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
