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Women's Health Rotation > Neoplasms, part 3 > Flashcards

Neoplasms, part 3 Flashcards

1
Q

Stage III ovarian CA

A

Microscopic peritoneal implants outside of the pelvis

or limited to the pelvis with extension to the small bowel or omentum

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2
Q

Stage IIIA ovarian CA

A

Microscopic peritoneal metastases beyond pelvis

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3
Q

Stage IIIB ovarian CA

A

Macroscopic peritoneal metastases beyond pelvis <2 cm in size

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4
Q

Stage IIIC ovarian CA

A

Peritoneal metastases beyond pelvis >2 cm or LN metastases.

Para-aortic LN metastases are considered regional LNs

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5
Q

Stage IV ovarian CA

A

Distant metastases to the liver or outside the peritoneal cavity

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6
Q

How to do a clinical breast exam

A

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

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7
Q

Clinical breast exam tips

A

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

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8
Q

Pt complaint with breasts: discrete masses

A

Detected by the pt, often concerning for malignancy. Most malignancies are hard with rough, uneven edges, BUT NOT ALL!

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9
Q

Pt complaint with breasts: pain

A

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)

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10
Q

Pt breast complaints: unusual nipple d/c

A

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)

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11
Q

Other sx concerning for breast malignancy

A

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)

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12
Q

Meds which can cause galactorrhea: anti-hypertensives

A

Aldomet
Atenolol
Verapamil

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13
Q

Meds which can cause galactorrhea: anti-depressants

A

Fluoxetine
Paroxetine
Sertraline, etc

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14
Q

Meds which can cause galactorrhea: anti-psychotics and phenothiazines

A

Chlorpromazine

Prochlorperazine

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15
Q

Meds which can cause galactorrhea: H2-receptor blockers

A

Famotidine
Ranitidine
Cimetidine

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16
Q

Meds which can cause galactorrhea: hormones

A

Prempro
Depo Provera
OCPs

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17
Q

Meds which can cause galactorrhea: herbs

A 
Anise
Blessed thistle
Red clover
Red raspberry
Nettle
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18
Q

Meds which can cause galactorrhea: other drugs

A 
Isoniazid
Cyclobenzaprine
Sumatriptan
Valproic acid
Amphetamines
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19
Q

Symptomatic pt with the breast: skin changes

A

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

20
Q

RFs of breast CA

A

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

21
Q

Lifestyle RFs of breast CA

A

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

22
Q

What type of breast CA are most breast CAs?

A

Ductal, in the tissues that move milk to the nipple

23
Q

What percentage of CAs are estrogen and/or progesterone sensitive?

A

2/3

Tumors may also be HER2 positive or negative (a growth-promoting protein)

24
Q

Drugs that are widely used to treat breast CA

A 
Tamoxifen
Raloxifene (Evista)
Arimidex (anastozole)
Aromasin (exemestane)
Femara (letrozole)
Faslodex (fulvestrant)
25
Q

General staging of breast CA

A

TMN and then numbering

26
Q

Tumor staging with breast CA: TX

A

Primary tumor cannot be assessed

27
Q

Tumor staging with breast CA: T0

A

No evidence of primary tumor

28
Q

Tumor staging with breast CA: TIS

A

Carcinoma in situ (DCIS, LCIS, or Paget dz of the nipple with no associated tumor mass)

29
Q

Tumor staging with breast CA: T1

A

Tumor is 2 cm (3/4 of an inch) or less across

30
Q

Tumor staging with breast CA: T2

A

Tumor is more than 2 cm but not more than 5 cm (2 inches) across

31
Q

Tumor staging with breast CA: T3

A

Tumor is more than 5 cm across

32
Q

Tumor staging with breast CA: T4

A

Tumor of any size growing into the chest wall or skin. This includes inflammatory breast CA

33
Q

Lymph node staging with breast CA: NX

A

Cannot be assessed

34
Q

Lymph node staging with breast CA: N0

A

No spread or requires PCR testing

35
Q

Lymph node staging with breast CA: N1

A

Involves 1-3 nodes

36
Q

Lymph node staging with breast CA: N2

A

Involves 4-9 nodes

37
Q

Lymph node staging with breast CA: N3

A

Greater than 10 nodes or more distant nodes involved

38
Q

Metastasis staging with breast CA: MX

A

Presence of distant spread cannot be assessed

39
Q

Metastasis staging with breast CA: M0

A

No distant spread is found on X-rays (or other imaging procedures) or by physical exam

40
Q

Metastasis staging with breast CA: cMo(i+)

A

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

41
Q

Metastasis staging with breast CA: M1

A 
Spread to distant organs is present
MC sites:
Bone
Lung
Brain
Liver
42
Q

Types of breast CA tumor findings

A

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.

43
Q

Inflammatory breast CA

A

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

44
Q

Sx of IBC that are in addition to the sx described in previous flashcard

A

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

45
Q

Paget’s dz of the breast

A

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

Women's Health Rotation (15 decks)

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