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Breast Conditions Flashcards

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1
Q

What is the fisherman paradigm?

A

That breast cancer is predominately a systemic disease at outset. It is neccessary to eradicate micro metastases with systemic therapies;

  • hormonal
  • chemo
  • biological (herceptin)
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2
Q

What are the clincially relevant risk factors for breast cancer?

A
  1. female
  2. growing older
  3. gene mutations
  4. atypical ductal or lobular hyperplasia
  5. lobular carcinoma in sity
  6. atypical epithelial hyperplasia
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3
Q

What are the epidemiological risk factors for breast cancer?

A
  1. birth of first child after age of 30
  2. consumption of an alcoholic beverage one or more times per day
  3. early menarche
  4. FHx of breast cancer
  5. previous breast cancer
  6. nulliparity
  7. postmenopausal obesity
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4
Q

What are the most common symptoms of breast cancer?

A

Dimpled or depressed skin

Visible lump

Nipple chance e.g. inversion

Bloody discharge

Texture change

Colour change

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5
Q

_____ ________ is the most common histologic type of breast cancer, accounting for as many as __% of breast malignancies.

A

Ductal carcinoma is the most common histologic type of breast cancer, accounting for as many as 80% of breast malignancies.

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6
Q

What are the typical findings of ductal carcinoma?

A

Stellate solid mass or pleomorphic causing calcifications

Malignant solid mass may be circular and the calcifications may be non-casting

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7
Q

How is definitive diagnosis of ductal carcinoma made?

A

Image-guided tissue core biopsy

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8
Q

DCIS is most commonly _________ and perceived on screening mammography as malignant ________, usually ________ and of the ______ type

A

DCIS is most commonly nonpalpable and perceived on screening mammography as malignant calcifications, usually pleomorphic and of the noncasting type

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9
Q

How is definitive diagnosis of DCIS made?

A

Stereotatic vacuum assisted core biopsy

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10
Q

Invasive lobular carcinoma spreads diffusely with a typical histologic ____ ___ pattern

A

Invasive lobular carcinoma spreads diffusely with a typical histologic indian file pattern

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11
Q

LCIS is a risk factor for what?

A

Invasive carcinoma of the ductal type

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12
Q

What are the two variations of breast surgery?

A

Breast-conserving surgery (BCS)

Mastectomy

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13
Q

What is the preferred treatment for breast cancer?

A

Breast conserving surgery

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14
Q

What forms can BCS take?

A

Wide local excision with or without an oncoplastic procedure

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15
Q

What is an essential component of BCS?

A

Radiation therapy

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16
Q

How is irradiation used in breast conserving surgery?

A

total dose of whole breast irradiation of 4500–5000 centigrays is administered in fractions using opposed tangential fields

course usually administered in daily fractions (5 days per week) for 3–6 weeks.

A boost dose of irradiation to the tumor bed increases the target dosage to 6000–6500 centigrays.

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17
Q

What is a modified radical mastectomy?

A

Total mastectomy

Removes the entire breast, including the overlying skin and axillary lymph nodes

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18
Q

What is the modification with modified radical mastectomy?

A

Preservation of the pectoralis major muscle, facilitates improved wound healing and, potentially allows reconstruction

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19
Q

Who are candidates for breast reconstruction?

A

Most women who require or request mastectomy

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20
Q

Immediate or delayed breast reconstruction following conventional ___-____ _____ ________ (____) often results in prominent ____ on the new breast and a paddle of skin that is of a different ____ and ____.

A

Immediate or delayed breast reconstruction following conventional non-skin sparing mastectomy (NSSM) often results in prominent scars on the new breast and a paddle of skin that is of a different color and texture.

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21
Q

___-______ __________ (___) preserves most of the overlying skin during an immediate breast reconstruction (IBR) thus leading to a superior ______ outcome

A

Skin-sparing mastectomy (SSM) preserves most of the overlying skin during an immediate breast reconstruction (IBR) thus leading to a superior aesthetic outcome

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22
Q

How can breast reconstruction be achieved?

A
  • breast prosthesis
  • latissimus dorsi myocutaenous flap (usually plus a breast prosthesis)
  • deep inferior epigastric perforator free flap (DIEP)
  • transverse rectus abdominis myocutaenous (TRAM) flap
  • superior/inferios gluteal artery perforator (S-GAP, I-GAP) free flaps
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23
Q

What determines choice of reconstruction method?

A
  • body habitus
  • co-morbidity
  • smoking history
  • size and shape of her breasts
  • preference
  • surgeons experience
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24
Q

What are the indications for post-mastectomy RT?

A

More than 3 nodes

+ve surgical margins

Tumours larger than 5cm

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25
Adjuvant therapy; **\_\_\_\_\_\_\_\_\_** **\_\_\_\_\_\_\_\_\_\_\_\_**, often called **\_\_\_\_\_\_\_\_\_\_\_**, was found to be more effective than the single-drug therapies.
Adjuvant therapy; **multidrug** **chemotherapy**, often called **polychemotherapy**, was found to be more effective than the single-drug therapies.
26
What adjuvant systemic therapies are available?
Chemotherapy Hormonal therapy Targeted therapy
27
What is the most commonly used hormonal therapy?
Tamoxifen
28
What is herceptin (trastuzumab,TZ)?
Recombinant humanized monoclonal antibody which targets HER-2
29
What is bevacizumab
Recombinant humanized monoclonal antibody against vascular endothelial growth factor First line therapy for metastatic breast cancer
30
What is lapatinib?
Dual inhibitor of epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER-2) tyrosine kinases
31
When is lapatinib indicated for use?
It is indicated for use in *combination* with **capecitabine** for the treatment of patients with advanced breast cancer or **metastatic breast cancer** (MBC) whose tumors overexpress **HER-2** (ErbB2) and who have received *previous treatment* that included an **anthracycline**, a **taxane**, and **herceptin**.
32
What is the commonest benign neoplasm of the breast and how is it usually diagnosed?
Fibroadenoma Diagnosed as palpable mass (1-3cm) in the early reproductive years Confirmed with US core biopsy
33
How are fibroadenomas usually described by examination?
typically **rubbery** to **firm**, **mobile**, **smooth** with **distinct borders**, and is usually **nontender**
34
When and how are fibroadenomas removed?
Electively if womans preference Lumpectomy or percutaenous vacuum assisted core biopsy as out-patient under local anaesthesia
35
How can phyllodes tumours be differentiated from fibroadenomas?
Often larger (3-6cm) Tend to occur in older women (35-45 y/o) Tend to increase in size Requires histologic verficiation
36
How are phyllodes tumours treated?
Excised with wide (1cm), clear, surgical margins and caredully followed up
37
What is mastalgia?
Pain
38
How does mastalgia present?
* women during reproductive years * usually cyclic but can be noncyclic * diffuse and most intense in immediate premenstrual phase * usually bulateral
39
Noncyclic mastalgia is usually **\_\_\_\_\_\_**, often **\_\_\_\_\_\_**, and **\_\_\_\_** responsive to treatment than **\_\_\_\_** mastalgia.
Noncyclic mastalgia is usually **localized**, often **persistent**, and **less** responsive to treatment than **cyclic** mastalgia.
40
What is it imperative to ascertain in mastalgia?
That pain is not of nonbreast etiology affecting the anterior chest wall
41
List some etiologies of anterior chest wall pain
* Achalasia * Angina * Cervical radiculitis * Cholecystitis * Cholelithiasis * Coronary artery disease * Costochondritis (Tietze syndrome) * Fibromyositis * Hiatal hernia * Myalgia * Neuralgia * Osteomalacia * Phantom pain * Pleurisy * Psychological pain * Pulmonary embolus * Pulmonary infarct * Rib fracture * Sickle cell disease * Trauma * Tuberculosis
42
What dp most women with cyclic mastalgia have?
An intense varient of physiologic breast changes that occur during the menstrual cycle
43
When can a woman with mastalgia be reassured that her symptoms are physiologic?
After complete evaluation and examination including a mammogram for a woman \>35 years
44
What may improve mastalgia?
* well-fitting bra * regular exercise * evening primrose oil * tamixofen * topical NSAIDs *
45
When do breast cysts appear?
occur during the late reproductive years of a woman's life
46
Describe a cyst on examination
* typically palpable, clearly defined, soft, mobile, and smooth * borders are distinct. * often somewhat tender, especially before menstruation. * may be multiple and/or bilateral
47
What is an effective way of diagnosing and treating a cyst?
FNA
48
What fluid aspirated from a cyst must be sent for cytological evaluation?
Only grossly bloody fluid
49
What can occur within a cyst and is associated with bloody cyst fluid?
Benign intracystic papillary proliferation calles a papilloma
50
When is pappiloma suspected clinically?
Cyst aspirate grossly bloody Residual mass after aspiration
51
What is recommended for papilloma diagnosis?
Ultrasound-guided core biopsy of any intra-cystic solid lesion or iregular cystic wall
52
What is physiologic nipple discharge?
* Clear, yellow and watery in women of reproductive age * Physiologic
53
What is pathologic nipple discharge?
Bloody discharge, particularly from a single duct
54
What is the commonest etiology of spontaenous nipple discharge?
Intraductal papilloma or papillomas- BENIGN
55
What is the management for intraductal lesions causing nipple discharge?
Excision and histological evaluation
56
What are the investigations of pathological nipple discharge?
* mammography * Ultrasonography * surgical excision of discharging ducts
57
What is paget's disease of the nipple?
Variant of ductal carcinoma, intraductal, and/or invasive
58
How does paget's disease of the nipple present?
Erythematous weeping lesion on the surface of the nipple and the areola Usually presents as dry, scaly, eczematous lesion
59
How is paget's disease diagnosed?
Histologic tissue biopsy (incisional or punch) Often underlying palpable mass or radiological abnormality
60
What is the treatment for puerperal mastitis?
* course of antibiotics effective for Staphylococcus aureus; * **flucloxacillin** 500 mg orally every 6 hours or * **augmentin** 625 mg every 8 hours for 7 days * should be administered as soon as clinical signs of mastitis; * *fever, erythema, induration, tenderness, and swelling*
61
Describe ongoing management of mastitis?
Patient should be examined every 3 days to be certain the infection is responding to therapy and that there is no abscess formation
62
If there is lack of response to mastitis antibiotics what should be done?
It should be changed
63
What is the advice regarding breastfeeding and mastitis?
Breastfeeding should be continued if already begun and/or the infected breast can be pumped until the mastitis clears
64
How does a breast abscess present?
a flocculent sometimes-bulging mass usually located in the central area of the mastitis
65
How can a breast abscess be verified?
. Focused ultrasound can verify a fluid-filled (pus) center
66
What is diagnostic (and therapeutic) of a breast abscess?
* **Aspiration** with a number 18-gauge needle using local anesthesia is diagnostic and can be therapeutic if all the pus is aspirated. * The aspirate is sent for **microbiological** analysis
67
When might the aspiration of a breast cyst have to be repeated?
every 3 days, particularly if there is more than 10 milliliters of pus initially aspirated
68
If repeated aspirations are not effective in clearing an abscess what should be done?
Open surgical dependent drainage under GA Antibiotics continued until evidence of cellulitis has cleared
69
Nonpuerperal mastitis is **uncommon** and even **rare** in postmenopausal women. What are the usual pathogens?
* S. aureus * Peptostreptococcus magnus * Bacteroides fragilisare
70
What is the treatment for nonpeurperal mastitis?
* re-examined every 3 days until the infection clears. * Augmentin 625 mg orally every 8 hours for 7 days as initial therapy is usually effective. * Alternately, cephalexin 500 mg orally every 6 hours for 7 days can be prescribed.
71
What is chronic mastitis associated with?
Subareolar abscess
72
What can occur in chronic mastitis and what should be done?
Periareolar fistulae, should be surgically exicsed with inflammation is quiescent
73
What should be considered in chronic mastitis that is unresponsive to antibiotic therapy?
Inflammatory carcinoma
74
How does an adenolipoma usually present?
As a smooth palpable mass with a characteristic mammographic pattern
75
When does apocrine metaplasia of epithelial cells occur?
Apocrine metaplasia of the epithelial cells, which enlarge and are eosinophilic are histologically noted in the lining of a cyst
76
Ductal hyperplasia is a **\_\_\_\_\_** histologic process, but when the hyperplasia is **\_\_\_\_\_\_** it is associated with an increased risk of **\_\_\_\_\_\_\_\_** and thought potentially to be the beginning of **\_\_\_\_\_\_\_\_\_\_\_\_** to **\_\_\_\_\_\_** carcinoma **\_\_** **\_\_\_** and eventually **\_\_\_\_\_\_** **\_\_\_\_\_\_** carcinoma.
Ductal hyperplasia is a **benign** histologic process, but when the hyperplasia is **atypical** it is associated with an increased risk of **carcinoma** and thought potentially to be the beginning of **transformation** to **ductal** carcinoma **in** **situ** and eventually **invasive** **ductal** carcinoma.
77
Fat necrosis can mimic **\_\_\_\_\_** by **\_\_\_\_\_\_\_\_\_** but has a distinct **\_\_\_\_\_\_\_\_\_\_\_** appearance and is often secondary to **\_\_\_\_\_\_** **\_\_\_\_\_\_**. Fat necrosis usually subsides **\_\_\_\_\_\_\_\_\_\_** but may leave a residual **\_\_\_\_\_\_\_\_\_\_\_\_\_** **\_\_\_\_\_\_\_**.
Fat necrosis can mimic **cancer** by **examination** but has a distinct **mammographic** appearance and is often secondary to **breast** **trauma**. Fat necrosis usually subsides **spontaneously** but may leave a residual **mammographic** **lesion**.
78
A galactocele is a **\_\_\_\_\_** **\_\_\_\_-\_\_\_\_ \_\_\_\_** most commonly associated with **\_\_\_\_\_\_\_** or **\_\_\_\_\_\_**. **\_\_\_** can diagnose and drain a galactocele.
A galactocele is a **palpable** **milk-filled cyst** most commonly associated with **pregnancy** or **lactation**. **FNA** can diagnose and drain a galactocele.
79
A lipoma has a **\_\_\_,** **\_\_\_\_\_** border on mammography, can be **\_\_\_\_\_\_\_**, and reveals only **\_\_\_\_\_\_** cells by **\_\_\_\_\_\_**.
A lipoma has a **thin,** **smooth** border on mammography, can be **palpable**, and reveals only **adipose** cells by **biopsy**.
80
What is mondor's disease?
Phlebitis and subsequent clot formation in the superficial (skin) veins of the breast
81
How does mondor's disease present?
Phlebitis as firm, vertical, cord-like structure usually associated witha history of trauma to the breast
82
How does mondor's disease resolve?
Sponaneously in 8-12 weeks

Reproductive & Sexual Health (54 decks)

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