BREAST Flashcards
most common Lymphoma of the breast
The most common cell type is a B-cell lymphoma.
Surgery may be required for definite diagnosis, but not for treatment as lymphomas are highly sensitive to radiation and chemotherapy.
Adjuvant therapy with tamoxifen leads to a significant prolongation of disease-free and overall survival for what patient population and with what breast disease fetures
premenopausal and postmenopausal women with estrogen receptor (ER)-positive disease and negative or positive nodes.
The aromatase inhibitors (AIs) are indicated for
ONLY for POSTmenopausal women.
They do not produce adequate estrogen blockade in premenopausal women.
Direct comparisons with tamoxifen demonstrate that aromatase inhibitors
aromatase inhibitors increase disease-free survival,
with NO improvements in overall SURVIAVAL have been seen to date.
Trastuzumab
monoclonal antibody treatment directed against HER2.
Sentinel node localization by the radiocolloid drug used and onset
99mTc sulfur colloid
Intradermal injection
External lymphoscintigraphy is performed using dynamic and static
localization by the radiocolloid can occur as early as 10 minutes, and could take up to a few hours.
For women followed-up for 20 years after a biopsy with LCIS, the incidence of invasive carcinoma in either breast was
20%.
regarding LCIS When an invasive carcinoma does develop, the most common type is
infiltrating DUCTAL carcinoma.
Although these patients may have a higher incidence of infiltrating lobular carcinomas than the general population, the incidence of infiltrating DCUTAL carcinoma is significantly higher.
Infection complicates breast-feeding - most common pathogens
account for 80% of all breast infections,
S. aureus organisms are by far the most common pathogens in this setting.
no evidence that poor hygiene is involved in the pathogenesis of lactational abscess or cellulitis.
Many breast infections begin as cellulitis without abscess formation.
Infection complicates breast-feeding management
When an actual abscess is suspected, percutaneous aspiration can establish the diagnosis and allow for bacterial culture and sensitivity testing.
Open surgical drainage may be indicated, particularly for large abscesses, but repeated aspiration and antibiotic therapy results in resolution of many smaller abscesses.
Although women may choose to cease breast-feeding, there is no absolute indication for this. When mastitis or breast infection is suspected clinically, the possibility of inflammatory carcinoma must be entertained. Any inflammatory process that does not respond completely and promptly to antibiotics or drainage should be subjected to biopsy to rule out cancer.
LCIS
Unlike DCIS, LCIS is not an obligate precursor for invasive disease. It is considered a “high-risk factor” that confers an increased rate of developing invasive disease (approximately 1%–2% a year, and 30%–40% lifetime) (188). Both invasive-ductal and lobular cancer can occur with LCIS. The risk can persist for up to 30 years; however, studies report that most of the cancers occur between years 15 and 30 postdiagnosis. The increased risk of invasive disease is bilateral, and although the common belief was that this risk was equal for both breasts (185,189,190), there is recent evidence to suggest that cancer is up to three times more likely in the ipsilateral breast (190,191). Although conventional wisdom teaches that LCIS is not an obligate precursor for invasive disease, there is a growing body of scientific data that suggests that some variants of LCIS may act as precursors
Benign lesions of the breast are classified into three major categories:
nonproliferative, proliferative, and proliferative with atypia.
Nonproliferative breast lesions
NOT associated with an increased risk of breast cancer,
account for approximately 70% of palpable breast masses.
proliferative breast lesions
slight increase in risk in the setting of proliferative lesions without atypia equated as an increase in relative risk by a factor of 1.5 to 2.0.
Atypia in a proliferative lesion, which includes atypical ductal hyperplasia, increases relative risk by a factor of 4.0 - 5.0, and can rise as high as 9.0 when found in a woman with a first degree relative with breast cancer.
Cyclical mastalgia treatment
evening primrose oil is the only one shown to have a response in over 50% of women treated.
This appears to be related to the regulation of abnormal levels of certain essential fatty acids, but more studies are needed to define the exact mechanism involved.
he earliest and most favorable phase of breast malignancy is t
Correct. The earliest and most favorable phase of breast malignancy is the intraepithelial or noninvasive variety known as ductal carcinoma in situ (DCIS). Because mammography has been extensively applied to the screening of asymptomatic women, the frequency of this diagnosis has increased fivefold since 1973. Histologically, DCIS shows a progression from a papillary pattern (which is well-differentiated and nonpleomorphic), through a cribriform pattern (demonstrating cellular polarity and atypia), and, finally, a comedo pattern (with architectural distortion, cellular necrosis, and calcium deposition). These histologic categories have been related to prognosis, with comedo variety demonstrating more aggressive biologic behavior than noncomedo types. The tendency of DCIS to involve multiple sites in the same breast is explained by the spread of tumor outward from the primary site, likely through the ductal system. When a diligent search is made for these occult tumors, multiple sites of malignancy can be demonstrated in 60% of cases. Bilaterality of DCIS likely arises from the same cause as multicentricity and is found in 10% to 15% of patients, a rare equivalent to that seen with invasive carcinomas. Most studies have failed to demonstrate any relationship between multiple sites of DCIS and recurrence or mortality. The treatment of DCIS should be based on the clinical and pathologic characteristics of each case. Treatment must clearly distinguish between incidentally, mammographically, and clinically detected lesions. Total mastectomy has been the traditional treatment for DCIS with an overall mortality rate of 1.7% in long-term follow-up. Recently, however, breast-conserving techniques have also been used. Wide local resection alone has been successfully applied for lesions less than 25 mm in diameter. Wide excision and adjuvant radiotherapy have been used for lesions larger than 25 mm, provided that all of the tumor can be removed with a margin of normal tissue. In this group of patients, the ten-year rate of local recurrence is 16% and the cause-specific survival rate is 97%. An important perspective on breast conservation for DCIS is that 50% of all local recurrences are invasive and, as such, have the potential for systemic metastasis or death. Until more data are available from clinical trials, mastectomy is recommended for those patients whose tumor characteristics carry a substantial risk of local recurrence: large size, comedo histology, positive tumor margins, extensive multicentricity, and young age. Axillary lymph node dissection is generally not considered a part of the treatment of either comedo or noncomedo DCIS, because the yield of positive lymph nodes is less than 2%. It may be indicated in patients with palpable adenopathy or those in whom foci of invasion are noted on pathology. Cytotoxic chemotherapy does not improve either the rate of local recurrence or the long-term survival of DCIS. Data on tamoxifen are still inconclusive.
