Breast Changes + Cervical Cancer Flashcards
(124 cards)
1
Q
x-ray, best for detecting calcifications, masses and architectural distortion in the breast
- cannot show if mass is solid or cystic
- low sensitivity in women w/ dense breast tissue
A
Mammogram
2
Q
sound waves, best for differentiating solid and cystic masses in the breast
*typically cannot show calcifications
A
Ultrasound
3
Q
magnetic fields that have to be enhanced with contrast; best for seeing tissue with increased blood flow such as tumors in the breast
- **high sensitivity and high negative predictive value
- **high false positive rate
A
MRI
4
Q
with bilateral milky discharge (galactorrhea) and pregnancy test negative, order:
A
serum prolactin + TSH
5
Q
with bilateral milky discharge (galactorrhea) and hyperprolactinemia, order:
A
MRI of sella turcica to rule out prolactin-secreting tumor
6
Q
test done for dark/black nipple discharge to evaluate for bleeding
A
Guaiac testing
7
Q
small needle inserted to aspirate cells for cytology; commonly used to differentiate solid and cystic masses and targets breast mass/thickening
A
Fine-needle aspiration biopsy
8
Q
large bore needle used to obtain cores of tissue for histologic examination, stereotactic mammography used for localization and targeting of tissue to be biopsied
* targets calcification seen on mammogram, masses or other abnormalities visible only by mammography (i.e. not visible with ultrasound)
A
Stereotactic core needle biopsy
9
Q
large bore needle used to obtain cores of tissue for histologic examination, US used for localization and targeting of tissue to be biopsied
*targets lesions visible only with MRI
A
Ultrasound-guided core needle biopsy
10
Q
uses wire or radioactive seed to localize an occult mammographic, sonographic or MRI detected abnormality prior to excisional biopsy
*targets mass or calcification seen on imaging in a location that cannot be effectively assessed with core biopsy
A
Needle-localized breast biopsy
11
Q
surgical procedure that requires skin excision, mass removed with the surrounding margin of tissue
- targets palpable breast mass/thickening or skin changes
- used for initial diagnosis only when needle biopsy is not feasible
A
Excisional breast biopsy
12
Q
Type of Nipple Discharge: usually in women >50 yo Dilation of ducts/inflammation BILATERAL MULTIDUCTAL Green/black nipple discharge; sticky green brown or black
A
Mammary duct ectasia
13
Q
Type of Nipple Discharge: Lesion in duct Spontaneous (without stimulation) UNIDUCTAL UNILATERAL Bloody nipple discharge
A
Intraductal papilloma
14
Q
Type of Nipple Discharge:
Milky discharge in someone who is not pregnant/lactating in the last 12 months
BILATERAL
MULTIDUCTAL
May occur spontaneously OR with nipple stimulation
A
Galactorrhea
15
Q
Factors that make nipple discharge \_\_\_\_\_\_\_\_\_\_: Spontaneous Unilateral From a single duct Clear, bloody, or serosanguinous Associated with a mass Occurs in older women
A
worrisome
16
Q
Factors that make nipple discharge \_\_\_\_\_\_\_\_\_\_: Occurs with manipulation or stimulation Bilateral Multiductal Milky Yellow, green, brown, or black Mass present
A
less worrisome
17
Q
Subjective Info for c/o \_\_\_\_\_\_\_\_\_\_: Duration and color Spontaneous or only with stimulation Unilateral or bilateral One duct/hole or multiple Medications Associated symptoms - pain, mastalgia, breast mass History of breast dx or surgery ROS: hypo/hyperthyroid, pituitary tumor, hyperprolactinemia, menstrual, pregnancy, lactation general medical, family hx esp breast and ovarian cancer
A
nipple discharge
18
Q
Objective Info for c/o ___________:
Comprehensive breast exam - inspect and palpate in upright and supine positions, include lymph nodes
If discharge can be reproduced or seen - note color, consistency, laterality, location, number of ducts using the clock method
Skin changes
Masses
Tenderness
Addition based on ROS: thyroid palpation if s/p thyroid surgery, visual field for galactorrhea in women not pregnant or breastfeeding
A
nipple discharge
19
Q
dilation of ducts w/ surrounding inflammation and fibrosis that usually occurs in women > 50 yo,
A
Mammary duct ectasia
20
Q
Diagnostics for __________:
*depends on masses presence and discharge characteristics
If discharge black–>guaiac test for blood
If age>40 and hasn’t had a mammogram in last 6 months–>mammogram
A
Mammary duct ectasia
21
Q
Treatment for __________:
- Advise to avoid nipple stimulation and follow up in 3-4 months
- Expectant management due to benign process
- Surgically treated with removal of the subareolar duct system if imaging shows focal thickening of the duct wall or if symptoms are severe
A
Mammary duct ectasia
22
Q
small benign growth in the duct usually occurs in women 40-50 years of age
A
Intraductal papilloma
23
Q
Diagnostics for ____________:
*depends on if mass present and characteristics of discharge
Spontaneous, unilateral and uniductal and reproducible on exam:
-Age >30 = mammogram and US
-Age <30 = US and if indicated, mammogram
A
Intraductal papilloma
24
Q
Treatment for __________:
Without atypia, single papilloma and < 1 cm: Do not remove
Multiple papillomas or single papilloma > 1 cm: duct excision
A
Intraductal papilloma
25
milky discharge in a woman who has not been pregnant or lactating in the last 12 months
galactorrhea
26
```
Diagnostics for ____________:
Pregnancy test
If negative → serum prolactin and TSH
If hyperprolactinemia present - imaging of sella turcica with MRI to rule out pituitary prolactin-secreting tumor
Pregnant → normal
```
galactorrhea
27
Treatment for __________:
-Decrease breast/nipple stimulation to decrease discharge
-Outside of pregnancy/lactation:
Pituitary tumors → expectant management, medication, and/or surgery
Meds: bromocriptine and cabergoline
Discontinuation of meds → recurrence of galactorrhea, therefore lifelong therapy required
Discontinuing medication causing galactorrhea
galactorrhea
28
```
Subjective Data for ___________:
Menstrual cycle → luteal phase through first few days of menstruation
**possible pregnancy!**
Caffeine intake
Hormone use
Cyclic, noncyclic or chest wall pain
Focal or diffuse
Medication
Family history of breast and ovarian cancer
ROS to eliminate non-breast causes
```
Mastalgia
29
```
Likely cause of ___________:
hormonal changes (cyclic)
increased estroge
deficient progesterone
hyperprolactinemia
Many meds - just look it up
pregnancy
possibly caffeine especially recent big increase in amount
```
Mastalgia
30
Diagnostics for _______:
- Pregnancy test
- Imaging: only if mass with abnormality occurs with CBE
- Age > 30: mammogram and US
- Age < 30: US and if indicated, mammogram
Mastalgia
31
Subjective Date for ___________:
When noticed, any changes patient made
Other symptoms - mastalgia, discharge
History of breast disease or surgery
Menstrual, pregnancy, lactation, and general med history
Family history of breast or ovarian cancer
Breast Masses
32
```
Objective Data for ___________:
CBE
Palpable mass -- size, shape, consistency, or texture - discrete or poorly differentiated borders; tender, mobile or fixed
Skin changes, nipple discharge
Location in relation to a clock
```
Breast Masses
33
Diagnostics for ____________:
Palpable area of concern?
-Age < 30: US
-Age >/= 30: mammogram with or without US
(dependent on suspicion for malignancy)
Biopsy is done for definitive diagnosis (usually fine needle but more invasive if needed)
Breast Masses
34
dense epithelial and fibroblastic tissue, usually nontender, encapsulated, round or oval, movable, firm, rubbery, can be large
Fibroadenoma
35
incidence of this breast mass decreases with increased age- commonly benign usually singular mass in younger women
Fibroadenoma
36
treatment for Fibroadenoma
expectant management
37
breast mass that usually decreases in size postmenopausally and many completely resolve
Fibroadenoma
38
fluid-filled mass most common in 35-50 yo women
| *Discrete, tender, mobile, size may fluctuate with menstrual cycle
Cyst
39
Treatment for Asymptomatic cysts
expectant management
40
Treatment for Large, painful cysts
aspiration
41
Treatment for Complicated cysts
biopsy of debris to r/o atypia or malignancy
42
area of fatty tissue may occur in the breast or other areas - usually in later reproductive years
Discrete, soft, nontender, may or may not be mobile
Lipoma
43
If there are suspicious findings at Lipoma site on mammography or US, treatment is:
excision of lipoma
44
If lipoma site on mammography or US is consistent with lipoma on examination and tissue sampling, treatment is:
no excision needed
45
Poorly defined, firm, nontender, nonmobile mass that is usually result of trauma or surgical manipulation of the tissue that resolves spontaneously
Fat necrosis
46
Glandular tissue, fat and fibrous connective tissue mass
* Discrete, nontender, nonmobile, may be nonpalpable with incidental dx on imaging studies
* Average age of diagnosis: 45 yo
Hamartoma
47
Breast mass that may require excision for diagnosis but otherwise can be managed expectantly
Hamartoma
48
Milk-filled cysts that usually occur during or after lactation
* Discrete, firm, sometimes tender
* Duct dilation often have an inflammatory component
Galactocele
49
breast mass that requires aspiration for diagnosis and appropriate treatment
Galactocele
50
not indicated by pain or lack of pain, although most don’t report pain
breast cancer
51
```
Symptoms of __________:
bone pain
arthralgias
cough
jaundice
abdominal pain
headache
visual disturbances
malaise
loss of appetite
weight loss
fever
fatigue
```
metastasis of breast cancer
52
```
Suspicious for _________:
skin changes
lesion is hard
painless
irregular borders
may be immobile and fixed to the skin or surrounding tissue
```
breast cancer
53
Suspicious for _________:
skin changes
lesion is hard
painless
irregular borders
immobile mass fixed to the skin or surrounding tissue
enlarged axillary cervical and supraclavicular lymph nodes
breast cancer
54
areas of examination in breast cancer patient
lungs, abdomen, neuro
55
```
Diagnostics for ___________:
Mammogram
US
possibly MRI
tissue sampling
```
breast cancer
56
```
Treatment for _________:
Staged
May be graded
tumor markers assessed
lymph node involvement,
Surgery
chemo
radiation
hormones
bisphosphonates
monoclonal antibodies - combo and individualized
```
breast cancer
57
most significant risk factor for breast cancer
Age
58
```
Risk Factors for __________:
BRCA 1 or 2 mutation
smoking
age
female sex
personal hx
family hx
genetic mutations
breast lesions with atypia
dense breast tissue
high-dose radiation to chest (esp during puberty)
menarch before age 12
menopause after age 55
nulliparity
first full-term pregnancy after age 30
current use of COC
use of COC after menopause
weight gain after age 18
physical inactivity
alcohol consumption
Jewish ancestry
Born in North America, North Europe, Asia, or Africa
```
breast cancer
59
Protective for __________:
Breastfeeding (decreased risk by 4.3% per year)
Moderate to vigorous physical activity for at least 4 hours/week (decreased risk by 30-40%)
Maintaining a normal weight
Decreasing alcoholic drinks
breast cancer
60
American Cancer Society no longer recommends ___________for screening purposes at al
clinical breast exam (CBE)
61
ACOG recommends annual mammography screening starting at age _______
40
62
USPSTF recommends bi-annual mammography screening starting at age ______
50
63
```
Prevention measures for _________:
BRCA 1 and 2 testing
Chemoprevention Meds - SERMs, tamoxifen, raloxifene, (these two only FDA approved for this) aromatase inhibitors and others
Prophylactic mastectomy
Possibly salpingooophorectomy
```
breast cancer
64
Squamous metaplasia on cervix is:
normal
65
Normal physiological process that occurs at the squamocolumnar junction or transformation zone
squamous metaplasia
66
Where more fragile columnar epithelial cells are replaced with harder squamous epithelial cells
transformation zone
67
Process initiated by the eversion of the columnar epithelium onto the ectocervix - occurs under the influence of estrogen and its ensuing exposure to acidic vaginal pH
squamous metaplasia
68
Squamous metaplasia may arise through reproductive years but is most active during:
adolescence and first pregnancy
69
where columnar endocervical epithelium and squamous ectocervical epithelium meet and this is where most cervical cancers arise
transformation zone
70
_____% of cervical cancer is from HPV
99.7%
71
___ cervical cancer is not sexually transmitted
Clear cell adenoma
72
most HPV infections are undetectable within ___-___ years
1-2
73
high-rsk HPV infections are ___________ infections that cause cervical cancer
persistent
74
woman contracting HPV in her ___s have higher chance of immune system unable to remove infection if they it is high-risk type
30s
75
high risk types of HPV
Type 16 and 18
76
```
Risk Factors for __________:
Early age at first intercourse (<18 yo)
**most importantly, how close to menarche/puberty (closer, the more risk)
Sexual Behavior
Multiple sex partners
Smoking- 2X risk
Immunosuppression
HIV/AIDS
Medications- COCs- 2X risk w/ > 5-year use
**Returns to normal after 10 years of d/c
High Parity- 3+ full-term pregnancies
Genetic disposition
Mother or sister with cervical CA
Diet Low in fruits and veggies
Diet Low in levels of Vitamin C, E, folate, and carotenoids
Poverty
DES (Diethylstilbestrol)
**Daughters of women who took DES are 40X higher risk (these women are >40 yo now)
Hx HSV-2
Hx Chlamydia
```
HPV
77
```
Prevention of ________:
Routine screenings!
Vaccine!
Decrease modifiable risk factors!
Safe sex
Smoking cessation (especially w/ abnormal pap)
```
HPV
78
Girls aged 11 to 14 only need ___ doses of vaccine 6 months apart while...
Older teens and adults need all ___ doses
2 for younger vs 3 for older
79
younger teens develop greater __________ from the HPV vaccine than do older teens and young adults.
immunity
80
vaccine that has now been approved for women and men aged 27 - 45 who need a 3-dose series for full protection like older teens do.
Gardisil-9 56ine
81
Pap tests screen for:
cellular changes in the cervix resulting from some types of HPV infections
82
Pap rests DO NOT screen for:
genital warts or condyloma accuminata
83
Pap test result that shows absence of endocervical/transformation zone component of endocervical or squamous metaplastic cells
Satisfactory
84
Pap test result that shows absence of intraepithelial cells or malignancy
Negative
85
Advantages of _______ Pap test:
More complete removal of cellular material
Sample can be used for HPV DNA, Chlamydia, Gonorrhea and Trich testing which eliminates need for 2nd visit for cytologic abnormality
Liquid-Based
86
Disadvantages of _________ Pap test:
Neither more sensitive or specific
Higher cost
Not considered diagnostic for Trich (NAAT should follow to confirm)
Liquid-Based
87
Factors that cause incorrect __________:
Not obtaining enough cells for evaluation
Leaving most of sample on collecting device
Obscured detection of abnormal cells d/t presence of blood, mucus, air drying, or other artifacts on slide
Pap test
88
ASC-US and LSIL results are _____ worrisome
less
89
ASC-H and HSIL results are _____ worrisome
more
90
Nontender breast masses
```
Fibroadenoma
Lipoma
Phyllodes Tumor
Hamartoma
Fat Necrosis
```
91
Tender breast masses
Cyst
| Sometimes Galactocele
92
Mobile breast masses
Fibroadenoma
Cyst
Phyllodes Tumor
MAYBE Lipoma
93
Nonmobile/Fixed breast masses
MAYBE Lipoma
Hamartoma
Fat Necrosis
94
Discrete breast masses
All except Fat Necrosis
95
I'll defined breast mass
Fat Necrosis
96
Firm breast masses
Galactocele
Fibroadenoma
Phyllodes Tumor
Fat Necrosis
97
Soft breast masses
Lipoma
98
May observe skin stretching due to rapid growth of this breast mass
Phyllodes Tumor
99
Breast mass that may be nonpalpable and only diagnosed with imaging
Hamartoma
100
Breast mass that occurs in adolescents and younger women
Fibroadenoma
101
Breast mass that occurs during/after lactation
Galactocele
102
Breast mass that occurs in late reproductive yeara
Lipoma
103
Breast mass that occurs at age 35-50
Cyst
104
Breast mass that occurs in ages 30-50
Phyllodes Tumor
105
Breast mass in women average aged 45
Hamartoma
106
Breast mass that can occur at any age
Fat necrosis
107
Pap results that will probably resolve especially in young women showing mild dysplasia, cervical intraepithelial neoplasia CIN1
LSIL
108
Pap result that means danger! Potentially CA already! - atypical squamous cells, cannot exclude high-grade lesions
ASC-H
109
Pap results that are almost 100% are HPV, moderate to severe dysplasia, carcinoma in situ, CIN 2 and 3
HSIL
110
Pap results that are considered OK
Negative
| ASC-US
111
GLANDULAR cells that are the red, beefy part of cervix and potentially uterine cells
**these are RARE so higher likelihood of being CA
Not related to HPV associated changes (HPV testing not helpful)
AGUS
112
concerning type of discharge from breasts
clear
spontaneous
unilateral
bloody
113
for c/o nipple discharge, what kind of exam do you perform?
CBE
114
questions to ask for ___________:
cyclic?
unilateral/bilateral?
pregnancy?
mastaligia
115
breast pain is concerning when it occurs post-___________
menopausal
116
Effective reliefs for __________:
supportive, well-fitting bra
reassurance
caffeine and fat reduction
mastalgia
117
________ Signs:
nipples pointing different directions
nipple retraction/flattening
palpable axillary lymph nodes
Worrisome
118
sole risk factor present in the vast majority of breast cancer
older age
119
pap result "don't ask us, because we don't know"
| therefore, reflex test for HPV for most
ASC-US
120
pap results "likely yes to HPV" but often low risk for type that causes cancer
Management type depends on age/other factors
LSIL
121
pap results "yes to HPV" higher risk of cancer
HSIL
122
pap results "may already be cancer but probably not"
ASC-H
123
pap results glandular cells - rare result but often concerning
AGC
124
Reasons to give Gardasil at ______ years old:
only need 2 doses instead of 3
better immune response
11-12
