Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SURGERY CARDS > NMS Breast > Flashcards

NMS Breast Flashcards

1
Q

Breast cancer treatment for Stage 0, I, II?

A

Stage 0-I with small <1 cm tumors: lumpectomy, axillary sampling, radiation, hormonal treatment if ER+

Stage I with larger 1-2 cm tumors: lumpectomy, sentinel node biopsy, radiation, hormonal treatment + chemo if ER+ and premenopausal

Stage II: lumpectomy, sentinel node biopsy, radiation, hormonal treatment + chemo if ER+ and premenopausal
+ option for radical mastectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Breast Cancer treatment for Stage III, IV?

A

Stage III: must get preop chemo and MRI for surgical planning (usually modified radical mastectomy) + further chemo and radiation

Stage IV: chemo + palliative radiation + surgery if painful/infected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Breast Cancer staging/metastatic workup

A

CBC, LFT, alk phos, Ca, Tbili, CT chest + liver, bone scan, renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When to get MRI?

A

Surgical planning of advanced breast ca, poor renal function (cant do CT with contrast), evidence of spinal/brain mets (steroids, cord decompression, radiation, surgery if possible)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What drugs can cause gynecomastia?

A

Diuretics, estrogens, INH, marijuana, digoxin, alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Important risk factors for breast ca?

A

Prev hx (in self), fam hx (premenopausal), older age, ovarian or endometrial ca hx, older first full-term pregnancy, oopherectomy (check this), obesity, rich North American, hx fibrocystic dz, single, urban, white, early menarche and late menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Screening recommendations for breast ca

A

Disclaimer: breast exams are not recommended anymore I don’t think

Non high risk: monthly self exams at 20, professional breast exams 20-39 2 2 years, yearly after 40, mammograms q 1-2 years at 30-40, yearly after 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

False negative rate of mammograms

A

7-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

BIRADS 0-5 definitions

A

0: needs additional eval
1: normal
2: benign, recommend routine screening
3: prob benign, recommend 6 month followup
4: suspicious, recommend bx
5: highly suggestive of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Difference between screening and diagnostic mammography

A
  1. screening cranio-caudal and mediolateral oblique views
  2. diagnostic can do magnification mammography; diagnostic is cranio-caudal + mediolateral oblique views PLUS mediolateral and lateromedial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Types of calcifications on mammogram that are suspicious of malignancy

A

Pleomorphic, heterogeneous, fine/linear/branching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

2 entities that look like DCIS histopathologically but have higher cancer risk

A
  1. sclerosing adenosis

2. atypical ductal hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment for fibrocystic disease

A

elimination of caffeine, vitamin E supplement, cyst aspiration, f/u in 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What could a 14 cm mass in a young woman be

A

cystosarcoma phyllodes: large, occasional ulceration of skin.
excise with generous margins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common cause of bloody discharge and treatment

A

intraductal papilloma: mammography + ductogram + excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prognostic indicators in breast cancer

A

histologic type: IDC (invasive ductal ca), ILC (invasive lobular ca), inflammatory ca
worse than
tubular, papillary, mucinous, or Paget’s

ER+ better; progesterone (?), aneuploidy worse prognosis
Ki-67+ (higher S phase fraction or mitotic index) = worse prognosis
Her-2 Neu+ (human epidermal growth factor receptor) = worse prognosis and shorter relapse time
younger at dx tend to do worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does inflammatory carcinoma of breast look like

A

ulcerated, edema of breast, peau d’orange, retraction of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does retraction of skin overlying the mass mean?

A

suggests invasion of breast support structures and lymphatics

worse prognosis!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what do you do when fluid cysts recur

A

excise cyst to rule out cancer.

prognosis depends on pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what does it mean when mass is fixed to deeper tissues

A

invasion to tissue outside breast = worse prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

significance of lymph node palpable in supraclavicular area

A

= distant metastasis

M1=stage IV
unresectable and incurable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

arm edema means: ?

A

obstruction of axillary lymphatics = worse prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What to do with crusty lesion in nipple?

A
  1. biopsy nipple lesion and subareolar mass to rule out Paget’s disease
  2. if Paget’s + and confined to nipple then excision of nipple areolar complex or primary radiotherapy
  3. if underlying DCIS: excision and radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Surgical principles in mgmt of breast ca

what does it mean if you have >10 LN involved

A
  1. establish diagnose
  2. completely eradicate primary tumor
  3. regional nodes or distant mets?
  4. wide excision + radiation good for localized tumor with clear margins
  5. mastectomy usually for larger/multicentric tumors
  6. removal of axillary LNs are for staging, not treatment
  7. decrease in survival correlates with increase in # of LNs involved;
    poor prognosis: >10 LNs = 10-year survival of 14%
  8. systemic adjuvant treatment in breast ca with axillary node involvement decreases risk of recurrence by 30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Blood supply to breast

A

arterial: internal mammary (thoracic) and lateral thoracic
venous: axillary and internal mammary vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Lymphatic drainage of breast? divisions?

A

axillary LN chain

Level I: lateral to pec minor
Level II: posterior to pec minor
Level III: medial to pec minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Radical mastectomy

A

removal of: breasts, skin, pec major and minor, axillary LNs

only for tumors that extend into the muscle!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Modified radical mastectomy

A

spares pec major!

removes breasts, skin, pec minor, axillary LNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Auchincloss modification of radical mastectomy

A

spares pec minor!

removes breasts, skin, axillary LNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Patey modification

A

transection of pec minor and dissection of level III nodes (medial to pec minor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Simple mastectomy

A

removal of breast, nipple-areolar complex, skin.

usually for LCIS and DCIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When to radiate after mastectomy

A
  1. tumors > 5 cm that involve margin of resection or invade pec fascia or muscle
  2. axillary radiation when > 4 LN involved
  3. radiation of internal mammary nodes if apparent on sentinel node imaging
  4. supraclavicular nodes if extranodal extension into axillary fat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Limits of dissection for mastectomy

A

clavicle, lat(issimus dorsi?), costal margin, lateral border sternum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Lumpectomy? Segmental mastectomy?

A

For 4 nodes are positive or positive extracapsular invasion

Note: radiation after lumpectomy greatly reduces chance of local recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Does lumpectomy with radiation affect survival rates

A

not compared to modified radical mastectomy in stages I and II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What measurements do you need for staging

A

tumor size, LN bx, histology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is standard method for LN bx

A

remove nodes at levels I (lateral to pec minor) and II (posterior to pec minor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How do you do a sentinel LN bx

A
  1. inject dye or radiotracer around primary tumor
  2. wait for dye or tracer to reach node
  3. take it out and perform histo/path
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

If sentinel node negative for tumor, what are chances that other nodes are negative?

A

> 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Most physicians dont advocate modified radical mastectomies for tumors less than what?

A

<2 cm

41
Q

Does radiation increase survival

A

no, only decreases local recurrence

42
Q

Contraindications to radiation treatment

A
  1. prior radiation to chest or breasts
  2. connective tissue disease
  3. positive margins
  4. extensive DCIS (often seen as diffuse microcalcifications)

also: pregnancy

43
Q

4 methods of breast reconstruction

A

1) TRAM (transverse rectus abdominus myocutaneous) flap
2) lat (issimus doris?) flap
3) DIEP (deep inferior epigastric perforator)
4) free flap

44
Q

Flaps not as successful in which patients

A

obese and smokers

45
Q

Contraindications for mastectomies

A
  1. primary lesions involving chest wall
  2. extensive local or regional dz
  3. stage III or IV cancer
46
Q

Mgmt of stage 0 and I BC with <1 cm tumors (no nodes)

A

lumpectomy + axillary sampling + radiation + hormonal tx if ER+ (Aromatase inhibitor for postmenopausal, Tamoxifen for premenopausal)

47
Q

At what stage of BC do you check for mets

A

Stage I

48
Q

What is in the workup for mets

A
  • CXR for lung and bone mets;
  • liver enzymes for liver mets–> abdominal CT if liver -enzymes or bilirubin or alk phos abnormal
  • bone scan and/or head CT if bone pain or neuro complaints,
49
Q

Mgmt of stage I br ca with larger (1-2 cm) tumor and no nodes

A

lumpectomy + axillary sampling + radiation + hormonal tx if ER+ and chemo only if premenopausal

50
Q

Mgmt stage II br ca

A

lumpectomy + axillary sampling + radiation + hormonal tx if ER+ and chemo if node positive or premenopausal without node negative (table 11-8, p. 342)

51
Q

Chemo is poorly tolerate in what population?

A

elderly

52
Q

Who responds better to chemo

A

premenopausal patients

53
Q

Who responds better to hormonal treatment

A

postmenopausal

54
Q

Follow-up surveillance protocol for Stage I and II

A
  1. see dr. 2x/yr
  2. annual CXR + LFTs
  3. if lumpectomy, mammogram that breast q6 mo for 2 years then annually
  4. if mastectomy. mammogram the other breast (how frequently?)
55
Q

After mastectomy what are chances of Ca developing in remaining breast

A

15%

56
Q

Stage I, 5-year

A

93%

57
Q

Stage II, 5-year survival

A

72%

58
Q

Mgmt Stage III Breast Ca

A

1) consult onc for neoadjuvant chemo (before surg)

2) surg

59
Q

Mgmt stage IV breast ca

A

1) palliative radiation and chemo

2) surg only reserved for local control of primary tumor (painful or infected)

60
Q

Imaging modality to plan for surg

A

MRI

61
Q

Stage III 5 yr survival

A

41%

62
Q

Stage IV 5 yr survival

A

18%

63
Q

Breast mass with cellulitis and edema =

A

Inflammatory carcinoma

64
Q

Tx for inflammatory carcinoma

A
  1. staging workup: CBC, liver enzymes, alk phos, Ca, Tbili, CT chest, bone scan, CT liver with contrast or MRI w/gadolinium if poor renal function
  2. chemo
  3. modified radical mastectomy
  4. adjuvant chemo
  5. hormonal tx for ER+
  6. radiation for chest and regional LN basins
65
Q

What should you do if you have pathological fracture from cancer

A

Due to bony mets, control the cancer locally with radiation and orthopedic repair, radiation shouldn’t interfere with fracture union

66
Q

If after dx breast ca you get neuro sx like decreased sensation or motor function, what do you do

A

MRI, steroids, cord decompression, radiation

67
Q

If after dx of breast ca you get new seizures, what do you do

A

CT/MRI to dx brain mets, immediate steroids to decrease ICP, surgery or irradiation

68
Q

Coma/confusion with hx of breast ca could be what

A

acute hypercalcemia due to bony mets or PTH-related peptide release (usually breast ca or lung cancer)

69
Q

Abx for mastitis?

A

dicloxacillin/cefalexin (usually S.aureus or coag neg staph)

70
Q

If a mastitis doesn’t heal with abx, what are we worried about

A

inflammatory ca

71
Q

Mgmt of breast ca in pregnancy

A

Stage I and II mastectomy or lumpectomy with radiation after birth is safe.

Lumpectomy discouraged in early pregnancy bc of need for radiation.

Stage III and IV: rapid radiation and chemo, may need to abort

72
Q

Is ER or prog status reliable during pregnancy

A

No

73
Q

What do you do for breast mass in a man

A

mammogram to diff gynecomastia from cancer, mastectomy, and radiation

74
Q

when do men usually present with breast ca

A

after 60; tend to present at later stage

75
Q

What can cause gynecomastia

A

diuretics (spironolactone), estrogens, INH, weed, dig, etoh

76
Q

Most common sites of metastasis

A

lungs, liver, bone, brain, ovaries

77
Q

what cancers predisposed by BRCA1 mutation (2)

A

breast and ovarian

78
Q

screening recommendations for breast cancer (based on level of risk)

A

NORMAL RISK: q1y mammo with clinical exam starting at age 40; HIGH RISK: q1y mammo with q6m exam starting at age 30

79
Q

what study should follow finding of microcalcifications on mammogram

A

MAGNIFICATION mammogram –> stereotactic vs. open biopsy depending on low vs. high suspicion (open bx allows excision)

80
Q

tx for DCIS

A

if unifocal: lumpectomy;

if multifocal: simple mastectomy

81
Q

when to combine radiation with mastectomy

A

NEVER; no need for radiation if breast has been resected

82
Q

implications and tx of LCIS

A

LCIS is an incidental finding on breast bx that is an INDICATOR, NOT PRECURSOR of malignancy –> no role for resection, only for close surveillance (q6m exam/mammo)

83
Q

workup of simple cyst in breast

A

aspiration –> if resolves, NTD; if bloody or persistent, need cytology –> excision

84
Q

characteristics and workup of fibrocystic dz

A

often multiple, bilateral, fluctuates with menstrual cycle;

TREATMENT: cyst aspiration –> 3mo f/u –> bx/excision if persistent

85
Q

characteristics and tx of fibroadenoma

A

most common lesion in young females (<25 y); benign; TREATMENT: multiple, including excision, bx, or observation (if small)

86
Q

characteristics and tx of phyllodes tumor

A

LARGE, BULKY mass –> excision

87
Q

mgmt of bloody nipple discharge

A

suggests intraductal papilloma; need surgical bx +/- excision

88
Q

mgmt of clear, non-milky nipple discharge from multiple ducts

A

likely fibrocystic dz –> observation

89
Q

how does age affect breast cancer prognosis

A

younger women do worse :(

90
Q

what types of skin changes cant be seen with breast cancer (3)

A

ALL ARE BAD

  1. ULCERS: suggest inflammatory carcinoma;
  2. PEAU D’ORANGE/EDEMA: suggests lymphatic involvement
  3. SKIN/NIPPLE RETRACTION: suggests invasion of support structures
91
Q

what does eczematoid lesion of nipple suggest? what is mgmt

A

Paget’s dz of nipple, almost always a/w underlying malignancy –> mammo/PE –> mastectomy + staging if mass, bx nipple if not

92
Q

when to do lumpectomy/simple mastectomy vs. modified radical mastectomy

A

depends on size of solitary tumor.

if 5 cm, need to do modified radical mastectomy

93
Q

how to tx metastatic breast cancer

A

stages III and IV –> palliative chemo/rads/surg + hormonal tx

94
Q

how does menopause change adjuvant treatment for breast cancer

A

premenopausal: chemo;
postmenopausal: hormonal

95
Q

how to deal with local recurrence following breast surgery

A

if 1st surgery was mastectomy, do local excision; if 1st surgery was lumpectomy, do mastectomy

96
Q

what do you suspect in pt with h/o breast cancer who presents with coma

A

hypercalcemia

97
Q

tx for mastitis

A

warm compresses, antibiotics (for staph and strep)

98
Q

tx of breast abscess

A

surgical drainage (incision and drainage), NOT needle drainage

SURGERY CARDS (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions