Chapter 17 Breast Conditions

Question 1

Mastalgia

When does this happen

What is it related too
What meds can cause this

Answer 1

Breast pain

Benign, happens 1-2 weeks before menses

r/t hormonal changes of the menstrual cycle

Combined estrogen and progesterone meds can cause this

Question 2

Classification of mastalgia
1) Cyclic
2) non cyclic
3) chest wall pain

Answer 2

1) Cyclic - begin in luteal phase end in menses, bilateral s/s:Sore/aching

2) Noncyclic- Unrelated to menstrual cycle
Unilateral localized, Sharp/burning in nature

3) Localized and worse with movement

Question 3

Mastalgia ask about what drink?

Diagnostic testing

Pharmacological therapy

Answer 3

<30 y/o- targeted US for focal pain
>30 y/o- Mammogram

Danazol: FDA approved for mastalgia
Tamoxifen and Bromocriptine

Question 4

Nipple discharge
Normal Lactation

Galactorrhea unrelated to child bearing

Nonmilky discharge

Answer 4

Galactorrhea - milk discharge who has not been pregnant or lactating in past 12 months.

You should check for hypothyroidism, hyperthyroidism, pituitary tumor, and hyper prolactinemia.

Question 5

Nipple discharge diagnostic testing

Black nipple discharge what test?

Medication to treat galactorrhea

Answer 5

Check serum prolactin level and TSH measurement

Nipple black discharge- give fecal occult blood test

Bromocriptine & Cabergoline

Question 6

Benign breast tumor most common

Answer 6

Most common fibroadenoma

Question 7

Breast cancer

DCIS (Dual Carcinoma in Situ)

Tx

Answer 7

BRCA1 and BRCA2 gene

DCIS- earliest manifestation of breast cancer

Tx: large/high grade tumor: Total mastectomy and tamoxifen therapy

Question 8

Invasive Breast Cancer

Answer 8

most common malignancy discrete solid mass that metastasizes to bones, liver, brain, and lung

Tx: Surgery, chemo, radiation, hormonal therapy, bisphosphonate

Monoclonal antibodyL: Bevacizumab, Cetuximab, Panitumumab, Trastuzumab

Question 9

Paget Disease

Answer 9

Rare form of breast cancer

Cause nipple change and ulceration

Punch biopsy diagnostic tool for Paget Disease

Tx: Margins are positive: Mastectomy . Tamoxifen after surgery recommended

Question 10

Inflammatory Carcinoma

Answer 10

Rapid progressive that spreads to lymphovascular

s/s: Erythema, edema, warmth, skin thickening , peau d orange **

Tx: mammography and skin biopsy if abx don’t work

Question 11

Breast Cancer Prevention

Answer 11

Tamoxifen & Raloxifene- FDA Approved

High risk of thromboembolic event and endometrial cancer