Surgery Breast Flashcards
malignant breast carcinoma
malignant phyllodes tumor
nonmodifiable risk factors for breast cancer
- 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
modifiable risk factors for breast ca
- age at 1st birth > 30 yo
- ocps >/= 5 years
- previous radiation treatment
- alcohol
- obesity
most common breast cancer presentation
breast mass
other symptoms of breast ca
- 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
standard mammographic views
mediolateral oblique (superior and inferior aspects)
craniocaudal (medial and lateral aspects)
indications of tomosynthesis (3d mammogram)
- extremely dense breasts
- strong fhx of breast ca
- previously had breast ca
uses of ultrasound
- determine if mass is solid or cystic
- shows borders, margins, vascularity, hardness, muscle invasion
- cannot see microcalcifications
what is fnab
- uts guided
- needle draws sample fluid and tissue (gauge 23)
- minimally invasive
- can be used for sus axillary nodes
- cannot see tissue architecture
what is core needle biopsy
- recommended for solid lesions
- uts guided + large bore needle (gauge 14)
- can get immunohistochemistry
what is excision biopsy
- no longer recommended initial biopsy
- makes incision
indication for mammogram guided needle localization excision biopsy
- non palpable microcalcifications
- hook wire
- specimen mammogram to make sure microcalcifications are taken out
what is mammotome excision biopsy
- percutaneous way to take out mass
- makes 1 mm incision + large bore needle through mass -> slice the tissue
- no need for stitches
what is stereotactic mammotome excision biopsy
- make incision and insert needle
- take out cores of calcifications under mammography
types of mastectomy
- 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)
what is breast conservation surgery
- remove breast mass + gross margin of 1 cm
- depression over the area of resection is seen post-op
what is mastectomy with reconstruction
- 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
what are surgery options for lymph nodes
axillary node dissection and sentinel node biopsy
axillary node dissection is not done anymore because of ___
lymphedema
what is sentinel node biopsy
- 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
procedure for sentinel node biopsy
- inject radioactive colloid with blue dye
- gamma probe is used to identify where nodes are by making a noise
- biopsy nodes
indications for chemo
- 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
types of targeted therapy
her2: herceptin (trastuzumab)
kinase-i, mtor-i, p13k-i, parp-i
immunotherapy in breast ca
- boosts immune response of nk cells
- pd-1 / pdl-1: atezolizumab
criteria for radiation therapy
- > 5 cm tumor
- > 4 nodes
- lymphovascular invasion
complication: bird skin, fibrosis of lungs
hormonal therapy in breast ca
- blocks endogenous substances, blocks synthesis of hormones
- tamoxifen, aromatase inhibitors
if + = take for 10 years
if - not required
annual mammogram should start at ___
40 yo, can also use breast uts (but must still do mammogram)
clinical breast exam should start at ___
30 yo
