Monday, 2-27-Normal and abnormal breast (Wootton)

Question 1

__ is responsible for growth of adipose tissue and lactiferous ducts

__ is responsible for stimulation of lobular growth and alveolar budding

Answer 1

estrogen

progesterone

Question 2

risk factors for breast CA (laundry list)?

Answer 2

• age
• personal hx of breast CA
• hx of atypical hyperplasia
• high breast tissue density
• 1st degree relatives w/ breast CA or ovarian CA
• early menarche (age <12)
• late cessation of menses (age>55)
• no term pregnancies
• never breastfed
• recent and long term use of OCs
• postmenopausal obesity
• personal hx of endometrial or ovarian CA
• EtOH consumption
• Height (tall)
• High SES
• Ashkenazie jews

Question 3

a palpable breast mass qualifies for what?

Answer 3

biopsy –> FNA/core/excisional

Question 4

mammography is best win these women?

Answer 4

40 yrs and older

Question 5

ACOG recommendations for mammography? Clinical exam?

Answer 5

mammo-age 40+ annually

cliical exam-age 20-39=1-3 yrs; age 40+=annually

Question 6

this method is useful in evaluating inconclusive mammogram findings, best for evaluating young women (age <40) and others with dense breast tissue, allows to differentiate between cystic vs solid lesions, and used for guidance when doing core needle biopsy

Answer 6

Ultrasound

Question 7

this method is a useful adjunct to dx mammography in suspicious masses, used post-CA dx for further evaluation of staging, used with implants, and women at high risk for breast CA like BRCA carrieres

Answer 7

MRI

Question 8

__ is useful in determining solid versus cystic masses

Answer 8

FNA biopsy-smaller needle (22-24 gauge)

• clear fluid=no further eval
• bloody=sent for cytology and need dx mammogram/US

Question 9

this method is used to get tissue from larger solid masses for Dx and uses a large needle (14-16 gauge)

Answer 9

core needle biopsy

Question 10

causes of cyclic mastalgia? noncyclic mastalgia? extramammary mastalgia?

Answer 10

cyclic-starts at luteal phase, ends after onset of menses

noncyclic: tumors, mastitis, cysts
extramammary: chest wall trauma, shingles, fibromyalgia

Question 11

only FDA approved tx for mastalgia?

others?

Answer 11

Danazol only FDA approved tx but unpleasant side effects

can also do SERMs, OCs or Depo provera, proper fitting bra, weight loss, exercise, decrease caffeine intake, Vit E supplements

Question 12

concern with bloody nipple discharge?

Answer 12

considered CA until proven otherwise

• concern for intraductal carcinoma or invasive ductal carcinoma
• could be benign intraductal papilloma
• evaluate with breast ductography and requires ductal excision

Question 13

when should you be concerned for malignancy of a breast mass?

Answer 13

• > 2 cm in size
• immobile
• poorly defined margins
• firmness
• skin dimpling/retraction/color changes
• bloody discharge
• ipsilateral LAD

Question 14

fibrocystic changes, cysts, fibrosis, adenosis, lactational adenomas, galactocele, and fibroadenomas are what type of breast masses?

Answer 14

Non-proliferative-benign

Question 15

most common tumor in female breast that usually occurs in late teens to early 20s?

Answer 15

fibroadenoma

-solid , rubbery, mobile, typically solitary

Question 16

epithelial hyperplasia, sclerosing adenosis, complex sclerosing lesions (radial scar) and papillomas are what type of breast masses?

Answer 16

Proliferative WITHOUT atypia-Benign

Question 17

__ are intraductal growths seen in women 30-50 yrs old, cause serous or serosanguinous discharge and considered benign, proliferative without atypia

Answer 17

papillomas

Question 18

LCIS and DCIS are what type of breast masses?

Answer 18

Prolfierative lesions WITH atypia

Question 19

tx of both LCIS and DCIS?

Answer 19

both tx with excision and then followed w/tx with SERMs

Question 20

lifetime risk of developing breast CA? lifetime risk of dying from it?

Answer 20

develop=1:8

die=1:28

Question 21

age and race risk factors for breast CA?

Answer 21

majority after 50, white women at greater risk

Question 22

FH and genetic risk factors for breast CA?

Answer 22

1st degree relative, esp if dx under age 40

BRCA1- about 1/2 early onset breast and 90% hereditary ovarian

BRCA2- about 35% early onset breast, much lower risk of ovarian ca

Question 23

this type of breast CA makes up 70-80% of all breast CA, most common in women in their 50s, spreads to regional nodes

Answer 23

Ductal

Question 24

this type of breast CA is 5-15% of breast ca, more likely to be multipfocal and/or bilaterla

Answer 24

lobular

Question 25

__ presents as superficial skin lesion around the nipple (3% of breast CAs)

Answer 25

pagets disease

Question 26

__ breast CA makes up 1-4%, swelling and redness of underlying skin and induration of surrounding tissues

Answer 26

inflammatory breast CA

Question 27

in breast CA tx, use __ status in addition to staging to determine prognosis

Answer 27

receptor

Question 28

this receptor associated with worse prognosis and found in 20-30% invasive cancers

Answer 28

HER2/neu (oncogene)

Question 29

this hormonal tx is an estrogen antagonist, reduces risk of CA in contralateral breast as well

Answer 29

tamoxifen

Question 30

__ inhibitors prevent production of estrogen in postmenopausal women

Answer 30

aromatase (arimedex, femara)

Question 31

__ acts on protein made by HER2/neu

Answer 31

trastuzumab (herceptin)

-side effects: Heart failure

Question 32

tx follow-up of breast CA?

Answer 32

• 1st 2 yrs after dx: every 3-6 months
• annually after 1st 2 yrs
• most reoccurences will happen within 1st 5 yrs after tx