Tieman - Breast CIS Flashcards
Benign biopsy results
fibroadenoma, fibrocystic change
atypical hyperplasia biopsy results
3-6x increased risk of later invasive CA
lobular CIS biopsy results
risk factor not invasive CA
15-20% risk of invasive breast CA bilaterally
Ductal CA in situ biopsy results
treated the same small invasive CA
BI-RADS classifications for mammograms
BI RADS 0 - requires additional studies(ie repeat test)
BI RADS 1 - no abnormal findings
BI RADS 2 - benign finding
BI RADS 3 - probably benign finding
BI RADS 4 - suspicious abnormality
BI RADS 5 - highly suggestive of malignancy
What to do with BI rad scores
1/2 - routine screening
3 - 6 month follow up imaging
4/5 - image guided core biopsy
When is partial mastectomy indicated
removal of part of breast
T1/T2 breast CA if combined with post op radiation
When is total mastectomy indicated
removal of breast alone
breast CA w/ negative axillary lymph nodes
When is modified radical mastectomy indicated
removal of breast and axillary lymph nodes en block
breast CA w/ axillary lymph node involvement
When is radical mastectomy indicated
removal of breast, pectoralis muscles and lymph nodes
rarely used if CA is invading muscles
how is neoadjuvant therapy used
to downsize tumors before surger
treat inflammatory breast CA
Follow up for breast cancer
6-12 months, phy exam
yearly bilateral mammograms
look for mets - bone, brain, lung, liver, lymph
fibroadenoma
most common breast mass in women <30 yo
rare in women over 45
benign solid tumor w/ fibrous & epithelial elements
firm moveable, nontender, smooth/lobulated
use ultrasound to distinguish from a cyst
FNA
2 subtypes of fibroadenoma
Giant fibroadenoma > 5CM
juvenile fibroadenomas - adolescents and young adults
fibroadenoma - treatment
watched, excised(open or US) or cryoablation
if patient desires or enlarging rapidly
phyllodes tumor
similar to fibroadenoma but cellular stroma grows rapidly and large - benign or malignant
phyllodes tumor - treatment
benign - local excision with wide margins (likes to recur)
malignant - wide local excision or mastectomy(no nodes)
Fibrocystic breast disease
single or multiple cysts, women 35-55, hormonally sensitive(pain can come and go w/ menses, low malignancy risk
fibrocystic breast disease
U/S and aspirate
if multiple times then excise/biopsy
T staging
T1 - < 2cm
T2 - 2-5 cm
T3 - > 5cm
T4 - wall fixation or skin involvement
N staging
N0 - no nodal mets
N1 - mets to moveable ipsilateral axillary nodes
N2 - mets to fixed or matted axillary nodes
M staging
M0 - not distant mets
M1 - distant mets
what happens to estrogen levels in liver disease
estrogen levels go up
what are worrisome findings on US
spiculization
calcifications
irregular borders
