Breast Flashcards
(31 cards)
6 Ds of nipple changes in breast Ca
Discharge, deviation, depression, discoloration, destruction, dermatitis
Mx options of mastitis cx breast abscess
1) PO antibiotics(non teratogen)
2) Percutaneous aspiration
3) I & D
4) Stop breastfeeding
Red flags for nipple discharge
unilateral,uniductal, spontaneous(bra staining), persistent, bloody, elderly
Treatment for Pure Paget’s of the nipple without DCIS/IDC
Simple lumpectomy and remove Nipple Areolar Complex
Estrogen related RFs for breast cancer
Early menarche before 12?
Late menopause after 55
Nulliparity/ no children before age of 30
No breastfeeding
Hormone replacement therapy
OCPs
Genetic tests for Breast cancer
Invitae panel
BRCA 1/2 if young breast Ca < 50y.o or strong family Hx
Cowden syndrome(a/w breast,colon and thyroid Ca)
Hereditary Diffuse Gastric Ca( p53)
Indications for MRI Breast
Paget’s disease of the Nipple
- TRO concomitant lesions eg DCIS
Screening for high risk patients aged 35-40
- BRCA mutation
- First deg relative with BRCA
- Prev chest radiation
- Li Fraumeni or Cowden syndrome
- Nodal disease with occult primary
- Multifocal tumors
Breast Cancer TNM staging
Tis: DCIS/Paget’s disease of nipple
T1:
=<1mm
>1mm but <=5mm
>5mm but <=10mm
>10mm but <=20mm
T2: 20mm< and >50mm
T3: 50mm<
T4
Direct extension to chest wall ( Ribs, intercostal, serratus anterior, pectoralis minor NOT major ,muscle)
Extension to skin(Peau d’orange, ulceration, satellite skin nodule
T4a + T4b
d: Inflammatory Breast Cancer with lymphedema
3 components of curative breast cancer local mx
Breast surgery, Axilla surgery and Reconstruction
Curative options for breast surgery
1) Breast conserving therapy: Breast conserving surgery + whole breast RT
2) Simple mastectomy
3) Radical mastectomy
Reconstruction options post breast surgery
1) Grafts
-Implants: Silicone, Saline
Autologous
- Lat dorsi myocutaneous flap(LDMF)
- Transverse Rectus myocutaneous flap(TRAM)
- Deep Inferior Epigastric Perforator flap(DIEP), muscle sparing
2) Breast reconstruction
3) Nipple reconstruction
6 Ds of suspicious Nipple Areolar Complex changes
- Depression
- Discharge
- deviation
- discoloration
- destruction
- dermatitis
- Retraction
- Peau d orange(lymphoedema)
Red flags of nipple discharge
- unilateral
- uniductal
- spontaneous(bra staining)
- persistent
- serous and bloody
- elderly
Non Estrogen related risk factors for breast cancer
- BRCA 1/2 (a/w triple negative Breast Ca)
- FHx of Breast Ca
- Previous chest radiation
- High risk lesions
- Ductal Carcinoma in-situ(DCIS)
- Lobular carcinoma in-situ(LCIS)
- Atypical ductal hyperplasia(ADH) - Smoking
- Alcohol
Criteria for diagnosis of inflammatory breast cancer(T4d)
- Rapid onset of erythema, edema and peau d’orange appearance +- breast warmth and palpable lump
- Sx present for less than 6/12
- Erythema >⅓ of breast
- Histo showing poorly differentiated tumor diffusely invading breast parenchyma
Curative mx of inflammatory breast cancer
Chemo+RT+ Hormonal+ +surgery(including SLNB)
Suspicious features of BI RADS
- Skin and muscle involvement
- Vascularity
- Microcalcifications
Other suspicious features - Heterogenous
- Irregular borders
- Taller than wide
Indications for MRI Breast
- Paget’s disease of the Nipple
TRO concomitant lesions eg DCIS/IDC - Screening for high risk patients aged 35-40
- BRCA mutation
- First deg relative with BRCA
- Prev chest radiation
- Li Fraumeni or Cowden syndrome
- Nodal disease with occult primary
- Multifocal tumors
Options for histological dx of breast cancer
- Core biopsy
6-8x cores, may be done with MMG/US guidance
Histology and tumor architecture
Immunochemistry staining: Estrogen, Progesterone and Human epidermal growth factor receptors (ER, PR, HER2) - Punch biopsy
Especially for suspected inflammatory breast cancer, showing dermal lymphatic invasion by tumor cells - Vacuum Assisted Biopsy(VAB) for non palpable/ tumor surrounded by fluid
Contraindications to Breast Conserving therapy( Breast conserving surgery+ Whole breast RT)
- Poor tumor: breast ratio
- Multicentric disease
- Tumor >5cm
- RT contraindicated or patient not agreeable
Complications of Axillary clearance
- Thoracodorsal nerve injury
- Long thoracic nerve injury
- Lymphedema
- Joint stiffness
Mx of Atypical ductal hyperplasia
Microdochectomy kiv major duct excision
Mx of DCIS( Ductal carcinoma in situ)
BCS w/ WBRT and reconstruction
Unless multicentric disease or poor tumor:breast ratio
SLNB kiv AC only if specific indications
Hormonal therapy if ER/PR +ve, reduces recurrence
Indications for SLNB kiv axillary clearance for DCIS
- High grade tumor
- Comedo necrosis
- Mass forming
- Undergoing simple mastectomy( SLNB not accurate after)
