Normal and Abnormal Breast Flashcards
estrogen and progesterone- fxn
- estrogen- growth of adipose tissue and lactiferous ducts
- progesterone- stim of lobular growth and alveolar budding
evaluation of breast sx’s
- timely evaluation
- breast pain and mass- 2 most common
- pt hx
risk factors for breast cancer
- age
- hx of breast cancer
- hx of atypical hyperplasia
- high breast tissue density
- first degree relatives with breast or ovarian cancer
- early menarche (<12)
- late cessation of menses (>55)
- no term pregnancies
- never breastfed
- long-term use of oral contraceptives
Diagnostic testing
- mammogram
- US
- MRI
- FNA
- core bx
palpable masses- get what?
biopsy
mammography
detect lesions 2 yrs b/f they become palpable
- best in women 40 yo or older
- screening
- diagnostic
breast cancer screening guidelines
(ACOG)
- mammo- 40 yo+ annually
- clinical exam- age 20-39: 1-3 yrs; age 40+: annually
- self-breast exam
Ultrasonography
- evaluate inconclusive mammogram findings!!
- women < 40 yo and those with dense breast tissue
- cystic vs solid lesions
- guidance for core needle biopsies
MRI
- adjunct to diagnostic mammography
- post cancer dx for further evaluation
- used with implants
- women at high risk (BRCA)
Fine Needle Aspiration Biopsy
solid vs cystic!!
- clear fluid- needs no further evaluation
- bloody fluid- sent for cytology, pt needs mammogram/US
- if cyst completely disappears with aspiration- return in 3 months for clinical breast exam
- if cyst reappears or does not resolve- mammogram/US and perform bx
Core Needle Biopsy
- large needle
- larger solid masses for dx
Mastalgia
- cyclic (starts at luteal phase to menses)
- noncyclic- tumors, mastitis, cysts, meds
- extramammary- chest wall trauma, shingles, fibromyalgia
Mastalgia- tx
-Danazol- but horrible SE’s (not ever prescribed)
-oral contraceptives or Depo Provera may help
properly fitting bra, weight reduction, exercise, dec caffeine intake, vit E supplementation
nipple discharge
- usually benign
- could be endocrine disorder or cancer
- b/l, non-spontaneous, non bloody- fibrocystic changes or ductal eectasia
Bloody nipple discharge
- considered cancer till proven otherwise!!!
- concern for intraductal carcinoma or invasive ductal carcinoma
- benign intraductal papilloma
- evaluated with breast ductography- requires ductal excision
breast masses- concerns for malignancy
- > 2 cm
- immobility
- poorly defined margins
- firmness
- skin dimpling/ retraction/ color changes
- bloody nipple discharge
- ipsilateral lymphadenopathy
Benign breast masses
- non prolif
- prolif
- prolif with atypia
Benign breast masses- Non prolif lesions
(fibrocystic changes)
- cysts
- fibrosis
- adenosis
- lactational adenomas
- fibroadenomas- most common benign tumor in female breast (solid, rubbery, mobile, solitary)
Galactocele
cystic dilation of duct filled with milky fluid
- occurs near time of lactation
- infection may produce acute mastitis
Benign breast masses- prolif lesions
- epit hyperplasia
- sclerosing adenosis
- complex sclerosing lesions (radial scar)
- papillomas
Benign breast masses- prolif lesions with atypia
- LCIS
- DCIS
- tx with excision and then SERMs
breast cancer- risk factors
- > 50
- white women
- family hx- BRCA1/2
- reprod and menstrual hx
- radiation exposure
- overweight, alcohol
Breast cancer- histology
- ductal (80%)- spread to regional nodes
- lobular (10%)- multifocal and/or b/l
- nipple- pagets dz (3%)
- infl breast cancer (1-4%)
breast cancer- tx
- HER2- worst prognosis
- surgical tx- lumpectomy with radiation or mastectomy
- medical tx:
- chemotx
- tamoxifen
- aromatase inhibitors
- trastuzumab (SEs: HF, resp problems, allergic rxns)
breast cancer tx- follow up
- first 2 yrs after dx- every 3-6 months
- annually after 1st 2 yrs
- most recurrences will happen first 5 yrs after tx
