Neoplasms - Breast CA Flashcards

1
Q

when is Inflammatory breast cancer normally diagnosed

A

at an advanced stage

average age = 59

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2
Q

sx Inflammatory breast cancer

A

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

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3
Q

signs of mets for inflammatory breast CA

A

right upper quadrant pain, confusion, or bone pain

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4
Q

PE inflammatory breast CA

A

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

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5
Q

what fraction of pts will have distant mets at time of dx of inflammatory breast CA

A

1/3 of pts

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6
Q

definitive dx inflammatory breast CA

A

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

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7
Q

what if sx do not resolve w abx in case where it might be inflammatory breast CA or infection

A

core needle biopsy should be performed

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8
Q

Treatment of inflammatory breast cancer that is nonmetastatic

A

neoadjuvant chemotherapy followed by mastectomy and radiation

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9
Q

tx inflammatory breast CA that is metastatic

A

chemotherapy

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10
Q

RF for breast CA

A

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

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11
Q

most common type of breast cancer

A

infiltrating ductal carcinoma, which comprises over two-thirds of breast cancer diagnoses in the United States

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12
Q

second MC subtype of breast CA

A

Lobular carcinomas

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13
Q

is clinical exam sensitive in ruling out breast CA

A

no

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14
Q

what should be performed on all patients with breast masses that are suspected to be cancerous

A

Diagnostic mammography and ultrasonography

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15
Q

After mammography, the diagnosis of suspected breast cancer is typically confirmed with

A

ultrasound-guided core needle biopsy

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16
Q

what does ultrasound-guided core needle biopsy reveal for breast CA

A

tumor grade, type, and hormone receptivity

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17
Q

women with biopsy-proven breast cancer should undergo

A

genetic testing for the BRCA1 and 2 mutations

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18
Q

what should be performed before considering the removal of the regional axillary lymph nodes in breast CA

A

Sentinel lymph node biopsy

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19
Q

Primary treatment of early-stage (stages I, IIA, IIB) breast cancer

A

surgical excision with either lumpectomy or total mastectomy

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20
Q

tx for breast CA that are estrogen or progesterone hormone receptor-positive

A

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

21
Q

tx for breast CA that are HER2 positive

A

trastuzumab, a monoclonal antibody to the HER2 receptor after surgical excision

radiation therapy may be indicated as well

22
Q

tx for locally advanced breast cancers (stages IIB-IIIA, IIIB) and triple-negative (estrogen, progesterone, and HER2 receptor negative) breast cancer

A

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

23
Q

tx for metastatic breast CA - stage IV

A

palliation

24
Q

United States Preventive Services Task Force recommends breast cancer screening with

A

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

25
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
26
what is the single most important risk factor for developing breast cancer
age
27
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
28
Breast cancer is classified histologically as
ductal, lobular, or nipple, with most breast cancers being invasive ductal carcinomas
29
for breast CA: presence of these tissue markers is associated with better prognosis
estrogen and progesterone receptor tissue markers
30
BBW tamoxifen
endometrial hyperplasia and uterine malignancy
31
ADE tamoxifen
vasodilation, hot flashes, irregular menses, and fluid retention
32
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
33
Women are considered high risk for breast CA
with a 5-year risk at or exceeding 1.7%
34
tx for high risk women breast CA
prophylactic therapy, including treatment with selective estrogen receptor modulators (tamoxifen, raloxifene) or prophylactic mastectomy
35
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
36
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
37
American College of Obstetrics and Gynecologists (ACOG) screening guidelines for breast CA
annual screening for all women 40 years of age and older
38
Women with the BRCA1 gene mutation are more likely to be diagnosed with what form of breast cancer?
Medullary carcinoma
39
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
40
Pathologic evaluation of infiltrating ductal carcinoma
hard, grayish, gritty masses with an irregular, stellate shape
41
what is the most common type of breast cancer found in postmenopausal women
Infiltrating lobular carcinoma
42
what is the most common type of breast cancer found in younger women with a BRCA1 mutation
medullary breast CA
43
what is less common than other types of breast cancer but it is more aggressive and has a worse prognosis
inflammatory breast CA
44
Serosanguinous nipple discharge is a common presentation in
papillary breast CA
45
Peau d’orange changes and blistering are physical exam findings that are most consistent with
inflammatory breast CA
46
Available chemotherapeutic options for breast CA include
doxorubicin, cyclophosphamide, and paclitaxel
47
Mammography is generally avoided in patients
< 40 years old due to the increased density of breast tissue
48