Normal/Abnormal Breast Exam Flashcards
the breast are a modified ___ gland
sebaceous
secrete sebum
the breast are composed of what 4 things
fat, connective tissue, glands, milk ducts
how many lobes are in a normal breast and where do the majority of them lie
12-20 and most in the upper outer quadrant (tail of spence)
lobules consist of cluster of secretory cells lined by _____ cells (contractile)
myoepithelial
what is the most common route of metastasis in breast cancer?
internal mammary lymph nodes and ipsilateral lymph nodes to the breast cancer
breast tissue is ___ sensitive
hormonally
estrogen is responsible for growth of ______ and _____ in the breasts
adipose tissue and lactiferous ducts
progesterone is responsible for stimulation of _______ and _____ growth
lobular and alveolar budding/growth
what are some congenital anomalies of the breast
absence of breast, accessory breast/nipples along the milk line.
what is polythelia
extra nipples
what is polymastia
accessory breasts
breast complaints require a ____ evaluation
timely
two most common breast complaints
pain or a mass
risk factors for breast cancer
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
during physical exam of the breasts what must you do
evaluate both breasts and include the axilla and chest wall
what diagnostic tests can we use on breast pathology
mammogram, ultrasound, MRI, fine needle aspiration (FNA), and core. biopsy
palpable masses almost always get a _____
biopsy
mammograms are able to detect lesions about ___ years before they become palpable. ____ and ____ are suspicious findings.
2 years
densities and calcifications
(can detect less than 1cm masses)
mammography is best in women ____ years or older, why?
40 years
under 40 the breast are more dense and harder to detect masses
describe the difference between screening mammography and diagnostic mammography
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.
ultrasound in breast is best when evaluating women ____ years old and allows you to differentiate between ___ and ___ lesions
younger than 40 (higher breast density)
cystic vs solid
(also used to guide core needle biopsies)
MRI of breasts is useful in adjuct with? and is used for ?
mammography
post cancer diagnosis for STAGING and BRCA carriers
(very expensive)
fine needle aspiration biopsy is useful in determining ____ vs ____ masses
solid vs. cystic
FNAs are done where
in office
FNA use a gauge needle of what size, clear fluid requires? blood fluid requires? FNA overall looks at the ____ of the breast
22-24 gauge needle
clear- no further evaluation
bloody- sent to cytology and patients need a diagnostic mammogram/ultrasound
cytology
if a cyst completely disappears after FNA when should they return to the clinic for a clinical breast exam
4-6 months
after FNA if a cyst reappears or does not resolve with FNA you must do what?
get them a mammogram/ultrasound and preform a different biopsy
a core needle biopsy takes tissue with a needle ___ - ____ gauge and is used to get tissue from a ______ mass for diagnosis
14-16 gauge
larger sold mass
how many samples and how long are the core needle biopsies of tissue
3-6 samples, 2 cm long
mastalgia
breast pain
cyclic mastalgia starts at the ___ phase and ends after ______
luteal
ends after onset of menses
noncyclic mastalgia is?
not associated with the menstrual cycle and can be caused by tumors, mastitis, cysts, oral contraceptives
extramammary mastalgia can be caused by?
trauma to the chest wall, shingles, fibromyalgia
what is the only FDA approved treatment for mastalgia
danazol
what are the side effects of danazol
menstrual irregularities, benign intracranial hypertension, altered blood sugar, deepens voice, unusual hair growth, weight gain
selective estrogen receptor modulators like tamoxifen can be used to treat mastalgia off label but can cause increased risk of ____ and ____
endometrial hyperplasia and deep vein thrombosis
oral contraceptives can help with mastalgia becuase?
they block the cyclic component of breast pain
what can patients due to provide symptom relief with breast pain?
wear a fitting bra, reduce weight, exercise, decrease caffeine, vitamin E supplements and evening primrose oil
nipple discharge is usually _____
benign
nipple discharge could be a sign of ____ or ___ disorder
cancer or endocrine
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 ______ _____
fibrocystic changes or ductal ectasia
milky nipple discharge is common with childbearing but may indicate ________ or ________
hyperprolactinemia or hypothyroidism
what medications can cause a milky nipple discharge?
psychotropics (anxiety meds) or oral contraceptives
breast masses concerns for malignancy signs
greater than 2 cm
immobility
poorly defined margins
firm
skin dimpling/retraction/color changes
bloody nipple
ipsilateral lymphadenopathy
bloody nipple discharge is considered ___ until proven otherwise
cancer
with bloody nipple discharge there is concern for?
intraductal carcinoma, invasive ductal carcinoma, or a begning intraductal papilloma
bloody nipple discharge is evaluated with
breast ductography (localize the duct involved)
and requires ductal excision
non proliferative benign breast masses have a ___ risk of developing cancer
1.0 risk (equal to general population)
proliferative without atypia breast mass has a ____ risk of developing cancer
1.5-2.0 risk
proliferative with atypia breast mass has a ___ risk of developing cancer
8.0-10.0 risk
what are the common noproliferative breast masses?
fibrocystic changes, adenosis, lactational adenoma, fibroadenomas
what are fibrocystic changes in the breast
a spectrum of changes observed in the normal breast
dilated lobules and cysts
in fibrocystic chnage cysts rupture and cause scarring and inflammation what causes the cysts to rupture?
estrogen/hormone stimulation
what is adenosis
lobular growth with an increased number of glands (too many acini per lobule)
what is lactational adenomas caused by?
hormonal response
what is a fibroadenoma
a solid, mobile, rubbery bengin tumor in the female breast that is typically 2-4 cm
what is a galactocele
cystic dilation with milky fluid
galactocele occurs when
near time of lactation
galactoceles can have a secondary infection that may produce ?
acute mastitis
a galactocele can typically be ___ aspirated
needle
benign breast masses that are proliferative without atypia types
epithelial hyperplasia
sclerosing adenosis
complex sclerosing lesions/radial scar
papillomas
what is epithelial hyperplasia?
overgrowth of cells that line the ducts
what is sclerosing adenosis
increased fibrosis in breast lobules
what is complex sclerosing lesions/radial scar
tubules that are trapped in dense stroma surrounded by radiating arms of epithelium
what are the proliferative breast lesions with atypia
LCIS or DCIS
what is LCIS
a risk factor for developing breast cancer when malignant cells replace the normal epithelium lining the lobules of the breast (lobular carcinoma insitu)
what is ductal carcinoma insitu
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
how do we treat DCIS and LCIS
excision and then treatment with selective estrogen receptor modulators (HER2, tamoxifen)
most breast cancer happen after the age of ____ expect for african americans which is typically around age 45
50
what is the gail model-breast cancer risk
can be falsely elevated with?
high risk patients
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)
4 histology types of breast cancer?
ductal, lobular, nipple(pagets), inflammatory
ductal breast cancer is the most common and spreads to the ____ nodes, and is most common in women aged ____
regional nodes
50 years old
lobular breast cancer is the most aggressive and can be ________ (multifocal/bifocal)
multifocal
nipple breast cancer also known as pagets disease presents as a ?
superifical skin lesion
inflammatory breast cancers present with swelling and redness and ___ of the surrounding tissues
induration
the ____ at diagnosis of breast cancer is one of the most important indicators of prognosis
stage
5 year survival rates
localized disease-
regional disease-
metastatic disease -
LD- 99%
RD-86%
MD- 27%
use ____ ___ in addition to staging to determine prognosis
receptor status (estrogen or progesterone receptor)
if there are estrogen or progesterone receptors found this is a ____ finding
positive
Her2/neu finding in breast cancer is a ____ prognosis
worse
surgical therapy for breast cancer
lumpectomy with radiation
mastectomy
( they both have the same outcomes)
___ therapy is used in combination with surgical therapy to reduce reoccurrence
medical
chemotherapy kills _____ cells
cancer
hormone therapy works in premenopausal women to ?
antagonize estrogen and reduce the risk of cancer in breasts
aromatase inhibitors work by?- post menopausal women
preventing estrogen production in postmenopausal women
Herceptin (trastuzumab) acts on?
protein made by Her2/neu
side effects of trastuzumab
heart failure, respiratory problems, serious allergic reactions
