studies
What are some signs/symptoms of fat necrosis of the breast?
- Common after segmental resection, radiation therapy, or flap reconstruction following mastectomy
- Common after MVA or assault
- Ecchymosis
Treatment course of fat necrosis of breast?
- If untreated, mass generally disappears
- Core needle biopsy is safest course
- Frequently entire mass must be excised
Statistics for Female breast carcinoma?
- 1 in 8 American woman
- Second most common cancer in woman
- Second leading cause of cancer death
Risk factors for female breast carcinoma?
- Age (Rise rapidly until early 60’s)
- Family Hx of Breast/Ovarian cancer
- Genetics ( BRAC1, BRAC2, and mutations)
- Reproductive Hx (Nulliparous, pregnancy >30)
- Menstrual Hx (early menarche <12, late menopause >55)
- Previous Medical Hx (cancer)
What is the most reliable means of detecting breast cancer?
- Mammography screening
- Slow growing cancers can be identified up to 2 years before mass is passable
What is the frequency recommendations for mamography?
- <40: Not recommending in average risk
- 40-49: Shared decision with Pt, if yes screen every two yrs
- 50-74: Recommend every 2 years
- > 75: only recommended if life expectancy is >10 yrs
What are some other images for female breast carcinoma?
- MRI and Ultrasound
- For those at high risk
- Not for general general population
What is no longer recommended by American cancer society and has not shown to improve survival?
Breast self-examination
What are some early signs of female breast carcinoma?
- About 70% usually present with painless lump
* 90% of above were self discovered
What are some less frequent symptoms of female breast carcinoma?
- Breast pain
- Nipple discharge
- Erosion, retraction, enlargement, or itching of the nipple
- Redness, generalized hardness, enlargement, or shrinking of the breast
What are some rare symptoms of female breast cancer?
- Axillary Mass or swelling
- Back/joint pain
- Jaundice
- Weight loss
What is found early on physical exam for female breast cancer?
- Single, nontender, firm-to-hard mass with ill-defined margins
- Mammographic abnormalities and no palpable mass
What is found late on physical exam for female breast cancer?
- Skin/nipple retraction
- Axillary lymphadenopathy
- Breast enlargement, erythema, edema, pain
- Fixation of mass to chest wall or skin
What are some lab findings of female breast cancer?
- Increased alkaline phosphate (caused by liver/bone metastases)
- Increased serum calcium
Diagnostic tests for female breast cancer?
Core needle biopsy
Treatment of female and male breast cancer?
- Referred to Gen Surg for work up and eval
- Depending on stage of cancer:
- Surgical resection (partial or full mastectomy)
- Radiation
- Systemic therapy (chemo, target therapy, bisphosphonates)
Follow up for female breast cancer?
- Pt should be monitored in long term
- Local/distant recurrences within 2-5 yrs
- first two yrs: exam every 6 months
- annually thereafter
- Special attention to contralateral breast
General considerations for male breast cancer?
- Rare (<1% of all breast cancer)
- Average age of occurrence is 70
- Increase incidence with prostate cancer
- BRAC2 mutation common
- Prognosis worse in men
Signs and symptoms of male breast cancer?
- Pt present with painless lump
- Hard, ill-defined, nontender mass beneath nipple or areola
- Current or Hx of gynecomastia
Imaging/diagnosis of male breast cancer?
- Mammography
- Ultrasound
- Biopsy
Prognosis of male breast cancer?
5 year survival
What are some characteristics of nipple discharge?
- Serous
- Bloody
- Associated mass (more likely neoplastic)
- Unilateral (neoplastic or non-neoplastic)
- Bilateral (most likely non-neoplastic and endocrine in etiology)
Serous nipple discharge is most likely due to what?
Benign Fibrocystic changes (FCC) such as duct ectasia
Bloody nipple discharge is most likely due to what?
- Neoplasticpapilloma or carcinoma
- Bloody duct should be excised
What are common causes of nipple discharge in non-lactating women?
- Duct ectasia (type of FCC)
- Intraductal ectasia (type of FCC)
- Carcinoma
What is duct ectasia and intraductal ectasia?
Spontaneous, unilateral, serous, or serosanguineous discharge from a single duct
What are some other causes of nipple discharge?
- Milky discharge from hyperprolactinemia
- Oral contraceptives or estrogen replacement
- Breast abscess
What should be done for milky nipple discharge from hyperprolactinemia?
- Serum prolactin levels to rule out pituitary tumor
- TSH to rule out hypothyroidism
- Antipsychotic drugs can cause elevated prolactin levels leading to lactation
What type of discharge can oral contraceptives or estrogen replacement cause?
Clear, serous, or milky discharge
What type of discharge can breast abscess cause?
- Purulent discharge
- Usually requires abscess done in hospital setting
Lab findings for nipple discharge?
Cytological evaluation of discharge to identify malignant cells
Imaging for nipple discharge?
- Mammography
- Ultrasound
Treatment for nipple discharge?
Discuss with physician sup for referral to Gen surg, breast clinic, or OB/GYN depending on discharge type
Follow up for nipple discharge?
Pt re-examined every 3-4 months for a year
What is menorrhagia?
Blood loss >80 mL
What is metrorrhagia?
Bleeding between periods
What is polymenorrhea?
Bleeding that occurs more often than every 21 days
What is oligomenorrhea?
Bleeding that occurs less frequently than every 35 days
What are some general considerations for abnormal uterine bleeding?
- Normal menstrual bleeding lasts average of 5 days (2-7 day range)
- Mean blood loss during cycle is 40 mL
- Descriptive terms:
- Heavy
- Lift
- Menstrual
- Intermenstrual
Etiologies of abnormal uterine bleeding are structural in nature and are remembered by what acronym?
PALM-COIEN
What is PALM-COIEN?
Polyp Adenomyosis Leiomyoma Malignancy Coagulopathy Ovulatory dysfunction (most common) Endometrial (commonly hypaplasia) Iatrogenic Not yet classified
In adolescents, AUB is usually the result of what?
Anovulation
- due to immature hypothalamic-pituitary ovarian axis
- considered normal
What is the most common cause of AUB?
Ovulatory dysfunction (AUB-O)
AUB is often the result of what in women age 19-39?
- Pregnancy
- Structural lesions
- Anovulatory cycles
- Use of hormonal contraceptives
- Endometrial hyperplasia
Signs and symptoms of AUB?
- May have painful menstrual cramping
- Asymptomatic for spotting
- May show signs of anemia (Fatigue, pallor, picia, weakness)
What does the diagnosis of AUB depend on?
- Hx of duration, amount of flow, associated pain
- Hx of pertinent illness
- Hx of medication (warfarin, heparin, exogenous hormones)
- Hx coagulation disorders
- Physical exam
- Pelvic exam
Imaging for AUB?
- Transvaginal Ultrasound
- Sonohysterography or hysteroscopy
Treatment for AUB?
- Refer to OB-GYN
- Depends on etiology
- AUB-O:
- treated hormonally with progestin
- NSAIDs can reduce blood loss
What are some special considerations for postmenopausal bleeding?
- defined as bleeding that occurs 6 months or more after cessation of menstrual cycle
- Cancer until proven otherwise
- Transvaginal ultrasound
Most common causes of postmenopausal bleeding?
- Endometrial atrophy
- Endometrial proliferation or hypertrophy
- Endometrial or cervical cancer
