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COMAT: Surgery > Breast > Flashcards

Breast Flashcards

1
Q

what are the major breast cancer susceptibility genes

A

BRCA1 and BRCA2

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2
Q

what option exists to decrease the risk fo breast cancer in women with BRCA

A

prophylactic bilateral mastectomy

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3
Q

what is the ‘triad of error’ for misdiagnosed breast cancer

A

age <45
self-diagnosed mass
negative mammogram

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4
Q

what are the history risk factors of breast cancer

A

NAACP

  • nulliparity
  • age at menarche
  • age at menopause
  • cancer of the breast (self or family)
  • pregnancy with first child
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5
Q

is ‘run of the mill’ fibrocystic disease a risk factor for breast cancer

A

no

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6
Q

what are the possible symptoms of breast cancer

A
  • no symptoms
  • mass in the breast
  • pain (most are painless)
  • nipple discharge
  • local edema
  • nipple retraction
  • dimple
  • nipple rash
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7
Q

why does skin retraction occur

A

tumor involvement of Cooper’s ligaments and subsequent traction on ligaments bull skin inward

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8
Q

what are the signs fo breast cancer

A 
mass
dimple
nipple rash
edema
axillary/supraclavicular nodes
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9
Q

what is the most common site of breast cancer

A

upper outer qudrants

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10
Q

what are the different types of invasive breast cancer

A
  • infiltrating ductal carcinoma
  • medullary carcinoma
  • infiltrating lobular carcinoma
  • tubular carcinoma
  • mutinous carcinoma
  • inflammatory breast cancer
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11
Q

what is the most common type of breast cancer

A

infiltrating ductal carcinoma

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12
Q

describe the appearance of the edema of the dermis in inflammatory carcinoma of the breast

A

peau d’orange

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13
Q

what is the classic picture of breast cancer on mammogram

A

spiculated mass

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14
Q

what option is best initial test to evaluate a breast mass in a woman <30

A

breast ultrasound

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15
Q

what tumor is associated with a radial scar

A

tubular carcinoma

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16
Q

what is the ‘workup’ for a breast mass

A

clinical breast exam
mammogram or breast ultrasound
FNA, core biopsy, or open biopsy

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17
Q

how do you proceed if a mass appears to be a cyst

A

aspirate it with a needle

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18
Q

is the fluid from a breast cyst sent for cytology

A

not routinely

- bloody fluid will be sent for cytology

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19
Q

when do you proceed to open biopsy of breast cyst

A
  • second cyst recurrence
  • bloody fluid in the cyst
  • palpable mass after aspiration
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20
Q

what hormone receptors must be checked for int he biopsy specimen

A

Estrogen and progesterone receptors

- this is key for determining adjuvant treatment

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21
Q

what are the sites of metastasis in breast cancer

A 
LNs
lung/pleura
liver
bones
brain
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22
Q

what are the major treatments of breast cancer

A

modified radical mastectomy

lumpectomy and radiation + sentinel LN dissection

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23
Q

what breast carcinomas are candidates for lumpectomy and radiation (breast-conserving)?

A

stages I and II (tumors <5cm)

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24
Q

what approach may allow a patient with stage IIIA cancer to have breast-conserving surgery

A

neoadjuvant chemotherapy

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25
Q

what is the treatment of inflammatory carcinoma of the breast

A

chemotherapy first

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26
Q

what is a sentinel node biopsy

A

instead of removing all the axillary LNs, the primary drawing or ‘sentinel’ LN is removed

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27
Q

how is the sentinel LN found

A

inject blue dye and/or technetium-labeled sulfur colloid

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28
Q

how does tamoxifen work

A

binds estrogen receptors

29
Q

can tamoxifen prevent breast cancer

A

yes

30
Q

what are the side effects of tamoxifen

A

endometrial cancer

DVT, pulmonary embolus, cataracts, hot flashes, mood swings

31
Q

what is DCIS

A

ductal carcinoma in situ

32
Q

what is DCIS also known as

A

intraductal carcinoma

33
Q

describe DCIS

A

cancer cells in the duct without invasion

34
Q

what are the signs/symptoms of DCIS

A

usually none, usually nonpalpable

35
Q

what are the mammographic findings of DCIS

A

microcalcifications

36
Q

what is the major risk with DCIS

A

subsequent development of infiltrating ductal carcinoma in the same breast

37
Q

what is LCIS

A

lobular carcinoma in situ

38
Q

what are the signs/symptoms of LCIS

A

none

39
Q

what are the mammographic findings of LCIS

A

none

40
Q

what is the most common cause of bloody nipple discharge in young women

A

intraductal papilloma

41
Q

what is the most common breast tumor in patients <30yo

A

fibroadenoma

42
Q

what is Paget’s disease of the breast

A

scaling rash/dermatitis of the nipple caused by invasion of skin by cells from a ductal carcinoma

43
Q

what is the most common cause of green, straw-colored, or brown nipple discharge?

A

fibrocystic disease

44
Q

what is the most common cause of breast mass after breast trauma

A

fat necrosis

45
Q

what must be ruled out with spontaneous galactorrhea

A

prolactinoma

46
Q

what is cystosarcoma phyllodes

A

mesenchymal tumor arising from breast lobular tissue

- most are benign

47
Q

what are the signs/symptoms of cystosarcoma phyllodes

A

mobile, smooth breast mass that resembles a fibroadenoma on exam, mammogram/ultraosund findings

48
Q

how is cystosarcoma phyllodes diagnosed

A

through core biopsy or excision

49
Q

what is the treatment of cystosarcoma phyllodes

A

if benign, wide local excision

if malignant, simple total mastectomy

50
Q

what is a fibroadenoma

A

benign tumor of the breast consisting of stromal overgrowth, collagen arranged in ‘swirls’

51
Q

what is the clinical presentation of a fibroadenoma

A

solid, mobile, well-circumscribed round breast mass, usually <40-

52
Q

how is fibroadenoma diagnosed

A

negative needle aspiration looking for fluid
ultrasound
core biopsy

53
Q

what is the treatment of fibroadenoma

A

surgical resection for large or growing lesions

small fibroadenomas can be observed closely

54
Q

what is fibrocystic disease

A

common benign breast condition consisting of fibrous (rubbery) and cystic changes in the breast

55
Q

what are the signs/symptoms of fibrocystic disease

A

breast pain or tenderness that varies with menstrual cycle
cysts
fibrous (nodular) fullness

56
Q

what is the treatment of symptomatic fibrocystic disease

A

stop caffeine
pain medications (NSAIDs)
vitamin E, evening primrose oil

57
Q

what is mastitis

A

superficial infection of the breast

58
Q

in what circumstance does mastitis most often occur

A

breastfeeding

59
Q

what bacteria most commonly causes mastitis

A

staph aureus

60
Q

why must the patient with mastitis have follow-up

A

to make sure she does not have inflammatory breast cancer

61
Q

what are the causes of breast abscess

A

mammary ductal ectasia and mastitis

62
Q

what is the most common bacteria causing breast abscess

A 
nursing  = S. aureus
nonlactating = mixed infection
63
Q

what is the treatment of breast abscess

A

antibiotics

needle or open drainage

64
Q

what is lactational mastitis

A

infection of the breast during breastfeeding

65
Q

what must be ruled out with a breast abscess in nonlacting women

A

breast cancer

66
Q

what is male gynecomastia

A

enlargement of the male breast

67
Q

what are the causes of male gynecomastia

A
  • medications
  • drugs (marijuana)
  • liver failure
  • increased estrogen
  • decreased testosterone
68
Q

what is the major differential diagnosis in an older patient with male gynecomastia

A

male breast cancer

69
Q

what is the treatment of male gynecomastia

A

stop or change medications, correct underlying cause

COMAT: Surgery (17 decks)

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