Normal and Abnormal Breast Exam (Wootton) Flashcards
1) What does Estrogen allow to grow in Breast?
2) Progesterone?
1) Adipose tissue and Lactiferous ducts
2) Lobular growth and Alveolar Budding
Es Adi Lact
Pro Lo Bud
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?
1) Menarche (age <12) and Menopause (age >55)
2) Nulliparity
3) OCP
What is able to detect lesions about two years before they become palpable.
They are best used in women of what age?
1) Mammography
2) 40 years and older
Ultrasonography
1) When should it be used?
2) In what age?
2) It allows differentiation between what lesions?
1) If mammography is inconclusive
2) Younger than 40
3) Cystic vs solid lesions
MRI Should be used in woman for who?
BRCA carriers who are high risk for Breast Cancer
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?
1) Solid versus cystic
2) Bloody Fluid (Clear fluid is good)
3) Mammogram or US
What are the proliferative benign breast mass WITHOUT atypia
Papilloma
Epithelial hyperplasia
Complex sclerosing lesions (radial scar)
Sclerosing Adenosis
PECS
If cyst reappears or does not resolve with aspiration what should be done?
1) Mammogram/ultrasound
2) Perform biopsy
What biopsy uses a large needle (14-16 gauge) to get tissue from larger solid masses?
Core Needle Biopsy
1) Mastalgia (breast pain) that is cyclic starts when in menstrual cycle?
2) When does it end?
1) Luteal phase
2) Onset of menses
What are some extramammary causes of mastalgia?
1) Chest wall trauma
2) Shingles
3) Fibromyalgia
The only FDA approved treatment for mastalgia in benign breast disease is?
Danazol
What are some considerations for symptoms relief in mastalgia treatment?
1) Weight reduction
2) Decrease caffeine intake
3) Primrose Oil
4) Properly Fitting Bra
5) Vitamin E supplementation
WD PPV
What is Non-spontaneous, non-bloody (can be clear, green or yellow) and bilateral nipple discharge is most consistent with?
1) Fibrocystic changes
2) Ductal ectasia
What can milky discharge indicate?
1) Hyperprolactinemia
2) Hypothyroidism
1) What type of nipple discharge should you consider cancer until proven otherwise?
2) What does it raise concern for?
1) Bloody
2) Intraductal carcinoma and Invasive ductal carcinoma
What are the 4 non proliferative benign breast mass
1) Fibrocystic changes
2) Adenosis
3) Fibroadenomas
4) Galactocele
What features of breast masses should raise concern for malignancy?
1) Skin dimpling/retraction/color changes
2) Immobility
3) Greater than 2cm in size
4) ipsilateral lymphadenopathy
SIGI
How is adenosis characterized by?
Lobular Growth with increased gland number
What is the most common benign tumor in female breast?
It usually presents in what age group?
How are they characterized by?
1) Fibroadenomas
2) Late teen/early 20s
3) Solid Solitary Rubbery Mobile (SSRM)
What is characterized as a cystic dilation of duct filled with milky fluid that occurs near time of lactation?
Galactocele
What proliferative benign breast mass without atypia is characterized by overgrowth of the cells that line the ducts?
Epithelial hyperplasia
How is Sclerosing adenosis characterized as?
Increased fibrosis within breast lobules
How is Complex sclerosing lesions (radial scar) characterized as?
tubules trapped in a dense stoma surrounded by radiating arms of epithelium?
What is Papilloma characterized as?
- Growth where
- What fluid seen?
- What age group?
Intraductal growth
serous/serosanguinous discharge
30-50
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?
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
Majority of breast cancer occurs in women above what age?
What race has the greatest risk?
1) After 50
2) Caucasian
What genes have a key connection to breast cancer?
Which one can cause breast cancer in men?
1) BRCA 1 and 2
2) BRCA 2
Why are overweight patients at an increased risk for breast cancer?
Due to the increased conversion of androstenedione to estrone
1) Ductal Carcinoma spreads where?
2) Lobular Carcinoma are more likely to be what?
1) Regional nodes
2) Multifocal or bilateral
What are the 4 Breast Cancer types?
Ductal
Lobular
Nipple (Paget’s Disease)
Inflammatory
What disease presents as superficial skin lesions at the nipple and make up about 3% of breast cancers?
Paget’s disease
What makes up 1-4% of breast cancers and presents with swelling and redness of underlying skin and hardening of surrounding tissues?
Inflammatory breast cancer
What is one of most important indicators of prognosis of breast cancer?
What is also used for prognosis?
What oncogene is the worst prognosis?
1) The stage at diagnosis
2) Receptor status (estrogen/Progesterone)
3) Her2/neu
What are surgical options for breast cancer treatment?
1) Lumpectomy with radiation
2) Mastectomy
1) What is the hormonal therapy such as using tamoxifen?
2) Who should use it?
3) What do they also do?
1) Estrogen antagonists
2) premenopausal women
3) Reduce risk of cancer in contralateral breast
What type of drugs are Arimidex and Femara?
2) What do they do to postmenopausal women?
1) Aromatase inhibitors
2) PREVENT Estrogen Production
Trastuzumab (Herceptin) acts on protein made by ____ receptors.
Her2/neu
