Normal And Abnormal Breast Exam Flashcards
What are the two most common complaints when women have breast problems?
Breast pain and breast mass
3 things to do during physical exam of the breast?
Evaluate Both breasts, axilla, and chest wall
What are the 5 diagnostic tests available to us for the breast?
Mammogram, US, MRI, FNA, and core biopsy
Which patient population do we use mammograms in, what is the ability of the mammogram, and what two ways do we use them?
Women over 40
Can detect a mass 2 years before it becomes palpable
Screening and diagnostic
At what age should we start mammograms and what age do we start clinical exams?
40 and 20
What patient population is US good to use for? What does the US allow us to do, 3 things?
Women younger than 40 with dense breast tissue
Solid vs. cystic lesions, inconclusive on mammogram, guide core needle biopsy
2 things to use MRI for?
Once you make the diagnosis of breast cancer, you can get a better picture for staging.
Use it initially on women with high risk for cancer like BRCA carriers
When we do do fine needle aspiration biopsy and what do we do after we get the results?
Useful to determine solid vs. cystic masses
If the cyst goes away, then come back in 3 months for a breast exam.
If cyst doesn’t go away, do mammogram/US and get biopsy of tissue.
3 types of breast pain?
Cyclic (with menses), noncyclic, and extramammary.
What is the only FDA approved drug for breast pain, but what is the catch?
Danazol, but it makes you into a man basically.
What does she recommend for breast pain?
Symptom relief like losing weight and making sure the women has a properly fitting bra, etc.
Bilateral discharge is most common with what breast condition?
Fibrocystic changes or ductal ectasia
Milky discharge can indicate what 3 conditions?
Hyperprolactinemia
Hypothyroidism
Certain medications
What are we thinking with bloody nipple discharge?
Cancer until proven otherwise
What are three things that we are thinking it could be with the bloody nipple discharge, how do we evaluate it, and how woul we treat it?
Intraductal carcinoma, invasive ductal carcinoma, or intraductal papilloma
Ductography
Ductal excision
When we find a mass in the breast, what are 7 features that heighten our concern for malignancy?
2 cm or bigger, Immobile, Firm, Poorly define margins, Changes in skin, bloody nipple discharge, ipsilateral LAD
What is the most common benign tumor in females and what age are they typically?
Fibroadenoma
Late teens early 20s.
How do we treat and manage LCIS and DCIS?
Treated with excision and managed with SERMs
7 risk factors for breast cancer
Over 50, white, first degree relative with breast cancer, BRCA 1 and BRAC 2 genes, radiation exposure, obese, alcohol
4 Histology types of breast cancer in order of decreasing frequency?
Ductal, lobular, nipple (pagets), and inflammatory
2 things unique about ductal and 1 thing unique about lobular she said?
Ductal most common in ladies who are in 50s and spread to LN
Lobular are more likely multifocal and bilateral
Two surgical options for breast cancer?
Lumpectomy with radiation
Mastectomy
4 things we do for adjuvant therapy?
Chemo to kill cancer cells
Hormonal therapy like tamoxifen to be anti estrogen
Aromatase inhibitors to prevent conversion of estrogen
Trastuzumab anti her2/neu.
Nasty side effect of trastuzumab?
Heart failure
What is appropriate follow up after diagnosis of breast cancer?
First 2 years see them every 3-6 months.
After 2 years, see them annually
8 risk factors for breast cancer?
Age, first degree relative of breast cancer or ovarian cancer, high breast tissue density, early menarche, late menopause, post menopausal obesity, long term oral contraceptive use, and alcohol use.
