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14 Onco > Surgery Breast > Flashcards

Surgery Breast Flashcards

1
Q

malignant breast carcinoma

A

malignant phyllodes tumor

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2
Q

nonmodifiable risk factors for breast cancer

A
  • increasing age
  • previous history of breast/ovarian ca
  • 1st degree relative with breast ca
  • onset of menstruation <12 yo
  • onset of menopause >55 yo
  • race
  • never been pregnant
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3
Q

modifiable risk factors for breast ca

A
  • age at 1st birth > 30 yo
  • ocps >/= 5 years
  • previous radiation treatment
  • alcohol
  • obesity
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4
Q

most common breast cancer presentation

A

breast mass

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5
Q

other symptoms of breast ca

A
  • axillary mass or metastasis (<1%)
  • nipple discharge (5%) (serous is most suspicious)
  • microcalcifications
  • nipple retraction (tumor infiltrates lactiferous ducts)
  • skin dimpling
  • skin changes: peau d’orange
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6
Q

standard mammographic views

A

mediolateral oblique (superior and inferior aspects)

craniocaudal (medial and lateral aspects)

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7
Q

indications of tomosynthesis (3d mammogram)

A
  • extremely dense breasts
  • strong fhx of breast ca
  • previously had breast ca
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8
Q

uses of ultrasound

A
  • determine if mass is solid or cystic
  • shows borders, margins, vascularity, hardness, muscle invasion
  • cannot see microcalcifications
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9
Q

what is fnab

A
  • uts guided
  • needle draws sample fluid and tissue (gauge 23)
  • minimally invasive
  • can be used for sus axillary nodes
  • cannot see tissue architecture
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10
Q

what is core needle biopsy

A
  • recommended for solid lesions
  • uts guided + large bore needle (gauge 14)
  • can get immunohistochemistry
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11
Q

what is excision biopsy

A
  • no longer recommended initial biopsy

- makes incision

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12
Q

indication for mammogram guided needle localization excision biopsy

A
  • non palpable microcalcifications
  • hook wire
  • specimen mammogram to make sure microcalcifications are taken out
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13
Q

what is mammotome excision biopsy

A
  • percutaneous way to take out mass
  • makes 1 mm incision + large bore needle through mass -> slice the tissue
  • no need for stitches
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14
Q

what is stereotactic mammotome excision biopsy

A
  • make incision and insert needle

- take out cores of calcifications under mammography

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15
Q

types of mastectomy

A
  • total mastectomy (skin and breast)
  • modified radical mastectomy (skin, breast, level 1 and 2 ln)
  • radical mastectomy (skin, breast, pectoralis)
  • toilette mastectomy with split thickness skin graft (when cannot be primarily closed)
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16
Q

what is breast conservation surgery

A
  • remove breast mass + gross margin of 1 cm

- depression over the area of resection is seen post-op

17
Q

what is mastectomy with reconstruction

A
  • skin / nipple sparing
  • immediate or delayed
  • skin or nipple is spared depending on indications for the patient
  • work with plastic surgeon to reconstruct breast: tram flap or latissimus dorsi flap
18
Q

what are surgery options for lymph nodes

A

axillary node dissection and sentinel node biopsy

19
Q

axillary node dissection is not done anymore because of ___

A

lymphedema

20
Q

what is sentinel node biopsy

A
  • guard nodes is where tumor drains before axillary ln
  • negative biopsies of sn = cancer has not spread
  • representative of the status of the rest of the axillary nodes
  • done in the early stages of breast ca
21
Q

procedure for sentinel node biopsy

A
  • inject radioactive colloid with blue dye
  • gamma probe is used to identify where nodes are by making a noise
  • biopsy nodes
22
Q

indications for chemo

A
  • to decrease or prevent systemic recurrence
  • neo-adjuvant therapy
  • to assess response from her2 + and triple negative breast ca
  • post op adjuvant
  • primary treatment for stage 4
23
Q

types of targeted therapy

A

her2: herceptin (trastuzumab)

kinase-i, mtor-i, p13k-i, parp-i

24
Q

immunotherapy in breast ca

A
  • boosts immune response of nk cells

- pd-1 / pdl-1: atezolizumab

25
Q

criteria for radiation therapy

A
  • > 5 cm tumor
  • > 4 nodes
  • lymphovascular invasion

complication: bird skin, fibrosis of lungs

26
Q

hormonal therapy in breast ca

A
  • blocks endogenous substances, blocks synthesis of hormones
  • tamoxifen, aromatase inhibitors

if + = take for 10 years
if - not required

27
Q

annual mammogram should start at ___

A

40 yo, can also use breast uts (but must still do mammogram)

28
Q

clinical breast exam should start at ___

A

30 yo

14 Onco (27 decks)

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