Normal/Abnormal Breast Exam

Question 1

the breast are a modified ___ gland

Answer 1

sebaceous

secrete sebum

Question 2

the breast are composed of what 4 things

Answer 2

fat, connective tissue, glands, milk ducts

Question 3

how many lobes are in a normal breast and where do the majority of them lie

Answer 3

12-20 and most in the upper outer quadrant (tail of spence)

Question 4

lobules consist of cluster of secretory cells lined by _____ cells (contractile)

Answer 4

myoepithelial

Question 5

what is the most common route of metastasis in breast cancer?

Answer 5

internal mammary lymph nodes and ipsilateral lymph nodes to the breast cancer

Question 6

breast tissue is ___ sensitive

Answer 6

hormonally

Question 7

estrogen is responsible for growth of ______ and _____ in the breasts

Answer 7

adipose tissue and lactiferous ducts

Question 8

progesterone is responsible for stimulation of _______ and _____ growth

Answer 8

lobular and alveolar budding/growth

Question 9

what are some congenital anomalies of the breast

Answer 9

absence of breast, accessory breast/nipples along the milk line.

Question 10

what is polythelia

Answer 10

extra nipples

Question 11

what is polymastia

Answer 11

accessory breasts

Question 12

breast complaints require a ____ evaluation

Answer 12

timely

Question 13

two most common breast complaints

Answer 13

pain or a mass

Question 14

risk factors for breast cancer

Answer 14

age, history of breast cancer, atypical hyperplasia, high breast tissue density, first degree relatives, early menarche, late menopause, no pregnancies (unopposed estrogen), birth-control, postmenopausal obesity, tall high, jewish

Question 15

during physical exam of the breasts what must you do

Answer 15

evaluate both breasts and include the axilla and chest wall

Question 16

what diagnostic tests can we use on breast pathology

Answer 16

mammogram, ultrasound, MRI, fine needle aspiration (FNA), and core. biopsy

Question 17

palpable masses almost always get a _____

Answer 17

biopsy

Question 18

mammograms are able to detect lesions about ___ years before they become palpable. ____ and ____ are suspicious findings.

Answer 18

2 years

densities and calcifications

(can detect less than 1cm masses)

Question 19

mammography is best in women ____ years or older, why?

Answer 19

40 years

under 40 the breast are more dense and harder to detect masses

Question 20

describe the difference between screening mammography and diagnostic mammography

Answer 20

screening is when there are no complaints just a checkup with 4 images, 2 craniocaudal and 2 mediolateral

diagnostic is done in women with a complaint or palpable mass, contralateral breast should also be imaged.

Question 21

ultrasound in breast is best when evaluating women ____ years old and allows you to differentiate between ___ and ___ lesions

Answer 21

younger than 40 (higher breast density)

cystic vs solid

(also used to guide core needle biopsies)

Question 22

MRI of breasts is useful in adjuct with? and is used for ?

Answer 22

mammography

post cancer diagnosis for STAGING and BRCA carriers

(very expensive)

Question 23

fine needle aspiration biopsy is useful in determining ____ vs ____ masses

Answer 23

solid vs. cystic

Question 24

FNAs are done where

Answer 24

in office

Question 25

FNA use a gauge needle of what size, clear fluid requires? blood fluid requires? FNA overall looks at the ____ of the breast

Answer 25

22-24 gauge needle clear- no further evaluation bloody- sent to cytology and patients need a diagnostic mammogram/ultrasound cytology

Question 26

if a cyst completely disappears after FNA when should they return to the clinic for a clinical breast exam

Answer 26

4-6 months

Question 27

after FNA if a cyst reappears or does not resolve with FNA you must do what?

Answer 27

get them a mammogram/ultrasound and preform a different biopsy

Question 28

a core needle biopsy takes tissue with a needle ___ - ____ gauge and is used to get tissue from a ______ mass for diagnosis

Answer 28

14-16 gauge larger sold mass

Question 29

how many samples and how long are the core needle biopsies of tissue

Answer 29

3-6 samples, 2 cm long

Question 30

mastalgia

Answer 30

breast pain

Question 31

cyclic mastalgia starts at the ___ phase and ends after ______

Answer 31

luteal ends after onset of menses

Question 32

noncyclic mastalgia is?

Answer 32

not associated with the menstrual cycle and can be caused by tumors, mastitis, cysts, oral contraceptives

Question 33

extramammary mastalgia can be caused by?

Answer 33

trauma to the chest wall, shingles, fibromyalgia

Question 34

what is the only FDA approved treatment for mastalgia

Answer 34

danazol

Question 35

what are the side effects of danazol

Answer 35

menstrual irregularities, benign intracranial hypertension, altered blood sugar, deepens voice, unusual hair growth, weight gain

Question 36

selective estrogen receptor modulators like tamoxifen can be used to treat mastalgia off label but can cause increased risk of ____ and ____

Answer 36

endometrial hyperplasia and deep vein thrombosis

Question 37

oral contraceptives can help with mastalgia becuase?

Answer 37

they block the cyclic component of breast pain

Question 38

what can patients due to provide symptom relief with breast pain?

Answer 38

wear a fitting bra, reduce weight, exercise, decrease caffeine, vitamin E supplements and evening primrose oil

Question 39

nipple discharge is usually _____

Answer 39

benign

Question 40

nipple discharge could be a sign of ____ or ___ disorder

Answer 40

cancer or endocrine

Question 41

with nipple discharge you want to further categorize it wether that be unilateral/bilateral, color, consistency, spontaneous/expressed. For example: non-spontaneous, non-bloody, bilateral discharge is most consistent with ____changes or ______ _____

Answer 41

fibrocystic changes or ductal ectasia

Question 42

milky nipple discharge is common with childbearing but may indicate ________ or ________

Answer 42

hyperprolactinemia or hypothyroidism

Question 43

what medications can cause a milky nipple discharge?

Answer 43

psychotropics (anxiety meds) or oral contraceptives

Question 44

breast masses concerns for malignancy signs

Answer 44

greater than 2 cm immobility poorly defined margins firm skin dimpling/retraction/color changes bloody nipple ipsilateral lymphadenopathy

Question 45

bloody nipple discharge is considered ___ until proven otherwise

Answer 45

cancer

Question 46

with bloody nipple discharge there is concern for?

Answer 46

intraductal carcinoma, invasive ductal carcinoma, or a begning intraductal papilloma

Question 47

bloody nipple discharge is evaluated with

Answer 47

breast ductography (localize the duct involved) and requires ductal excision

Question 48

non proliferative benign breast masses have a ___ risk of developing cancer

Answer 48

1.0 risk (equal to general population)

Question 49

proliferative without atypia breast mass has a ____ risk of developing cancer

Answer 49

1.5-2.0 risk

Question 50

proliferative with atypia breast mass has a ___ risk of developing cancer

Answer 50

8.0-10.0 risk

Question 51

what are the common noproliferative breast masses?

Answer 51

fibrocystic changes, adenosis, lactational adenoma, fibroadenomas

Question 52

what are fibrocystic changes in the breast

Answer 52

a spectrum of changes observed in the normal breast dilated lobules and cysts

Question 53

in fibrocystic chnage cysts rupture and cause scarring and inflammation what causes the cysts to rupture?

Answer 53

estrogen/hormone stimulation

Question 54

what is adenosis

Answer 54

lobular growth with an increased number of glands (too many acini per lobule)

Question 55

what is lactational adenomas caused by?

Answer 55

hormonal response

Question 56

what is a fibroadenoma

Answer 56

a solid, mobile, rubbery bengin tumor in the female breast that is typically 2-4 cm

Question 57

what is a galactocele

Answer 57

cystic dilation with milky fluid

Question 58

galactocele occurs when

Answer 58

near time of lactation

Question 59

galactoceles can have a secondary infection that may produce ?

Answer 59

acute mastitis

Question 60

a galactocele can typically be ___ aspirated

Answer 60

needle

Question 61

benign breast masses that are proliferative without atypia types

Answer 61

epithelial hyperplasia sclerosing adenosis complex sclerosing lesions/radial scar papillomas

Question 62

what is epithelial hyperplasia?

Answer 62

overgrowth of cells that line the ducts

Question 63

what is sclerosing adenosis

Answer 63

increased fibrosis in breast lobules

Question 64

what is complex sclerosing lesions/radial scar

Answer 64

tubules that are trapped in dense stroma surrounded by radiating arms of epithelium

Question 65

what are the proliferative breast lesions with atypia

Answer 65

LCIS or DCIS

Question 66

what is LCIS

Answer 66

a risk factor for developing breast cancer when malignant cells replace the normal epithelium lining the lobules of the breast (lobular carcinoma insitu)

Question 67

what is ductal carcinoma insitu

Answer 67

a precursor lesion when the ducts are filled with atypical epithelial cells and women are at an increased risk for invasive cancer or DCIS reocurrence

Question 68

how do we treat DCIS and LCIS

Answer 68

excision and then treatment with selective estrogen receptor modulators (HER2, tamoxifen)

Question 69

most breast cancer happen after the age of ____ expect for african americans which is typically around age 45

Answer 69

50

Question 70

what is the gail model-breast cancer risk can be falsely elevated with? high risk patients

Answer 70

determine the risk of developing breast cancer falsely elevated in patients with multiple breast biopsies high risk patients are counseled on prophylactic therapy (1.7% risk or higher)

Question 71

4 histology types of breast cancer?

Answer 71

ductal, lobular, nipple(pagets), inflammatory

Question 72

ductal breast cancer is the most common and spreads to the ____ nodes, and is most common in women aged ____

Answer 72

regional nodes 50 years old

Question 73

lobular breast cancer is the most aggressive and can be ________ (multifocal/bifocal)

Answer 73

multifocal

Question 74

nipple breast cancer also known as pagets disease presents as a ?

Answer 74

superifical skin lesion

Question 75

inflammatory breast cancers present with swelling and redness and ___ of the surrounding tissues

Answer 75

induration

Question 76

the ____ at diagnosis of breast cancer is one of the most important indicators of prognosis

Answer 76

stage

Question 77

5 year survival rates localized disease- regional disease- metastatic disease -

Answer 77

LD- 99% RD-86% MD- 27%

Question 78

use ____ ___ in addition to staging to determine prognosis

Answer 78

receptor status (estrogen or progesterone receptor)

Question 79

if there are estrogen or progesterone receptors found this is a ____ finding

Answer 79

positive

Question 80

Her2/neu finding in breast cancer is a ____ prognosis

Answer 80

worse

Question 81

surgical therapy for breast cancer

Answer 81

lumpectomy with radiation mastectomy ( they both have the same outcomes)

Question 82

___ therapy is used in combination with surgical therapy to reduce reoccurrence

Answer 82

medical

Question 83

chemotherapy kills _____ cells

Answer 83

cancer

Question 84

hormone therapy works in premenopausal women to ?

Answer 84

antagonize estrogen and reduce the risk of cancer in breasts

Question 85

aromatase inhibitors work by?- post menopausal women

Answer 85

preventing estrogen production in postmenopausal women

Question 86

Herceptin (trastuzumab) acts on?

Answer 86

protein made by Her2/neu

Question 87

side effects of trastuzumab

Answer 87

heart failure, respiratory problems, serious allergic reactions