Normal and Abnormal Breast

Question 1

What is the normal breast composed of?

Answer 1

Glands
Ducts
Fat and CT

Question 2

There are 12-20 lobes in the normal breast, with greater amount of glandular tissue where?

Answer 2

UOQ

Question 3

The normal breast is rich in blood supply and lymphatics. What 2 lymph nodes are common routes of metastasis?

Answer 3

Ipsilateral LN

Internal Mammatory LN

Question 4

What causes growth of fat tissue and ducts in the breast?

Answer 4

Estrogen

Question 5

What causes growth of lobes and alveolar budding in the breast?

Answer 5

Progesterone

Question 6

What are 4 congenital anomalies of the breast?

Answer 6

1. Absence of breast
2. Accessory breast tissue along milk line
3. Extra nipples
4. Extra breasts

Question 7

Polythelia

Answer 7

Extra nipples

Question 8

Polymastia

Answer 8

Accessory breasts

Question 9

What are the 2 most common complaints of the breast?

Answer 9

Pain

Mass

Question 10

Breast complaints need a ____ evaluation

Answer 10

TIMELY

Question 11

List as many risk factors for breast cancer as you can

Answer 11

Age
Early menarche (<12)
Late cessation of menses (>55) and post-menopause obesity 
NO pregnancies
Use of oral contraceptives
Tall
High breast tissue density 
1st degree relatives with breast/ovarian cancer

Question 12

List as many risk factors for breast cancer as you can

Answer 12

Age
Early menarche (<12)
Late cessation of menses (>55) and post-menopausal obesity
Oral contraceptive use
NO pregnancies
High breast tissue density
Tall
1st degree relatives with breast/ovarian cancer

Question 13

What should be evaluated in the breast physical exam?

Answer 13

BOTH breasts + axilla + chest wall

Question 14

Palpable breast masses will always get?

Answer 14

BIOPSY

- core needle/fine needle aspiration/excision

Question 15

In what patients is mammography best?

Answer 15

Women > 40

Question 16

Women > 40 should get what diagnostic test?

Answer 16

Mammography

Question 17

Mammography can detect?

Answer 17

Lesion 2 years before its palpable

Question 18

In what patients is ultrasound best?

Answer 18

Women < 40

Question 19

Women < 40 years old should get what diagnostic test?

Answer 19

Ultrasound

Question 20

Women with dense breast tissue should get what test?

Answer 20

Ultrasound

Question 21

What can Ultrasound differentiate between?

Answer 21

Cystic and solid lesions

Question 22

When is MRI used?

Answer 22

Post-cancer diagnosis evaluation

Women with high risk for breast cancer – BRCA (+)

Question 23

What does a Fine Needle Aspiration biopsy determine? What size needle?

Answer 23

Solid vs. cystic mass

SMALL needle

Question 24

If a Fine Needle Aspiration biopsy pulls clear fluid, next step?

Answer 24

NO further evaluation

Question 25

If a Fine Needle Aspiration biopsy pulls bloody fluid or if the cyst reappears, then what?

Answer 25

Need mammogram/ultrasound and tissue biopsy

Question 26

What does a Core Needle Biopsy get? Needle size?

Answer 26

Gets tissue from larger solid masses | LARGE needle

Question 27

Mastalgia

Answer 27

Breast pain

Question 28

2 types of Mastalgia?

Answer 28

Cyclic | Noncyclic

Question 29

Cyclic Mastalgia

Answer 29

Starts at luteal phase and ends after onset of menses

Question 30

Noncyclic Mastalgia

Answer 30

Can be caused by medications, tumors, cysts, mastitis

Question 31

What is the only FDA approved medication for Mastalgia, although it has many unpleasant side effects?

Answer 31

Danazol

Question 32

What are the non- medication options for Mastalgia?

Answer 32

- Properly fitting bra - Exercise - Decrease weight, caffeine - Vitamin E supplementation - Evening primrose oil

Question 33

What are the non-medication options for Mastalgia?

Answer 33

- Properly fitting bra - Exercise - Decrease weight, caffeine - Vitamin E supplementation - Evening primrose oil

Question 34

Nipple discharge - usually benign or malignant?

Answer 34

Benign

Question 35

If nipple discharge is bloody it is?

Answer 35

Considered cancer until proven otherwise

Question 36

How is bloody nipple discharge evaluated?

Answer 36

Breast ductography and requires ductal excision

Question 37

Nipple discharge is usually benign but when is it considered cancer?

Answer 37

BLOOD

Question 38

What are some characteristics of malignant breast masses?

Answer 38

- Size > 2cm - Immobile, firm, poor margins - Skin dimpling and color changes - Ipsilateral LAD

Question 39

3 types of Benign breast masses?

Answer 39

1. Non-proliferative 2. Proliferative without atypia 3. Proliferative with atypia

Question 40

Proliferative with atypia breast masses are what?

Answer 40

Malignant cells replace normal ductal/lobular epithelium | -- "carcinoma in situ"

Question 41

How should proliferative with atypia breast masses be treated?

Answer 41

Excision and SERM

Question 42

Breast cancer is the most common malignancy in women besides what?

Answer 42

Skin cancer | -- second leading cause of cancer related deaths

Question 43

What age and race are at an increased risk for breast cancer?

Answer 43

> 50 | white

Question 44

List the common types of breast cancer to the least common

Answer 44

Ductal --> LN spread Lobular -- multifocal Nipple Inflammatory

Question 45

What can be used to guide breast cancer treatment?

Answer 45

Receptor status

Question 46

What are positive findings with breast cancer?

Answer 46

Estrogen and progesterone

Question 47

Presence of what oncogene signifies a worse prognosis of breast cancer?

Answer 47

Her2/neu

Question 48

Surgical options can be considered with breast cancer. How do the 2 options compare to each other?

Answer 48

Mastectomy = Lumpectomy with radiation | - equal outcomes

Question 49

How does a mastectomy compare to a lumpectomy with radiation?

Answer 49

EQUAL