Neoplasms, part 3 Flashcards
Stage III ovarian CA
Microscopic peritoneal implants outside of the pelvis
or limited to the pelvis with extension to the small bowel or omentum
Stage IIIA ovarian CA
Microscopic peritoneal metastases beyond pelvis
Stage IIIB ovarian CA
Macroscopic peritoneal metastases beyond pelvis <2 cm in size
Stage IIIC ovarian CA
Peritoneal metastases beyond pelvis >2 cm or LN metastases.
Para-aortic LN metastases are considered regional LNs
Stage IV ovarian CA
Distant metastases to the liver or outside the peritoneal cavity
How to do a clinical breast exam
First, look. Look at the breasts with the woman standing naturally, arms raised, with her hands on her hips, with her bent over at the waist
Second, do the exam. Lawnmower technique has been demonstrated to be more effective than going in circles
Check for nipple d/c
Clinical breast exam tips
If you think you might feel something, see if she has a matching one on the other side. Bad things are seldom identical bilat
If you have ANY doubts, order mammogram or u/s or both
If nipple d/c, get cytology sample
Pt complaint with breasts: discrete masses
Detected by the pt, often concerning for malignancy. Most malignancies are hard with rough, uneven edges, BUT NOT ALL!
Pt complaint with breasts: pain
Can be associated with a number of processes including:
Cyclical in a menstruating woman (reflecting transient hormone-induced changes in the breast tissue), occasionally malignancies (can be sharp or aching)
Pt breast complaints: unusual nipple d/c
May include:
Blood, concerning for malignancy (but also seen in other benign conditions)
Milk when not pregnant, suggestive of inappropriate prolactin secretion from the pituitary- may also be induced by certain meds
Clear or pale white, suggestive of early pregnancy
Yellow or green suggests infection (or ductal ectasia)
Other sx concerning for breast malignancy
Rapid change in the appearance of one breast, over the course of days or weeks
Thickness, heaviness or visible enlargement of one breast
Discoloration, giving the breast a red, purple, pink or bruised appearance
Unusual warmth of the affected breast
Dimpling or ridges on the skin of the affected breast, similar to an orange peel
Itching
Enlarged LNs under the arm, above the collarbone or below the collarbone
Flattening or turning inward of the nipple (if new finding)
Meds which can cause galactorrhea: anti-hypertensives
Aldomet
Atenolol
Verapamil
Meds which can cause galactorrhea: anti-depressants
Fluoxetine
Paroxetine
Sertraline, etc
Meds which can cause galactorrhea: anti-psychotics and phenothiazines
Chlorpromazine
Prochlorperazine
Meds which can cause galactorrhea: H2-receptor blockers
Famotidine
Ranitidine
Cimetidine
Meds which can cause galactorrhea: hormones
Prempro
Depo Provera
OCPs
Meds which can cause galactorrhea: herbs
Anise Blessed thistle Red clover Red raspberry Nettle
Meds which can cause galactorrhea: other drugs
Isoniazid Cyclobenzaprine Sumatriptan Valproic acid Amphetamines
Symptomatic pt with the breast: skin changes
Redness suggests infection or inflammation- in the PP patient, this is often d/t mastitis. In women who have not recently nursed a baby it is worrisome for IBC
Peau d’orange quality that’s caused by an uncommon, aggressive inflammatory malignancy
Dimpling: often a sign there is a tumor beneath. Assess with pt supine, sitting, and standing
Asymmetry
Nipple retraction: often a sign there is a tumor beneath, unless that is how her nipple(s) has always been
Carefully palpate around and under the nipple
RFs of breast CA
Majority of breast CA cases occur in women older than age 50
Having one or more first-degree blood relatives who have been dx-ed with breast CA increases a woman’s chances
Women who had their first menstrual period before age 12 have a slightly increased risk
Women who go through menopause after age 55
Risk depends on age at first live birth and FHx of breast CA
Personal hx of breast abnormalities
Breast bxs
HRT
White women > black women…but black women tend to get the more aggressive ones
BRCA 1 and 2
75% of women who develop breast have NO identifiable RFs
Lifestyle RFs of breast CA
Breastfeeding your infants for 1-2 years decreases risk
30 minutes of exercise 5x/wk decreases breast CA risk
Drinking 2-3 alcoholic drinks per day is associated with 20% increased risk, while 5 per day is associated with 40% higher risk than non-drinkers
Smoking
What type of breast CA are most breast CAs?
Ductal, in the tissues that move milk to the nipple
What percentage of CAs are estrogen and/or progesterone sensitive?
2/3
Tumors may also be HER2 positive or negative (a growth-promoting protein)
Drugs that are widely used to treat breast CA
Tamoxifen Raloxifene (Evista) Arimidex (anastozole) Aromasin (exemestane) Femara (letrozole) Faslodex (fulvestrant)
General staging of breast CA
TMN and then numbering
Tumor staging with breast CA: TX
Primary tumor cannot be assessed
Tumor staging with breast CA: T0
No evidence of primary tumor
Tumor staging with breast CA: TIS
Carcinoma in situ (DCIS, LCIS, or Paget dz of the nipple with no associated tumor mass)
Tumor staging with breast CA: T1
Tumor is 2 cm (3/4 of an inch) or less across
Tumor staging with breast CA: T2
Tumor is more than 2 cm but not more than 5 cm (2 inches) across
Tumor staging with breast CA: T3
Tumor is more than 5 cm across
Tumor staging with breast CA: T4
Tumor of any size growing into the chest wall or skin. This includes inflammatory breast CA
Lymph node staging with breast CA: NX
Cannot be assessed
Lymph node staging with breast CA: N0
No spread or requires PCR testing
Lymph node staging with breast CA: N1
Involves 1-3 nodes
Lymph node staging with breast CA: N2
Involves 4-9 nodes
Lymph node staging with breast CA: N3
Greater than 10 nodes or more distant nodes involved
Metastasis staging with breast CA: MX
Presence of distant spread cannot be assessed
Metastasis staging with breast CA: M0
No distant spread is found on X-rays (or other imaging procedures) or by physical exam
Metastasis staging with breast CA: cMo(i+)
Small numbers of CA cells are found in blood or bone marrow (found only by special tests) or tiny areas of CA spread (no larger than 0.2 mm) are found in LNs away from the breast
Metastasis staging with breast CA: M1
Spread to distant organs is present MC sites: Bone Lung Brain Liver
Types of breast CA tumor findings
Endocrine receptor pos
HER2 pos- tned to be very aggressive and fast-growing tumors
Triple neg: includes the majority of CAs in pts with BRCA1 mutations. Tend to respond well to chemo but we don’t have new tx yet
Triple pos
Receptor neg tumors have poorer prognosis because many of our best txs do not work on them.
Inflammatory breast CA
Occurs when CA cells block the lymphatic vessels in the breast, causing the characteristic red, swollen appearance of the breast
Most pts have signs of advanced CA at the time of dx, including LAD and metastasis
Sx of IBC that are in addition to the sx described in previous flashcard
Rapid change in the appearance of one breast, over the course of days or weeks
Thickness, heaviness, or visible enlargement of one breast
Discoloration, giving the breast a red, purple, pink or bruised appearance
Itching
Enlarged LNs under the arm, above the collarbone or below the collarbone
Unusual warmth of the affected breast
Paget’s dz of the breast
Specialized form of intraductal carcinoma that extends to involve the skin of the nipple and areola
Eczema-like appearance to the nipple
USUALLY women over 40
Virtually always unilateral
There IS a mass underneath the nipple, but it is only clinically palpable 70% of the time
