Neoplasms - Breast CA Flashcards
when is Inflammatory breast cancer normally diagnosed
at an advanced stage
average age = 59
sx Inflammatory breast cancer
rapidly enlarging (within the past 6 months) area of breast erythema and induration, occupying at least one-third of the breast
pruritus, pain, swollen lymph nodes, and nipple changes
signs of mets for inflammatory breast CA
right upper quadrant pain, confusion, or bone pain
PE inflammatory breast CA
swollen, edematous breast with peau d’orange (skin edema causing pores to be noticeably enlarged), erythema, a tender mass, and nipple changes, such as retraction, flattening, crusting, or blistering
localized spread to axillary lymph node
what fraction of pts will have distant mets at time of dx of inflammatory breast CA
1/3 of pts
definitive dx inflammatory breast CA
breast ultrasound and mammography of bilateral breasts
a week-long course of antibiotics may be prescribed if you don’t know if infection or CA
what if sx do not resolve w abx in case where it might be inflammatory breast CA or infection
core needle biopsy should be performed
Treatment of inflammatory breast cancer that is nonmetastatic
neoadjuvant chemotherapy followed by mastectomy and radiation
tx inflammatory breast CA that is metastatic
chemotherapy
RF for breast CA
BRCA 1 or 2 genetic mutations, obesity, and prolonged exposure to estrogen (i.e., early menarche, nulliparity after age 30, late menopause, and postmenopausal hormone therapy)
personal or family history of breast, endometrial, or ovarian cancer
history of atypical hyperplasia on prior breast biopsies
fibrocystic breast dz
most common type of breast cancer
infiltrating ductal carcinoma, which comprises over two-thirds of breast cancer diagnoses in the United States
second MC subtype of breast CA
Lobular carcinomas
is clinical exam sensitive in ruling out breast CA
no
what should be performed on all patients with breast masses that are suspected to be cancerous
Diagnostic mammography and ultrasonography
After mammography, the diagnosis of suspected breast cancer is typically confirmed with
ultrasound-guided core needle biopsy
what does ultrasound-guided core needle biopsy reveal for breast CA
tumor grade, type, and hormone receptivity
women with biopsy-proven breast cancer should undergo
genetic testing for the BRCA1 and 2 mutations
what should be performed before considering the removal of the regional axillary lymph nodes in breast CA
Sentinel lymph node biopsy
Primary treatment of early-stage (stages I, IIA, IIB) breast cancer
surgical excision with either lumpectomy or total mastectomy
tx for breast CA that are estrogen or progesterone hormone receptor-positive
aromatase inhibitors (i.e., letrozole or anastrozole) and selective estrogen receptor modulators (i.e., tamoxifen or raloxifene) is indicated after surgical intervention for a duration of 3–5 years to reduce the rate of breast cancer recurrence
tx for breast CA that are HER2 positive
trastuzumab, a monoclonal antibody to the HER2 receptor after surgical excision
radiation therapy may be indicated as well
tx for locally advanced breast cancers (stages IIB-IIIA, IIIB) and triple-negative (estrogen, progesterone, and HER2 receptor negative) breast cancer
neoadjuvant chemotherapy is indicated before mastectomy or lumpectomy.
Locally advanced and triple-negative breast cancers are also treated post-surgically with radiation therapy and appropriate adjuvant therapies
tx for metastatic breast CA - stage IV
palliation
United States Preventive Services Task Force recommends breast cancer screening with
mammography biennially in women aged 50 to 74 years. Consideration for screening women earlier than age 50 should be based on risk factors and shared decision-making
or biennially starting at the age of 40 years old for women with increased risk
what is the second most common cancer diagnosis in women worldwide and is the second leading cause of cancer-related death in women
breast CA
what is the single most important risk factor for developing breast cancer
age
protective factors for breast CA
age younger than 30 years at the time of their first birth, breastfeeding, or those with limited alcohol consumption, short height, or low socioeconomic status
Breast cancer is classified histologically as
ductal, lobular, or nipple, with most breast cancers being invasive ductal carcinomas
for breast CA: presence of these tissue markers is associated with better prognosis
estrogen and progesterone receptor tissue markers
BBW tamoxifen
endometrial hyperplasia and uterine malignancy
ADE tamoxifen
vasodilation, hot flashes, irregular menses, and fluid retention
what is a clinical risk tool that can estimate a woman’s 5-year and lifetime risk of developing invasive breast cancer
The Gail Model
Women are considered high risk for breast CA
with a 5-year risk at or exceeding 1.7%
tx for high risk women breast CA
prophylactic therapy, including treatment with selective estrogen receptor modulators (tamoxifen, raloxifene) or prophylactic mastectomy
what is the best screening tool to diagnose breast cancer and can detect breast cancer as early as 2 years prior to a mass palpated on physical exam
screening mammogram
American Cancer Association screening guidelines for breast CA
annual screening with a mammogram for all women ages 45 through 54, followed by biennial screening for those older than 55 years of age
American College of Obstetrics and Gynecologists (ACOG) screening guidelines for breast CA
annual screening for all women 40 years of age and older
Women with the BRCA1 gene mutation are more likely to be diagnosed with what form of breast cancer?
Medullary carcinoma
The following features further increase the risk that a breast mass is cancerous
poorly defined borders, fixed to the underlying chest wall, new retraction of nipple, orange-peel skin, and palpable axillary lymph nodes
Pathologic evaluation of infiltrating ductal carcinoma
hard, grayish, gritty masses with an irregular, stellate shape
what is the most common type of breast cancer found in postmenopausal women
Infiltrating lobular carcinoma
what is the most common type of breast cancer found in younger women with a BRCA1 mutation
medullary breast CA
what is less common than other types of breast cancer but it is more aggressive and has a worse prognosis
inflammatory breast CA
Serosanguinous nipple discharge is a common presentation in
papillary breast CA
Peau d’orange changes and blistering are physical exam findings that are most consistent with
inflammatory breast CA
Available chemotherapeutic options for breast CA include
doxorubicin, cyclophosphamide, and paclitaxel
Mammography is generally avoided in patients
< 40 years old due to the increased density of breast tissue
