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GYN > Breast d/o > Flashcards

Breast d/o Flashcards

1
Q

NCCN recommends CBE every

A

1-3 years age 25-39 and yearly at age 40

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2
Q

American Cancer Society on CBE

A

evidence unclear, no recommendations; “be familiar

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3
Q

US Preventive Services Task Force CBE

A

not enough evidence

the idea is that if you are not consistently doing these exams then you can’t recognize the normal

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4
Q

the main recommendation around SBE

A

just to create awareness of what they normally feel like

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5
Q

how to document a lump or mass

A

cms from the nipple in a clock distribution

2cm mass at three o clock 4 cm from the nipple

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6
Q

fibrocystic breast tissue changes vs cysts

A

responds to hormonal changes a week leading up to your period

can get swollen or heavy

cyts are fluid filled pockets that also come and go with hormones

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7
Q

how to minimize fibrocystic breast tissue

A 
support,
 minimize caffeine & salt, 
daily exercise, 
low fat diet
 Vit E 100 IUs daily or Vit B6 100 mg daily
 Evening primrose oil capsules 1000-3000 mg qd or other omega-3s
NSAIDs
moist heat
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8
Q

accessory breast tissue in the axilla is seen commonly in this population

A

seen more with pregnancy

also seen commonly in overweight pts

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9
Q

firbroadenoma-what is it

A

benign tumor made up of glandular breast tissue and stromal (connective) tissue

15-25yo

can change with periods and get bigger with pregnancy or breast feeding

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10
Q

what do fibroadenoma looks like on ULS

A

hyperechoic oval or lobulated lump

really good through transmission without dark shawdoing
no angular borders and usually wider than it is tall

fallow for 6 mos to make sure it doesn’t change in size

can biopsy

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11
Q

ddx for fibroadenoma

what are we worried about

A

phyllodes tumor which is typically benign but can get really big really fast

need to look out for this

lactating adenoma is also possible with breast feeding

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12
Q

when are cysts found

what do you do to tx

A

pockets of fluid that respond to hormones and fluctuate more than a fibroandenoma

30-40 and stopping with menopause

smooth round and oval marble to egg sized
fluctuate
can go for a cm in size to 5 cm in size
do come back a lot so removing is not recommend but can aspirate

treat with ibuprofen and minimize caffeine

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13
Q

ddx of cysts

A

galactoceles -milk filled cysts in women who are usually recently breastfeeding

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14
Q

RED FLAGS for cysts

A

aspiration with blood
not good

can be a hematoma and need to send to cytology
could be a lesion that is bleeding in

also if the cysts comes back over night after asperation

with rough edges of internal echos a aspiration or biopsy is recommended

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15
Q

what do cysts look like on ultrasound and MRI

A

dark round fluid followed by a really hyperechoic shadow

on mammogram a round white marble

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16
Q

sebaceous cysts

A

can become painful and can be excised to lower the risk of infection

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17
Q

lipoma - how to differentiate from a cyst

A

feel rubbery and fatty
smooth mobile and round

on ULS it will be isoechoic (same as surroudning tissue (

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18
Q

types of biopsies

A

Fine needle aspiration
Core biopsy
Excisional biopsy

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19
Q

fibroadenoma biopsy most likely would use

A

fine needly aspiration

or core biopsy if that doesn’t work

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20
Q

tissue sample that is minimally invasive and

allows for tumor markers

A

Core biopsy

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21
Q

larger sample would need a ____

when would you need a larger sample

A

numb the skin entirely

Excision biopsy- especially if core biopsy did not make sense

Excise the lump itself or a piece of the lump

you get a pretty big incidence of infection

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22
Q

how does a core biopsy work

A

palpation guided or US guided
Reduces time in the OR for other biopsies

tiny little scare
use steri strips

can give you tumor markers -estrogen progesterone and HER2

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23
Q

types of discharge and how to differentiate

A

Physiologic (benign)-will be b/l white green clear or gray. will be multi ductal and stimulation to the breast

vs pathologic-issue causing it. single sided uniductal typically bloody or serous and happening on it’s own (no after stimulation)

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24
Q

for physiological discharge (

A

need a prolactin level -maybe an MRI

pregnancy test-HCG quant

thyroid

once in a while renal function

pregnancy

need to ask about medication
infection

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25
Q

MCC of pathological discharge

A

ii. Papilloma

  1. Benign lump in nature; sits in ducts
   2. Sometimes do hang out with atypical cells  3. Often removed

if there is nothing abnormal about them they can stay

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26
Q

medications that can cause nipple d/c

A

antidepressants, antipsychotics, htn meds, Opioid analgesics

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27
Q

what do you want to do for pathologic d/c

A

Ductography, breast MRI (sensitive but not specific), magnetic resonance ductography, and ductoscopy can be helpful in selected women but are not routinely necessary

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28
Q

Mastalgia

A

breast pain

need to get a good history to figure out if it’s related to diet, weight changes, hormonal contraception, often times will need a pattern and pain diary

can use OCP to help regulate cycles.

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29
Q

when would you get an ULS of MRI of mastalgia

A

if less than one quadrant can get a mammogram or uls to rule out cyst or mass that could be causing the pain

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30
Q

Mastitis

A

Breast infection, often as a result from breastfeeding/clogged ducts.

Spontaneous cases too, especially in smokers; can be chronic

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31
Q

Mastitis anbx

A

antibiotics (Keflex, Duricef, dicloxacillin )

(breastfeeding Bactrim, Clindamycin)
no absess–> dicloxacillian
if absess serial aspirations NO I and D

breast feeding technique, hot compresses,

I & D/aspiration for abscesses, rarely surgery

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32
Q

dx tests for mastitis

A

No imaging necessary if clinically suspect

Infection and complete resolution

ii. Systemic symptoms feels like the flu
1. Red, hot swollen breast +/- abscess

Imaging +/- biopsy if no improvement maybe a core biopsy or punch biopsy

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33
Q

a. Fungal of the breast tx with

A

nystatin

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34
Q

Infected Sebaceous Cyst tx

A

Infected Sebaceous Cyst – need I&D

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35
Q

Hidradenitis

A

younger women, obese, chronic infections/abscesses that can happen in under arm areas, under breast areas.

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36
Q

Hidradenitis

A

They need multiple I&Ds
doxycyxline
smoking cessation
weight loss

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37
Q

when would you biopsy a cyst

A

Complex cysts should be biopsied, particularly those with thickened cyst walls and/or septa, and solid components.

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38
Q

when do you see gynecomastia

A

Common during puberty if estrogen spikes before testosterone

rubbery, mobile, tender breast bud

Typically outgrow this
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39
Q

what is the cause of gynecomastia

A

d. Caused by an increase in the ratio of estrogen to androgen activity

Causes: drugs, medications (heroin, etoh can increase hormonal activity), hyperthyroidism, liver or kidney disease, hypogonadism, testicular tumors, aging

40
Q

dx of gynecomastia

A

g. Diagnosed on exam as a palpable mass of tissue at least 0.5 cm in diameter (usually underlying the nipple)

does feel like a breast bud
breast cancer will be outside of the nipple and will be a firmed fixed hard mass

41
Q

labs for gynecomastia

A

estradiol, testosterone, LH, FSH, prolactin, TSH, HCG (even in men)

-hyperthryoidism can cause it

42
Q

tx for gynecomastia

A

Plastic surgery if significant/bothersome

ii. Lifestyle modifications

43
Q

HCG for gynecomastia -why?

A

testicular mass screening

seen more in younger men

44
Q

ddx of gynecomastia

A

lipoma
pseudogynecomastia-fat
cancer

45
Q

meds that can cause gynecomastia

A

antidipressants
viagra
rogaine
cardio meds

46
Q

how common is breast cancer

A

a. 1 in 8 women will develop breast cancer in their lives

b. Average lifetime risk 12%;

47
Q

what ages do we typically see breast cancer

A

i. Early 40s to mid 80s is when it’s typically found

ii. Early stage is mostly where we catch them

48
Q

lifestyle modifications to minimize breast cancer

A

exercise

weight management -obesity increasing estrogen

limiting alcohol -4 glasses or less a week

breast feeding

having children before 35

49
Q

RF for breast cancer

A
  1. Radiation exposure
  2. Obesity (postmenopausal)
  3. Early menarche, late menopause
  4. Late or no pregnancy
  5. Smoking
  6. Alcohol
  7. HRT/OCPs
  8. Family history/genetic mutations (BRCA, CHEK2) –> can increase your risk for other cancers including ovarian cancer
  9. Previous breast cancer or high risk lesions
  10. ADH, ALH, LCIS
  11. Protective: breast feeding, multiple parity
50
Q

the most important factor in breast cancer

A

ii. Estrogen is important factor in breast cancer and can increase tumors. So adipose tissue in the breast tissue is another source of estrogen so keeping a healthy BMI is important
iii. Breast tumors that grow with estrogen are also linked with ETOH

51
Q

American cancer society recommends annual mammogram starting at age

A

45-55
every two years

can start at age 40

52
Q

The USPSTF recommends against routine screening mammography in women

A

40-49

The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient risk factors (fhx of breast cancer, history of breast biopsy etc)

a lot of time they end up needing biopsies that aren’t necessary Kaiser says 50

53
Q

Digital better for dense breasts and women

A

<50 yo

54
Q

Tomosynthesis -what is it and when would we use it

A

Tomosynthesis similar to a CT scan takes several xrays through the breast creating a “3D” picture. Combined with standard mammogram can increase detection rates and decrease false positive. Not reimbursed by most insurances, expensive, higher radiation exposure. May be a good adjuvant for very dense breast tissue.

55
Q

BI-RADA 2

A

benign managment is routine screening and likelihood of CA is 0%

56
Q

BIRAD 4

A

suspicious

tissue diagnosis is management and the can be low moderate or high risk of suspicion

57
Q

typically want to start mammograms for pt with a familial risk at

A

10 years younger than the earliest diagnosis in your family

58
Q

BIRADS 3

A

probably benign and need short interval follow up

59
Q

6 is a

A

known biopsy proven CA with surgical excision

60
Q

5 is a

A

high suggestive of malignancy and needs tissue diagnosis

61
Q

indications for an MRI screening

A

BRCA 1 or 2 gene mutation

First degree relative with BRCA 1 or 2

Increased lifetime risk

History of mammographicall occult breast cancer

Radiation therapy to the chest wall young age

leads to a lot of false positive
no radiation exposure

62
Q

can we use breast uLS for surveillance?

A
  • used for diagnostic workup in combination with mammogram. Not used for surveillance.
63
Q

Thermography- what is and when do we use it

A

Thermography-measures heat. Procedure is safe but does not detect or provide a diagnosis of any condition.

Currently not endorsed by any reputable medical agency including the american cancer society, national cancer institiute, american college of radiology, american medical association

64
Q

The American Cancer Society’s recommendations for MRI screening:

A

. Lifetime risk of breast cancer >20%

OR

. Hx radiation treatment to the chest prior to age 30 yo

65
Q

how do we determine lifetime risk of breast cancer >20%

A

The American Cancer Society’s recommendations for MRI screening:

66
Q

in-situ cancer is contained

A

In-situ cancer is contained within the ducts or lobules.

ducts more common

67
Q

management of ductal carcinoma in-sit

A

is treated so that it does not progress to invasive cancer. Should we call it cancer? Are we over treating people?

68
Q

what is in-situ

is it palpable?

A
  1. Precursor to invasive cancer in half of cases.
  2. Higher detection
  3. Pleomorphic microcalcifications seen on mammogram; not usually palpable
69
Q

inflammatory CA

A

cancer cells are blocking the lymphatic vessels

  1. Edematous, squishy, red
  2. Rare but advanced type of breast cancer
  3. Typically over 1/3rd of breast
70
Q

ddx of inflammatory CA

A

mastitis. If not able to treat with abx, then get mammogram

71
Q

cancer typically of the nipple

A

Paget’s disease

72
Q

TYPICAL AREAS OF METS

A

. BONE, LUNG, BRAIN, LIVER – TYPICAL AREAS OF METS

73
Q

younger women typically have these types of tumors

A
  1. Younger women typically tend to have more aggressive tumors
74
Q

what is the best type of tumor

A
  1. ER and PR status –>best tumor is ER and PR positive and HER2 negative
75
Q

what targets HER2

A

a. HER2 = more aggressive

i. Herceptin targets these tumors

76
Q

if ER, PR, and HER2 negative

A

ER, PR, and HER2 negative – no treatments

this is the most aggressive type of tumor

NOT GOOD
treat with chemo but higer incidence of recurrence and spread

77
Q

i. Chemotherapy done as tx for

A

– Neo-adjuvant or Adjuvant

1. Neoadjuvant – done in case of inflammatory cancer

78
Q

Endocrine therapy is used for

A

ER+ tumors only

  1. Meds that reduce estrogen in the body
    a. Taken for 5-10 years – menopausal like symptoms can be present
79
Q

Oncotype score –

A

DNA test on the tumor that tells you how well it will respond to chemo therapy

shows how aggressive and the recurrence risk might be and how effective chemo might be

herceptin targeted with chemo does have higher success rates

80
Q

b. Lymph node dissection is done for

A

biopsy proven cancer in the lymph nodes.

81
Q

treatment schedule for chemo

A

d. Treatment is usually 5 days a week for 5 weeks, starts 1 month after surgery or chemotherapy

82
Q

phyllodes tumor

A

like a fribroadenoma but changes really fast this is what we are worried about with firboadenomas

usually benign but can be malignant

83
Q

Mastitis imaging

A

don’t normally need it if you think there is an infection

84
Q

if you think there is an abssess

A

bactrim if you

85
Q

Noncyclic pain is most common in women and is described as

A

30-50

It is often described as a sharp, burning pain that occurs in one area of a breast.

86
Q

Occasionally, noncyclic pain may be caused by a

A

fibroadenoma or a cyst.

87
Q

BIRADS 1-3

A

MRI or ductogram

88
Q

bi-rads3-4

A

GET A TISSUE BIOPSY if benign then duct exicison

89
Q

density classifications

A

1- almost entirely fat
2 scattered -most of the population
3- heterogeneously dense -40%
4- extremely dense

90
Q

DCIS

A

this is stage 0

ductal carcinoma insitu

Precursor to invasive cancer in half of cases.

91
Q

DCIS-what does it look like

A

Abnormal number and morphology of cells lining the duct, not extending into the breast tissue.
Appears as new pleomorphic calcifications or linear branching. Not usually palpable

Treated like cancer,

92
Q

eczema os the nipple that doesn’t improve with steroids want to think about

A

pagets disease

93
Q

occurs when cancer cells block the lymphatic vessels in skin covering the breast,

A

inflammatory breast cancer
It is considered a locally advanced cancer — meaning it has spread from its point of origin to nearby tissue and possibly to nearby lymph nodes.
include:

94
Q

surgery would not be helpful in which pts with CA

A

METS

95
Q

lumpectomy is conducted with

A

radiation

96
Q

anti-estrogen therapy

A

tomoxifen

97
Q

herceptin is used for people that are

A

HER 2 positive

GYN (13 decks)

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