NMS Breast Flashcards
Breast cancer treatment for Stage 0, I, II?
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
Breast Cancer treatment for Stage III, IV?
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
Breast Cancer staging/metastatic workup
CBC, LFT, alk phos, Ca, Tbili, CT chest + liver, bone scan, renal function
When to get MRI?
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)
What drugs can cause gynecomastia?
Diuretics, estrogens, INH, marijuana, digoxin, alcohol
Important risk factors for breast ca?
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
Screening recommendations for breast ca
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
False negative rate of mammograms
7-20%
BIRADS 0-5 definitions
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
Difference between screening and diagnostic mammography
- screening cranio-caudal and mediolateral oblique views
- diagnostic can do magnification mammography; diagnostic is cranio-caudal + mediolateral oblique views PLUS mediolateral and lateromedial
Types of calcifications on mammogram that are suspicious of malignancy
Pleomorphic, heterogeneous, fine/linear/branching
2 entities that look like DCIS histopathologically but have higher cancer risk
- sclerosing adenosis
2. atypical ductal hyperplasia
Treatment for fibrocystic disease
elimination of caffeine, vitamin E supplement, cyst aspiration, f/u in 3 months
What could a 14 cm mass in a young woman be
cystosarcoma phyllodes: large, occasional ulceration of skin.
excise with generous margins
Most common cause of bloody discharge and treatment
intraductal papilloma: mammography + ductogram + excision
Prognostic indicators in breast cancer
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
What does inflammatory carcinoma of breast look like
ulcerated, edema of breast, peau d’orange, retraction of skin
What does retraction of skin overlying the mass mean?
suggests invasion of breast support structures and lymphatics
worse prognosis!
what do you do when fluid cysts recur
excise cyst to rule out cancer.
prognosis depends on pathology
what does it mean when mass is fixed to deeper tissues
invasion to tissue outside breast = worse prognosis
significance of lymph node palpable in supraclavicular area
= distant metastasis
M1=stage IV
unresectable and incurable
arm edema means: ?
obstruction of axillary lymphatics = worse prognosis
What to do with crusty lesion in nipple?
- biopsy nipple lesion and subareolar mass to rule out Paget’s disease
- if Paget’s + and confined to nipple then excision of nipple areolar complex or primary radiotherapy
- if underlying DCIS: excision and radiotherapy
Surgical principles in mgmt of breast ca
what does it mean if you have >10 LN involved
- establish diagnose
- completely eradicate primary tumor
- regional nodes or distant mets?
- wide excision + radiation good for localized tumor with clear margins
- mastectomy usually for larger/multicentric tumors
- removal of axillary LNs are for staging, not treatment
- decrease in survival correlates with increase in # of LNs involved;
poor prognosis: >10 LNs = 10-year survival of 14% - systemic adjuvant treatment in breast ca with axillary node involvement decreases risk of recurrence by 30%