Flashcards in Breast Deck (12)
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1
Breast cancer incidence
1 in 8 lifetime for women
2% of women less than 30 get breast cancer
2
Risk factors for breast cancer
Nulliparity
Age at menarche (55)
Cancer of breast (self or family)
Pregnancy of first child > 30
Benign biopsy of breast is risk factor for breast cancer
3
Breast cancer symptoms
No symptoms, mass, pain (most are painless), nipple discharge, edema, nipple retraction, dimple, nipple rash
4
Workup for breast cancer
Mammogram - look for mass, microcalcifications, stellate/speculated mass
Biopsy
- FNA (can't tell invasive vs in situ), core (can be rad guided) and excisional
U/S good for cysts
CXR (for lung mets)
LFTs (for liver mets)
Labs: Calcium, alk phos (both change with bone mets)
Check for estrogen and progesterone receptors to assess adjuvant treatment
5
Benign breast changes
Fibrocystic changes = rubbery and cystic changes in breast, varies with menstrual cycle
Fibroadenoma = collagen in swirls, most common in young women
- Phyllodes is variant that can be malignant
Intraductal papilloma = most common cause of bloody nipple discharge
6
Premalignant breast changes
DCIS (may progress to malignancy) - 1cm perform lumpectomy with 1cm margins + radiation OR total mastectomy
LCIS - incidental on bx. Seen as risk factor for breast cancer, always monitor other breast
7
Malignant breast changes
Invasive ductal carcinoma = #1
Invasive lobular
Inflammatory = most lethal
Paget's = nipple changes with discharge
8
Breast cancer staging
1 = tumor 5cm N0
3A = > 5cm tumor with mobile nodes OR any size with fixed axillary nodes
3B = Any tumor with ipsilateral internal mammary nodes OR peu d'orange OR chest wall invasion OR inflammatory cancer OR breast skin ulceration
4 = distant mets
9
Breast cancer treatment
1) Lumpectomy, axillary node dissection OR sentinal node w/radiation - stage 1 and 2
contraindicated if had previous radiation, +margins, extensive DCIS --- Do mastectomy
2) Modified radical mastectomy: breast, axillary nodes (II and I), nipple removed, place drains
Radical = take breast, pec major and minor, axillary nodes
Simple = entire breast removed but nodes left in place
3) Chemo - generally offered to women with stage 2 or more who are premenopausal
- role of neoadjuvant is good if want to conserve breast but must stage before beginning therapy to appreciate disease extent
4) Antiestrogen treatment - given for 5 years to people who are receptor +
10
Where do breast mets go?
LN
Lung
Liver
Bones
Brain
11
Levels of axillary nodes
Level 1 = lateral to pec minor
Level 2 = deep to pec minor
Level 3 = medial ro pec minor
12
