The Breast Flashcards
Tamoxifen
–selective estrogen receptor modulator
- estrogen AGONIST at endometrium, bone
- -increases risk of what cancer?
- -decreases risk of what disease? - estrogen ANTAGONIST at breast
- -used for prevention/treatment of what cancer?
Tamoxifen
–selective estrogen receptor modulator
- estrogen AGONIST at endometrium, bone
- -increases risk of endometrial cancer
- -decreases risk of osteoporosis - estrogen ANTAGONIST at breast
- -used for prevention/treatment of breast cancer with positive E/P receptor status
Breast Cancer Dx
–tumor arises from ductal epithelium, infiltrates supporting stroma
Infiltrating Ductal Carcinoma
–most common breast malignancy
Breast Cancer Dx
- -arises from lobular epithelium, infiltrates the breast stroma
- -tends to be bilateral
Invasive Lobular Carcinoma
Breast Cancer Dx
- -eczematous changes of the nipple with crusting, scaling, erosion, discharge
- -often co-occurs with DCIS
Other common associated carcinoma?
Paget Disease of the Nipple
- -often co-occurs with DCIS
- -often associated with underlying adenocarcinoma
Breast Cancer Dx
- -edema, erythema, warmth, diffuse induration of the skin (peau d’orange)
- -axillary lymphadenopathy (aggressive); often with distant metastasis
Inflammatory Breast Carcinoma
Two factors related to breast cancer that indicate a more favorable prognosis?
- re: receptor status
- re: lymph node status
Trastuzumab is often used as adjuvent tx for (+) HER2/neu status. Main associated toxicity?
Can you use postmenopausal HRT in women with a hx of breast cancer? What about pregnancy and OCPs?
Two factors related to breast cancer that indicate a more favorable prognosis?
- (+) E and P receptor status
- (-) LN status
Trastuzumab: cardiotoxicity
No HRT is women with hx of breast cancer.
Pregnancy and OCPs are acceptable.
What type of anti-estrogen drug is more effective than Tamoxifen at treating E/P+ breast cancers?
Aromatase Inhibitors
–eg, letrozole, anstrozole, exemstane
Prolactin stimulates ?
Oxytocin stimulates ?
One hormone that inhibits prolactin production?
Two hormones that stimulate prolactin production?
Prolactin stimulates milk production
Oxytocin stimulates milk letdown
Dopamine inhibits prolactin production.
Serotonin, TRH stimulate prolactin production.
3 breastfeeding contraindications:
- -two infectious diseases
- -one behavior
3 breastfeeding contraindications:
- -active, untreated TB
- -HIV
- -drug and alcohol abuse
Breast Mass:
- -freely mobile, rubbery
- -cyclic premenstrual mastalgia
- -clear fluid upon aspiration
- -may be bilateral
Fibrocystic Breast Change
Management: aspiration, follow-up, ultrasound
*caffeine intake may exacerbate pain
Breast Mass:
- -round, well-circumscribed, mobile, firm, rubbery, nontender
- -often in upper, outer quadrant
- -epithelial and stromal elements upon aspiration
Fibroadenoma
Management: conservative follow up; excisional biopsy if preferred
Breast Mass:
- -large, bulkly, mobile mass
- -overlying skin is warm, erythematous, shiny, engorged
- -rapid growth
Cystosarcoma Phyllodes
Management: wide local excision
Breast Mass:
- -bloody nipple discharge in premenopausal woman
- -serosanguineous discharge
- -involves epithelial lining of lactiferous ducts
Intraducatal Papilloma
Management: excision of involved ducts
Breast Mass:
- -nipple discharge that is sticky, multi-colored
- -noncyclic breast pain, nipple retraction, or subareolar masses
- -often bilateral
- -usually at or after menopause
- -inflammation of the ductal system
Mammary Duct Ectasia
(Plasma Cell Mastitis)
Management: local excision
Evaluation of a Breast Mass
Imaging modality in woman age less than 30?
Imaging modality in woman age greater than 30?
FNA
- -bloody discharge
- -clear discharge with mass resolution
Evaluation of a Breast Mass
Woman age less than 30 = ultrasound
Woman age greater than 30 = mammography
FNA
- -bloody discharge –> excisional biopsy
- -clear discharge with resolution –> repeat exam in 2m
