4. The NL and ANL Breast Flashcards
(59 cards)
1
Q
What are some of the risk factors for breast cancer?
A
- Age (50YO)
- No term pregnancies
- Never breastfed
- Recent and long-term use of OC’s
- Postmenopausal obesity (increased converion of andeostenedione => estrone)
- Alcohol (2-4 drinks/week = increased risk of dying)
- Hx of atypical hyperplasia, endometrial/ovarian cancer
2
Q
Why does early periods (< 12) and late cessation of period ( >55) increase risk of breast cancer?
A
Because longer exposure to estrogen
3
Q
Why is high breast tissue density increase risk of breast cancer?
A
More dense = less likely detected = diagnosed later
4
Q
Do shorter or taller people have a higher risk of breast cancer?
A
Taller
5
Q
What type of people have an increase risk of breast cancer?
A
- High SES
- Askenazi Jewish heritage
6
Q
How to perform PE of breasts?
A
- Evaluate:
- Breasts
- Axilla
- Chest wall
7
Q
Diagnostic tests for breasts
A
- Mammogram
- US
- MRI
- FNA
- Core biopsy
8
Q
What diagostic tests would you perform if a pt has a palpable mass?
A
-
Biopsy; either,
- FNA (fine needle aspiration)
- Core biopsy
- Excisional
9
Q
Mammograms are best in women of what age; how often?
A
40 YO or older
10
Q
- What is a mammogram?
- What do we look for on mammogram?
A
- Screening and diagnostic tool used to detect lesions 2 years BEFORE they are palpable.
-
Detects
- Densities/calcifications
- Masses less than 1cm.
11
Q
When/how is a mammogram performed for screening/diagnostic purposes?
A
-
Screening if no complaint/concerns;
- Take 4 images
- Can be done by standard radiograph vs digital enhacement
-
Diagnostic in women w/ a complaints/palpable mass or to adjunct an abnormal screening mammogram
- Check contralateral breast @ same time
12
Q
Ultrasounds are performed when:
A
- Inconclusive mammogram
- Best for young women (age <40) and others w/ dense breast tissue
- Need guidance when performing a core needle biopsy
13
Q
What do we look for on US?
A
- Differentiates between cystic vs. solid lesions ANDDDD solid tissue within or adjacent to a cyst that may be malignant
14
Q
American College of Ob/Gyn (ACOG) recommendations for:
- Mammograms
- Clinical exams
- SBE (self-breast exam)
- SBA (self-breast awareness)
A
- Annually after 40YO
- 20 -39 (q 1-3 years); after 40 (annually)
- Do for high-risk patients
- Recommended
15
Q
When is MRI useful for evaluating the breasts?
A
- Adjunct to diagnostic mammography if suspicious masses
- Staging a post-cancer diagnosis
- Women at high risk for breast cancer (BRCA carriers)
16
Q
Fine needle aspiration (FNA) biopsy determines if the mass is _______
A
Solid vs cystic;
17
Q
What is the next best step if fine needle aspiration (FNA) of a breast mass:
- Contains clear vs. bloody fluid?
- If the cyst reappears or does not go away?
A
- Clear = no further evaluation
Bloody = send to cytology and diagnostic mammogram/US
- Diagnostic mammogram/US & biopsy
18
Q
What is core needle biopsy of the breast used for; how many samples taken?
A
- Get 3-6 samples about 2cm long tissue is retrieved from larger solid masses to diagnose
19
Q
What are the 2 most common breast complaints?
A
- Breast pain (Mastalgia)
- Breast mass
20
Q
What are the 3 types of benign mastlagia (breast pain)?
A
- Cyclic breast pain = usually cystic; starts at luteal phase of menstrual cycle and ends after onset of menses
- Noncyclic breast pain = usually tumors, mastitis, cysts and can be assoc. w/ some meds (anti-depressants/HTNs, hormonal meds (OCP’s))
- Extramammary breast pain = chest wall trauma, shingles, fibromyalgia
21
Q
What is the only FDA approved treatment for benign mastalgia (breast pain) and what are the AE’s?
A
- Danazol
-
AE’s =
- Menstrual irregularities
- Benign intracranial HTN
- Alters blood sugar
- Deepens voice
- Unusual hair growth and weight gain
22
Q
What are some recommendations for symptom relief of benign mastalgia?
A
- Properly fitting bra
- Lose weight
- Exercise
- ↓ caffeine intake
- Vit E & evening of primrose oil
23
Q
______ is an off-brand treatment for mastalgia that can cause what side effects?
A
- Selective estrogen receptor modulator (SERM), tamoxifin
- DVT
- Endometrial hyperplasia
24
Q
What should we worry about when we see nipple discharge?
A
- Usually benign could be sign of endocrine disorder or cancer
25
**Non-spontaneous**, **non-bloody** (can be clear, green or yellow) and **bilateral** nipple discharge is most consistent with what?
1. **Fibrocystic changes**
2. **Ductal ectasia**
26
**Milky discharge** from pregnancy indicates:
1. **Childbearing**
2. **Hyperprolactinemia**
3. **Hypothyroidism**
4. **Medications (OCs/psychotropics)**
27
\_\_\_\_\_\_\_ **nipple discharge** is CONSIDERED **CANCER** until proven otherwise.
What kind of cancer and if not cancer, what else could it be?
* **Bloody**
* **Intraductal carcinoma** or **invasive ductal carcinoma**
* **Benign intraductal papilloma**
28
_**Bloody** nipple discharge_
* **Evalulate** = \_\_\_\_\_\_\_\_
* **Cure =** \_\_\_\_\_\_
* Evaluate = breast ductography
* Cure = excise duct
29
What are the 3 categories of **benign breast masses?**
1. **Non-proliferative**
2. **Proliferative w/o atypia**
3. **Proliferative w atypia**
30
What are the types of **non-proliferative benign breast masses?**
1. Fibrocystic changes
2. Cysts
3. Adenosis
4. Lactation adenomas
5. Fibroadenomas
6. Galactocele
31
Describe the following **_non-proliferative benign breast masses:_**
1. **Fibrocystic changes** (how commonly seen in NL breast)
2. **Cysts**
3. **Adenosis**
1. **Fibrocystic changes**: Dilation of lobules =\> form cysts; cysts rupture and scar and inflame; seen in 50% of NL breasts
2. **Cysts** = dilation of lobules
3. **Adenosis** = Lobular growth w/ # of glands
32
Describe the following **_non-proliferative benign breast masses:_**
1. **Lactation adenomas**
2. **Fibroadenomas**
3. **Galactocele** (secondary infection can cause what?)
1. **Lactation adenomas:** occur d/t hormones
2. **Fibroadenomas**: solid, rubbery, mobile and usually solitary that are usually 2-4cm (but can grow up to 15cm)
3. **Galactocele**: cystic dilation of duct filled w/ milky fluid that occurs near time of lactation.
1. Secondary infection can produce acute mastitis
33
Most common **benign** tumor in female breast?
-When does it usually occur?-
* **Fibroadenoma**
* Late teens- early 20s
34
* Concerns for malignancy of **breast masses (5)**
1. **\> 2 cm i**n size, immobile and firm
2. Poorly defined margins
3. Skin dimpling/retraction/color changes
4. Bloody nipple discharge
5. Ipsilateral lymphadenopathy
35
What are the types of **proliferative** benign breast masses **WITHOUT atypia? (4)**
How are they usually found?
Usually **not palpable** and found on **imaging**.
1. **Epithelial hyperplasia**
2. **Sclerosing adenosis**
3. **Complex sclerosing lesions (radial scar)**
4. **Papillomas**
36
Descibe the following **proliferative** benign breast masses **W/O atypia**?
1. Epithelial hyperplasia
2. Sclerosing adenosis
3. Complex sclerosing lesions (radial scar)
4. Papillomas:
1. **Epithelial hyperplasia**: overgrowth of cells that line ducts
2. **Sclerosing adenosis**: increased fibrosis of tissue within lobules
3. **Complex sclerosing lesions (radial scar**): tubules trapped in dense stoma surrounded by radiating arms of epithelium
4. **Papillomas**: intraductal growth that can cause serous or serosanguinous discharge typically seen in W 30-50
37
Which type of benign breast mass is an intraductal growth typically seen in women 30-50 y/o and causes serous or serosanguinous discharge?
Papillomas
38
What is proliferative lesions **with** atypia?
Types?
NL epithelium that lines ducts/lobules is replaced by malignant cells, forming a CIS. BM is intact, cannot metastasize
1. Lobular carcinoma in situ (**LCIS**)
2. Ductal carcinoma in situ (**DCIS**)
39
What is **not** a precursor to breast CA but **RF for developing breast CA?**
**LCIS**
40
What is **DCIS**?
Puts women at risk for \_\_\_\_\_\_\_.
* Ducts are filled w/ **atypical epithelial cells**
* Developing **invasive dz** or **recurrence of DCIS**
41
How are **LCIS** and **DCIS** treated?
1. **Excision**
2. Then, treat with **SERMs.**
42
* Breast cancer is the **most common** malignancy in women besides _____ cancer; 2nd leading cause of cancer deaths in US
**skin cancer**
43
Increased mammogram screening has ______ incidence of breast cancer.
**increased**
44
**Who** is at greatest risk of breast cancer?
(age and race)
**White** women over **50**
45
Difference between **BRCA1** and **BRCA2**?
If you had one, which one would you rather have?
1. **BRCA1**— in _½_ of _early_ onset breast cancers and _90% of hereditary ovarian cancers_
2. **BRCA2**—_~35%_ of _early_ onset breast cancers and much _lower_ risk of ovarian cancer
46
Radiation for what increases risk to breast cancer?
1. **Hodgkines disease**
2. **Enlarged thymus**
47
Using the **Gail Model-Breast Cancer r**isk tool, which women are considered high risk and how should they be managed?
1. Women w/ **5-year risk of 1.7% or more**
2. Counseled on prophylactic therapy (**chemoprevention**, **mastectomy**, **oophorectomy**)
48
**70-80%** of all breast cancers are what type and where does it spread?
**_Ductal_**
**Spread:** regional LN
49
Which type of breast cancer is more likely to be **multifocal** and/or **bilateral**?
**Lobular**
50
\_\_\_\_\_\_ is a superficial skin lesion of the **nipple** and makes up **3%** of breast cancers.
**Pagets disease**
51
What makes up **swelling** and **redness** of **underlying skin and induration** of surrounding tissues and makes up 1-4% of breast cancer?
**Inflammatory Breast Cancer**
52
What should be used **in addition to staging** to determine treatment of breast cancer?
1. **Presence of estrogen and progesterone receptor** (positive finding)
2. Present of **Her2/neu oncogene**
53
Which **2 surgical options** for **breast cancer** have equivalent outcomes?
1. **Lumpectomy w/ radiation**
2. **Mastectomy**
54
\_\_\_\_\_\_ has the **WORST** prognosis and is found in 20-30% of all invasive cancers.
**Her2/neu (oncogene)**
55
What type of therapy is used in ALL stages because it reduces the rest of reoccurancy by 1/2 and death by 30%?
**_Adjuvant therapy_**
1. **Chemotherapy** = kills all cancer cells
2. **Hormonal therapy** (tamoxifen)
3. **Aromatase inhibitors** (arimedex, femara)
4. **Trastuzumab** (herceptin)
56
Which drug can be used for Her2/neu-positive breast cancers; but what are the AE's?
- **Trastuzumab**
- AE's: heart failure, respiratory problems, serious allergic rxns
57
Which adjuvant therapy is used in **premenopausal** therapy vs **postmenopausal**?
* Premenopausal = hormonal therapy (tamoxifen) is a EST ANT that reduces risk in other boob as well
* Postmenopausal= aromatose inhibitors (arimedex/femara) prevents production of estrogen
58
What is the recommended timeline fo**r treatment follow-up** for breast cancer; when do the majority of reoccurrences happen?
- During the first 2 years after diagnosis: every 3-6 months
- After first 2 years: annually
- Most reoccurrences happen within first 5 years after tx
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