Breast Cancer

Question 1

What is the blood supply of the breast?

Answer 1

internal mammary (off subclavian) and lateral thoracis (off axillary) arteries

Question 2

What LN drain the breast

Answer 2

Axillary&raquo_space;» internal mammary

Question 3

Effect of __ on breast

• estrogen
• progesterone
• PRL
• oxytocin

Answer 3

• estrogen = ductal development and fat deposition
• progesterone = lobar-alveolar (stromal) development
• PRL = milk production
• oxytocin = milk let down

Question 4

Pt comes in with breast pain, next step?

Answer 4

h/o trauma = get US
high risk = get mammo
likely benight from H&P = reassurance, NSAIDs, sports bra, compress

Question 5

Blood discharge, think

Answer 5

intraductal papilloma

Question 6

milky discharge from nipple, think

Answer 6

preganacy
hyperPRL
hypothyroid
what meds are they taking (anti-psych)

Question 7

yellowish discharge from breast, think

Answer 7

fibrocystic change
galactocele
acute mastitis

Question 8

green/stick discharge from nipple, think

Answer 8

mammary duct ectasia

wiki: the lactiferous duct becomes blocked or clogged. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.

Question 9

purulent nipple discharge, think

Answer 9

breast abcess

Question 10

what is the incidence of breast cancer

Answer 10

1 in 8 women

Question 11

who gets screened for breast cancer

Answer 11

> 50 q2year

> 40 q year if strong fam history

Question 12

What is the MC location of breast cancer?

Answer 12

upper outer quadrant

Question 13

What are the MC site of breast cancer mets?

Answer 13

bone, liver, lung, brain, pleura

Question 14

What is the MC breast mass in
< 25 yo?
24-50?
> 50?

Answer 14

< 25 yo = fibroadenoma
24-50 = fibrocystic change
> 50 = infiltrating ductal carcinoma

Question 15

are malignant masses usually painful or painless?

Answer 15

painless

Question 16

find a breast mass in > 30 yo, next step?

Answer 16

mammo + core needle Bx –> excision if non-diagnostic

Question 17

Find breast mass in < 30 yo, next step?

Answer 17

US

Question 18

You get an US of a brast mass and it is solid, what is next step?

Answer 18

FNA

Question 19

You get an US of a brast mass and it is cystic, what is next step?

Answer 19

drain it, if it is bloodyor recurrent, get a core needle bx

**f/u in 4 weeks

Question 20

What is the BI-RADS

Answer 20

classification of mammos

Question 21

what does the BI-RADS score mean?
0
1
2
3
4
5
6

Answer 21

0 = incomplete/needs addnl imaging
1 = negative/routine follow up
2- benight/routine follow up 
3= probably benign/short term follow up (6mo)
4 = suspicious/core needly bx
5 = probmalignant/core needle bx
6 = def malignant/seek treatment

Question 22

firm, mobile mass <5cm, in young woman

Answer 22

fibroadenoma

Question 23

a firm moblie mass > 5cm seen in teens with rapid breast growth, Tx?

Answer 23

giant juvenile fibroadenoma, tx is excision to avoid breast defomity

Question 24

bloodly nipple discharge + tx

Answer 24

intraductal papilloma, tx galactogram/ductogram guided excision (due to small risk of carcinoma)

Question 25

huge benign tumor that distorts breast

Answer 25

phyllodes tumor

Question 26

mammo that shows clustered microcalcifications is most liekly

Answer 26

DCIS/infiltrating

Question 27

mamo that shows multiple/bilateral tumors is most likely

Answer 27

LCIS/infiltrating

Question 28

MC breast cancer

Answer 28

infiltrating ductal carcinoma

Question 29

"crusty" nipple eczema

Answer 29

paget's disease

Question 30

Staging for breast cancer

Answer 30

``` 1= < 2cm 2= < 2cm or LN+ 3 = 2+ nodes 4= distant mets ```

Question 31

treatemtn for ER/PR+ breast cancer

Answer 31

tamoxifen and aromatise inhibitors (letrozole, anastrazole, exemstane)

Question 32

Her2/neu+ inficates good or poor prognosis

Answer 32

poor

Question 33

treatment for Her2/neu+

Answer 33

trastuzamab

Question 34

what is a modified radical mastectomy

Answer 34

removes breast, pec maj/min and axillary LN

Question 35

painful, multiple, bilateral lumps that vary with menstrual cycle + Tx?

Answer 35

fibrocystic change dec tea/caffine/chocolate, aspirate domainant lump

Question 36

next step if pt has atypical ductal hyperplasia on bx?

Answer 36

excision bc has hish risk of becoming cancer

Question 37

treatment for acute mastitis

Answer 37

dicloxacillin + CONTINUE Breast feeding

Question 38

b/l breast pain and green/sticky d/c in perimenopausal woman

Answer 38

mammary duct ectasia

Question 39

presents as breast lump and calcification following trauma, next step?

Answer 39

dystrophic calcification, excision and bx to r/o cancer