Breast Cancer Flashcards
(39 cards)
Whats the most important lymphatic drainage in the breast?
Axillary lymph nodes
What is the general clinical presentation of breast cancer?
- breast lump
- nipple discharge
- breast pain
- change in nipple or areola
- change in breast size
- inflammatory symptoms
- abnormal mammogram with no symptoms
if a woman is younger than 40 and complaining of breast pain, what method of diagnosis should be done?
ultrasound
What is the difference between a high risk lesion and a premalignant lesions?
high risk: could develop cancer anywhere
premalignant: if untreated could turn into a malignancy in the same place
What are the high risk lesions?
PEARL
- Papillary lesions
- Expertise discordance (puts patient at high risk)
- Atypical hyperplasia
- Radial scar/complex sclerosing lesions
- Lobular carcinoma in situ (LCIS)
How do we manage a high risk lesion?
- Excision
- Risk reduction (stop OCPs for example)
- Surveillance
What are the risk factors for breast cancer?
- increasing age
- female
- obesity in post-menopausal women
- reproductive factors
- early menarche
- late menopause
- nulliparous
- older age of first pregnancy
- history of breast cancer
- genetic predisposition: BRCA, Li-Fraumeni (P53)
- family history in first degree relatives
- exogenous hormone use (OCP, HRT)
- high risk breast lesions
- previous breast biopsy (due to abnormal breast tissue discovered in the past)
- lifestyle (alcohol, smoking, no sleep)
- exposure to ionizing radiation of the chest at young age (younger than 30)
What are the most common Li-Fraumeni (P53) associated cancer types?
leukemia osteosarcoma brain breast adrenals
what are the protective factors against breast cancer?
- breast-feeding
- parity
- physical activity
- ovarian ablasion before 35 years
What are the specific clinical presentations of breast cancer?
- palpable mass: nontender, firm, irregular, immobile
- nipple discharge: serous or bloody
- nipple retraction
- excoriation of nipple: Paget’s disease
- axillary lymphadenopathy
- skin changes (dimpling, tethering, edema, peau d’orange)
- metastasis: lungs, bone, brain, liver
- suspicious lesion on imaging or biopsy
What workup should be done in case of breast complaint?
LABS IMAGING - bilateral mammogram - bilateral ultrasound - MRI if indicated - PET scan if indicated - Biopsy (FNA axilla, core biopsy, excisional biopsy) METASTATIC WORKUP - if early -> CXR, liver ultrasound - if advanced or high risk -> CT chest abdomen & pelvis, Bone scan
What are the histological types of breast cancer?
Carcinoma in situ -DCIS -LCIS Invasive (ductal) carcinoma NOS (most common) Invasive lobular carcinoma Paget's disease
Which type of cancer is usually bilateral and multicentric?
Invasive lobular carcinoma
DO MRI
How do we treat DCIS & LCIS?
DCIS - like cancer (mastectomy or BCT SLNB if high risk features) - hormonal therapy if ER+ LCIS - excision - risk reduction
What is Paget’s disease?
- Malignant cells that invade the nipple epidermis
- erythema & mild eczematous reaction that ulcerates
- it has a rapid progression
(could be associated with DCIS or invasive carcinoma)
What is the most rapidly lethal cancer of the breast?
Inflammatory breast cancer
What do we consider as early breast cancer?
Stage I and IIA (T <5cm, N-) or (T<2cm with <3LNs)
How do we diagnose and manage Paget’s?
Diagnose: scrape cytology, punch biopsy
Manage: excision of NAC if limited disease or mastectomy
When do we use aromatase inhibitors?
in post menopausal women (to block androgen conversion into estrogen)
What’s the difference between DCIS & LCIS?
DCIS LCIS
- 50-60 yr - 40-50 yr
- mass, pain, discharge - none
- microcalcifications - none
- 35% multicentric - 60-80% multicentric
- 10-20% bilateral - 50-70% bilateral
- invasive ductal - invasive ductal or lobular
Breast Conservative Therapy vs Modified Radical Mastectomy indications?
- patients wish, comorbidities, cosmesis
- ratio of tumor to breast size
- fixation/tethering
- multi centricity
- surgical margins
- contraindications to radiotherapy after BCT
How do we manage inflammatory breast cancer?
Full metastatic workup
Neoadjuvant chemotherapy ASAP
What is the DD of inflammatory breast cancer?
MASTITIS
what is the TNM staging?
TIS -> DCIS N1 = 1 - 3 positive regional nodes
T1mi: < or = 0.1 N2 = 4 - 9 positive regional nodes
T2: > 2 - 5cm N3 = > 10 positive regional lymph nodes
T3: > 5cm infraclavicular nodes
T4: invades chest wall or skin supraclavicular nodes
positive axillary & internal mammary nodes
