Normal and Abnormal Breast Exam (Wootton)

Question 1

1) What does Estrogen allow to grow in Breast?

2) Progesterone?

Answer 1

1) Adipose tissue and Lactiferous ducts
2) Lobular growth and Alveolar Budding

Es Adi Lact

Pro Lo Bud

Question 2

1) What are the 2 risk factors for breast cancer with menstruation?
2) Is nulliparity or multiparity considered a risk factor for breast cancer?
3) What medication is a risk factor for breast cancer?

Answer 2

1) Menarche (age <12) and Menopause (age >55)
2) Nulliparity
3) OCP

Question 3

What is able to detect lesions about two years before they become palpable.

They are best used in women of what age?

Answer 3

1) Mammography

2) 40 years and older

Question 4

Ultrasonography

1) When should it be used?
2) In what age?
2) It allows differentiation between what lesions?

Answer 4

1) If mammography is inconclusive
2) Younger than 40
3) Cystic vs solid lesions

Question 5

MRI Should be used in woman for who?

Answer 5

BRCA carriers who are high risk for Breast Cancer

Question 6

1) What is Fine Needle Aspiration Biopsy with a 22-24 gauge needle is useful in determining?
2) What type of fluid is sent for cytology if concerning?
3) What is done next if that occurs?

Answer 6

1) Solid versus cystic
2) Bloody Fluid (Clear fluid is good)
3) Mammogram or US

Question 7

What are the proliferative benign breast mass WITHOUT atypia

Answer 7

Papilloma
Epithelial hyperplasia
Complex sclerosing lesions (radial scar)
Sclerosing Adenosis

PECS

Question 8

If cyst reappears or does not resolve with aspiration what should be done?

Answer 8

1) Mammogram/ultrasound

2) Perform biopsy

Question 9

What biopsy uses a large needle (14-16 gauge) to get tissue from larger solid masses?

Answer 9

Core Needle Biopsy

Question 10

1) Mastalgia (breast pain) that is cyclic starts when in menstrual cycle?
2) When does it end?

Answer 10

1) Luteal phase

2) Onset of menses

Question 11

What are some extramammary causes of mastalgia?

Answer 11

1) Chest wall trauma
2) Shingles
3) Fibromyalgia

Question 12

The only FDA approved treatment for mastalgia in benign breast disease is?

Answer 12

Danazol

Question 13

What are some considerations for symptoms relief in mastalgia treatment?

Answer 13

1) Weight reduction
2) Decrease caffeine intake

3) Primrose Oil
4) Properly Fitting Bra
5) Vitamin E supplementation

WD PPV

Question 14

What is Non-spontaneous, non-bloody (can be clear, green or yellow) and bilateral nipple discharge is most consistent with?

Answer 14

1) Fibrocystic changes

2) Ductal ectasia

Question 15

What can milky discharge indicate?

Answer 15

1) Hyperprolactinemia

2) Hypothyroidism

Question 16

1) What type of nipple discharge should you consider cancer until proven otherwise?
2) What does it raise concern for?

Answer 16

1) Bloody

2) Intraductal carcinoma and Invasive ductal carcinoma

Question 17

What are the 4 non proliferative benign breast mass

Answer 17

1) Fibrocystic changes
2) Adenosis
3) Fibroadenomas
4) Galactocele

Question 18

What features of breast masses should raise concern for malignancy?

Answer 18

1) Skin dimpling/retraction/color changes
2) Immobility
3) Greater than 2cm in size
4) ipsilateral lymphadenopathy

SIGI

Question 19

How is adenosis characterized by?

Answer 19

Lobular Growth with increased gland number

Question 20

What is the most common benign tumor in female breast?

It usually presents in what age group?

How are they characterized by?

Answer 20

1) Fibroadenomas
2) Late teen/early 20s

3) Solid
Solitary
Rubbery
Mobile
(SSRM)

Question 21

What is characterized as a cystic dilation of duct filled with milky fluid that occurs near time of lactation?

Answer 21

Galactocele

Question 22

What proliferative benign breast mass without atypia is characterized by overgrowth of the cells that line the ducts?

Answer 22

Epithelial hyperplasia

Question 23

How is Sclerosing adenosis characterized as?

Answer 23

Increased fibrosis within breast lobules

Question 24

How is Complex sclerosing lesions (radial scar) characterized as?

Answer 24

tubules trapped in a dense stoma surrounded by radiating arms of epithelium?

Question 25

What is Papilloma characterized as?

• Growth where
• What fluid seen?
• What age group?

Answer 25

Intraductal growth
serous/serosanguinous discharge
30-50

Question 26

How do Breast masses due to proliferative lesion with atypia occur?

What are examples of these?

Both are treated with what and then followed with administration of?

Answer 26

1) When malignant cells replace normal epithelium lining Ducts or lobules
2) Lobular carcinoma in situ and Ductal carcinoma in situ
3) Excision and SERM

Question 27

Majority of breast cancer occurs in women above what age?

What race has the greatest risk?

Answer 27

1) After 50

2) Caucasian

Question 28

What genes have a key connection to breast cancer?

Which one can cause breast cancer in men?

Answer 28

1) BRCA 1 and 2

2) BRCA 2

Question 29

Why are overweight patients at an increased risk for breast cancer?

Answer 29

Due to the increased conversion of androstenedione to estrone

Question 30

1) Ductal Carcinoma spreads where?

2) Lobular Carcinoma are more likely to be what?

Answer 30

1) Regional nodes

2) Multifocal or bilateral

Question 31

What are the 4 Breast Cancer types?

Answer 31

Ductal
Lobular
Nipple (Paget’s Disease)
Inflammatory

Question 32

What disease presents as superficial skin lesions at the nipple and make up about 3% of breast cancers?

Answer 32

Paget’s disease

Question 33

What makes up 1-4% of breast cancers and presents with swelling and redness of underlying skin and hardening of surrounding tissues?

Answer 33

Inflammatory breast cancer

Question 34

What is one of most important indicators of prognosis of breast cancer?

What is also used for prognosis?

What oncogene is the worst prognosis?

Answer 34

1) The stage at diagnosis
2) Receptor status (estrogen/Progesterone)
3) Her2/neu

Question 35

What are surgical options for breast cancer treatment?

Answer 35

1) Lumpectomy with radiation

2) Mastectomy

Question 36

1) What is the hormonal therapy such as using tamoxifen?
2) Who should use it?
3) What do they also do?

Answer 36

1) Estrogen antagonists
2) premenopausal women
3) Reduce risk of cancer in contralateral breast

Question 37

What type of drugs are Arimidex and Femara?

2) What do they do to postmenopausal women?

Answer 37

1) Aromatase inhibitors

2) PREVENT Estrogen Production

Question 38

Trastuzumab (Herceptin) acts on protein made by ____ receptors.

Answer 38

Her2/neu