Breast Disease - Tieman Flashcards Preview

REPRO II Exam 1 > Breast Disease - Tieman > Flashcards

Flashcards in Breast Disease - Tieman Deck (65):
1

most common breast mass in young women

fibroadenoma

<30yo

benign

firm, moveable, non-tender

2

fibroadenoma diagnosis

U/S

FNA helpful - but can't distinguish from phyllodes

3

giant fibroadenoma

>5cm

4

tx of fibroadenoma

may be watched, excised, or treated with cryoablation

5

phyllodes tumor

stroma grows rapidly and tumor becomes large

may be benign or malignant - depends on mitotic rate and histo

malignant - tx - wide local excision or mastectomy

6

fibrocystic breast disease

cyst may be painless - multiple painful are common

35-55yo

fluctuate with menstrual cycle

7

fluctuate with menstrual cycle

fibrocystic breast disease

areas of fibrosis in ducts with destruction and dilation of terminal ductules and lobules

fill with cystic fluid

8

tx fibrocystic breast disease

aspiration

if recur - may be reaspirated

bloody aspirate - examine it

9

bilateral diffuse cyclical breast pain

fibrocystic breast disease

U/S - multiple small cysts

mammography - dense tissue - without mass

10

increased risk of fibrocystic breast disease

caffeine
chocolate
alcohol

11

tx of fibrocystic breast disease

support bra
analgesica
avoid trauma
danazol, tamoxifen - if severe
primrose oil
low fat diet
vit E

12

sclerosing adenosis

proliferation of fibrous stroma and terminal ductules with deposition of calcium

mammogram - look like microcalcifications of breast ca

no malignant potential

13

radial scar

complex sclerosing lesion

microcyst, epithelial hyperplasia, adenosis, central sclerosis

need bx - to distinguish from breast cancer**

slight increased risk to develop breast cancer

14

expressed nipple discharge

goes away when manipulation stopped

15

spontaneous nipple discharge

needs evaluated if serous/blood discharge

16

evaluation of nipple discharge

mammogram, cytology, U/S

17

unilateral, spontaneous, bloody/serous nipple discharge

duct excision required

95% benign papilloma
5% papillary carcinoma

18

bilateral nipple discharge

fibrocystic disease with duct ectasia
if not lactating - hyperPRL, hypothyroid, drug induced

19

lactational mastitis

younger
breast feeding women with fever
breast erythema and tenderness

staph aureus - tx antibiotics

may form abscess

20

chronc sub-areolar mastitis with duct ectasia

older women
diabetics who smoke

mixed flora

tx - antibiotics

may form abscess

21

non-resolving mastitis

requires biopsy*

bc looks like inflammatory breast cancer

22

fat necrosis

scarring folowing trauma, surgery, radiation

scar tissue, chronic inflammatory cells, and macrophages

often with calcifications

no malignant potential

23

male gynecomastia

diffuse male hypertrophy

pubertal - adolescent boys - rarely requires tx

senescent - males >50, medication associated - digoxin, thiazide, estrogens, phenothiazines, theophylline

must rule out underlying medical condition (cirrhosis, renal failure, malnutrition)

24

male breast cancer

harder, non-tender, fixed to surrounding sructure

25

lobes of breast

15-20

26

estrogen

ducts

27

progesterone

lobules

28

nipple openings

15-20

29

age <30

fibroadenoma

30

age 30-50

fibrocystic mass

31

age >60

majority of breast cancers

but cancer can happen at any age

32

social hx for breast ca

smoking, ETOH, occupation

33

family hx for breast ca

first degree relative - 2-3x risk increase

BRCA1 and 2 - 80% lifetime risk

endocrine disease

34

estrogen window

menarche to menopause

35

age of 1st pregnancy >35yo

1.5-3x increase risk of breast cancer

36

GAIL model

risk assessment for breast cancer

age, menarche age, age 1st birth, 1st relative with breast cancer, number of biopsies, race

37

patient <40yo with benign breast mass desiring excision

surgical biopsy

38

benign breast mass >40yo

mammogram
ultrasound
FNA
excise if malignant - repeat 3 months if benign

39

MRI of breast

high sensitivity
low specificity

more false positive readings and bx expenses

screening for high risk BRCA patients, dense breasts, small lesions, implants

40

FNA

minimally invasive
can be done in office

requires skilled cytopathologist

41

core needle biopsy

obtain tissue
ER/PR analysis

doesn't interrupt lymphatics

42

atypia on FNA or core needle bx

requires excision of entire lesion - to rule out malignancy

43

atypical hyperplasia on biopsy

3-6x increased risk of later invasive cancer

44

LCIS

tx as risk factor
15-20x increased risk of DCIS bilaterally**

excisional biopsy with clear margins

45

DCIS

tx with lumpectomy/radiation

46

most common invasive breast cancer

ductal
-favorable - medullary, tubular, mucinous, papillary

47

lobular carcinoma of breast

bilateral
slightly better prognosis than ductal

48

peau d'orange

inflammatory cancer of beast

49

breast cancer staging

T1 - 5cm
T4 - wall fixation or skin involved

N0 - no nodes
N1 - mets to ipsilateral nodes
N2 - mets to fixed or matted axillary nodes

50

stage 0 prognosis

Tis, N0, M0 - 95% 5 year

51

stage 1 prognosis

T1, N0, M0 - 85% 5 year

52

BI-RADS 0

requires additional studies

53

BI-RADS 1

no abnormal findings
-routine screening

54

BI-RADS 2

benign findings
-routine screening

55

BIRADS 3

probably benign
-6 month follow up

56

BIRADS 4

suspicious abnormality
-image guided bx

57

BIRADS 5

highly suggestive of malignancy
-image guided bx

58

mammotome biopsy

image guided

59

radical mastectomy

removal of breast, pec muscles, axillary nodes

rarely used - only if invades pectoralis muscles

60

modified radical mastectomy

remove breast, axillary nodes

61

partial mastectomy

remove part of breast

breast ca with negative axillary nodes

62

ALND

axillary lymph node dissection
-preferred tx if lymph node positive for cancer or patient doesn't want to risk having two procedures

complications - numbness - lymphedema

63

neoadjuvant therapy

chemo/rad before surgery

to down size and down stage tumors

64

anastrazole

aromatase inhibitor

65

breast cancer follow up

6-12 months

look for recurrence/mets

mammograms - yearly bilateral