The Normal and Abnormal Breast Flashcards
Where is most of the glandular tissue in the breasts?
-upper outer quadrants
What structure is where the duct opens into the nipple?
-the sinus!
What hormone is responsible for gorwht of adipose tissue and lactiferous ducts?-
estrogen
What hormone is responsible for stimulation of lobular growth and alveolar budding?
-progesterone
What are some diagnostic tests for the breast?
- Mammogram
- ultrasound
- MRI
- FNA
- Corebiopsy
What always gets a biopsy of some kind?
-palpable masses
When are mamograms best?
-in women over 40
What is the difference between screening and diagnostic mammogram?
- screening: no compaint/concerns
- Diagnostic: if there is a palpable mass or something
What is useful for evaluating inconclusive mamorgram findings and is best for evaluating young women <40
- and allows to differentiate between cystic versus solid lesions
- and used for guidance when performing core needle biopsies?
Ultrasonography
What is useful in determining solid versus cystic masses?
- FNA
- if bloody, sent to cytology
- if clear, it’s fine
- 22-24 gauge needle
What doe we do if the cyst completely disappears after FNA?
-return for clinical breast exam in 3 months
What do we do if the cyst reappears or does not resolve after FNA?
-diagnostic mammogram/ultrasound and perform biopsy
What is Core needle biopsy?
- larger 14-16 gauge needle
- Used to get tissue from larger solid masses for diagnosis
- 3-6 samples about 2 centimeters long are obtained
What is the only FDA approved tx for mastalgia?
-danazol
What is the caveat with danazol?
- bad side effects
- hairy and weight gain
What was the thing that was bolded on the mastalgia tx slide?
-properly fitting bra, weight reduction, exercise, decrease caffeine intake, and vitamin E supplementation
What is bloody nipple discharge considered until proven otherwise?
- cancer
- could be a benign intraductal papilloma though
What are some concerns for malignancy with breast masses?
- > 2cm
- immobility
- poorly defined margins
- firmness
- skin dimpling
- bloody nipples
What are the 3 categories of benign breast masses?
- non proliferative
- proliferative without atypia
- proliferative with atypia
What is the most common benign tumor of the femal breast?
-fibroadenoma
What is adenosis?
-lobular growth with increased number of glands
What is a galactocele?
- cystic dilation of duct filled with milky fluid
- occurs near time of lactation
- secondary infection may produce acute mastitis
- typically can be needle aspirated
What are the nonproliferative breast masses?
- fibrocystic changes
- cysts
- fibrosis
- adenosis
- lactational adenomas
- fibroadenomas
- galactoceles
What are the proliferative breast masses without atypia?
- ESCP
- eptihelial hyperplasia
- sclerosing adenosis
- complex sclerosing lesions (radial scar)
- Papillomas (more common)
What are the breast masses with atypia
- LCIS
- DCIS
What is both LCIS and DCIS treated?
-with excision and then followed with treatment with selective estrogen receptor modulators
What are some risk factors for breast cancer?
- older than 50
- being white
- 1st degree relatives
- BRCA1 and BRCA2
BRCA1
BRCA2
-about 35 % of early onset breast cancers and much lower risk of ovarian cancer
Where do most breast cancers occur?
- in the ducts
- 70-80% are ductal
Which kind of breast cancer is most likely to be bilateral?
-lobular
What receptor would we rather not see in breast cancer?
- HER2/neu
- worse prognosis and is found in 20-30% of invasive cancers
How would we treat breast cancer?
- lumpectomy with radiation
- mastectomy
- the outcomes are equal so… yeah
what are some adjuvant therapies we can use in breast cancer?
- -chemo: kill cancer cells
- hormonal therapy (tamoxifen): antagonize estrogen
- aromatase inhibitors
- trasuzumab: acts on ptn made by Her2/neu
What are some side effects of trastuzumab?
- heart failure is the bad one
- respiratory problems
- serious allergic reactions
What do we do for tx follow up with breast cancer?
- every 3-6 months for first 2 years
- then, annually after first years
- most reoccurrences will happen within first 5 years after tx
