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Clin Med 3 - Exam 3 (Women's Health) > Breast Diseases > Flashcards

Breast Diseases Flashcards

1
Q

what is the most common cause of benign breast disorders?

A

fibrocystic breast changes

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2
Q

what are fibrocystic breast disease influenced by?

A

hormones

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3
Q

fibrocystic breast disease sx’s worse when?

A

sx’s worse prior and during menstrual cycle b/c relates to the hormones

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4
Q

pathogenesis of fibrocystic breast disease?

A

hormone induced breast changes

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5
Q

what is created in fibrocystic breast disease?

A

estrogen-ductal elements -> cause discomfort and hyperplasia

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6
Q

is fibrocystic breast changes a disease?

A

no, it’s a normal variation in breast histology

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7
Q

risks for fibrocystic breast disease?

A

nulliparity, late menopause, estrogen replacement therapy

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8
Q

what is the clinical presentation of fibrocystic breast disease?

A

tender bilateral breast w/palpable nodule that blends into the surrounding breast tissue

lumpiness fluctuates with the menstrual cycle (increase and decrease in size)

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9
Q

what is the nodule like in fibrocystic breast disease?

A

smooth well-defined edges

freely moving (not hard)

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10
Q

is there usually a mass present in fibrocystic breast disease? if there is?

A

no there usually isn’t, but if there is then do US +/- FNA

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11
Q

when do you follow up for fibrocystic breast disease if equivocal or non-suspicious on exam?

A

re-examine in 2-4 weeks (follicular phase of menstrual cycle, days 5-7 best)

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12
Q

what is the best dx imaging for fibrocystic breast disease? what does it distinguish?

A

US

Distinguishes cystic from solid mass

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13
Q

US for fibrocystic breast disease is done before what? can use US to do what for FNA?

A

before a FNA - can use US to do needle guided FNA

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14
Q

what does it mean when fluid from cyst comes back clear? if mass is solid?

A

if clear = cyst

if solid = mammogram

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15
Q

when is mammogram used for fibrocystic breast disease?

A

Further evaluation of clinically suspicious masses

Further evaluation of solid masses

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16
Q

dx procedures for fibrocystic breast disease?

A

FNA or Core Needle Bx

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17
Q

when is FNA best done for fibrocystic breast disease?

A

after US to distinguish b/w a solid and cystic mass

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18
Q

if no aspiration or bloody aspiration from FNA of fibrocystic breast disease, what is the next step?

A

Core Needle Bx

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19
Q

can FNA be therapeutic for fibrocystic breast disease?

A

YES! can take off some fluid to decrease pain

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20
Q

what is the difference b/w FNA and Core Needle Bx?

A

FNA = cytology

Core Needle Bx = histology

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21
Q

Core bx used for what?

A

uncertain FNA findings

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22
Q

what can core needle bx show that FNA can’t?

A

epithelial hyperplasia/malignancy b/c does histology

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23
Q

what is the method of choice for histologic dx?

A

core needle bx

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24
Q

tx for fibrocystic breast disease?

A

reassurance to pt, avoid impact sports, wear bra

APAP, NSAIDs

Aspiration of cyst (if isolated mass noted)

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25
Q

if pt is in significant discomfort with fibrocystic breast disease, what is the tx?

A

Tamoxifen (off-label use)
-hormone receptor drug

Danazol (FDA approved)

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26
Q

when does pt with fibrocystic breast disease need followup if isiolated mass noted with aspiration of cyst?

A

4-6 weeks later to re-assess, then few times/year

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27
Q

sx’s of fibrocystic breast disease will recur until when?

A

onset of menopause

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28
Q

fibroadenoma common in who?

A

young women (10-30 y/o)

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29
Q

if mass is detected in >30 y/o what must you rule out?

A

fibrocystic changes or cancer

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30
Q

when does fibroadenoma NOT occur after?

A

does not occur after menopause

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31
Q

sx’s of fibroadenoma?

A

have tumor-like findings

increase in size with pregnancy

regress after menopause

***painless/non-tender

***rubbery

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32
Q

is size of fibroadenoma related to menses?

A

NO!!!, but size can still change d/t hormones

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33
Q

etiology of fibroadenoma?

A

benign glandular tumor

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34
Q

dx of fibroadenoma?

A

US, mammogram, core bx

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35
Q

when do you excise fibroadenoma?

A
  • Painful/Uncomfortable
  • Becomes larger
  • There’s malignancy on core biopsy
  • If the patient is worried about not removing mass
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36
Q

how do you monitor fibroadenoma?

A

serial breast exams (clinical breast exam and self)

mammogram/US

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37
Q

ddx for fibroadenomas

A

fibrocystic

breast cancer

breast fat necrosis

breast mastitis

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38
Q

what can breast fat necrosis cause? difficult to distinguish from what?

A

a mass with nipple or skin retraction

difficult to distinguish from breast cancer

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39
Q

what is breast fat necrosis due to?

A

trauma including surgery, radiation therapy

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40
Q

dx and tx of breast fast necrosis?

A

dx = core bx

tx = excision is sometimes needed when dx is not clear

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41
Q

who does breast mastitis occur in?

A

BREAST FEEDING MOTHERS

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42
Q

offending organism in breast mastitis?

A

S. aureus

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43
Q

sx’s of breast mastitis?

A

Unilateral inflammation, erythema, mastalgia, sore nipple, engorged breast

Systemic symptoms (fever, chills)

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44
Q

tx of breast mastitis? abx?

A

Regular emptying of the breast - breast feeding or mechanical suction (KEEP BREAST FEEDING!!!)

Abx: dicloxacillin

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45
Q

complication of breast mastitis?

A

Abscess - will need to be aspirated or excised if present

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46
Q

etiology of nipple discharge?

A
  • Normal lactation
  • Benign physiologic nipple discharge
  • Pathologic nipple discharge
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47
Q

what are benign physiologic nipple discharge causes? colors of discharge?

A

Galactorrhea í further workup with endocrine studies

White, clear, yellow, green, brown, gray, blue

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48
Q

what are pathologic nipple discharge causes?

A

Benign intraductal papillomas (MOST COMMON CAUSE)

Intraductal breast cancer

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49
Q

what drugs can cause galactorrhea and gynecomastia?

A

antipsychotics

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50
Q

when have pt with nipple discharge what exam should be performed?

A

complete breast exam of all 4 breast quadrants

also LNs:

  • Subareolar area
  • Axilla
  • Supraclavicular
  • Infraclavicular
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51
Q

what else needs to be assessed on PE for nipple discharge besides breast exam and LNs? elicit what?

A

skin changes for dimpling, edema, erythema, crusting of the nipple

elicit discharge

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52
Q

what LNs need to be assessed for nipple discharge?

A
  • Subareolar area
  • Axilla
  • Supraclavicular
  • Infraclavicular
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53
Q

sx’s of benign nipple discharge?

A

Provoked, bilateral, multiductal

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54
Q

sx’s of pathologic nipple discharge?

A

Unprovoked, unilateral, uniductal, blood/blood tinged discharge (sanguineous)

associated with breast mass

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55
Q

what lab to run if unclear sanginous nipple discharge?

A

Guaiac

56
Q

labs to run for bilateral/multi-ductal nipple discharge?

A
  • Pregnancy Test
  • Prolactin Levels -> can cause galactorrhea
  • Thyroid function
57
Q

primary dx test for nipple discharge?

A

US, Mammography, Ductography

Surgical excision if imaging is negative

Core needle bx if suspicious lesion

58
Q

is cytology of discharge useful?

A

NO!!!! cytology can’t tell you if nipple discharge is worrisome

59
Q

tx for physiologic nipple discharge?

A

Reassurance, may change medications if medication induced (ex: if on antipsychotics, may need to change med)

60
Q

tx for pathologic nipple discharge?

A

Terminal duct excision (this is when duct has carcinoma)

61
Q

if determined nipple discharge is breast cancer, proceed to what?

A

breast CA management

62
Q

what is the MOST COMMON cancer in women?

A

Breast Cancer

63
Q

breast cancer risk rises at what age and peaks at what age?

A

rises in 60s and peaks in 70s and then declines

64
Q

what genetic mutations are risk factors for breast cancer?

A

BRCA 1 and/or BRCA 2 genetic mutation

ASSHKENAZI JEWISH ANCESTRY

65
Q

what family history is a risk factor for breast cancer?

A

Breast Cancer in 1st Degree Relatives

  • Esp if diagnosed ≤ pre-menopausal
  • Bilateral breast cancer
  • Risk increases with increased number of 1st degree relatives with breast cancer
66
Q

what breast characteristics are risk factors for breast cancer?

A
  • High tissue breast density
  • Proliferative fibrocystic breast disease
  • Ipsilateral breast cancer
67
Q

what gynecological hx is a risk factor for breast cancer?

A
  • early menarche
  • late menopuase
  • nulliparous
  • never breast fed
  • last 1st preg
  • recent and long-term estrogen replacement therapy
  • post-menopausal obesity
68
Q

prior what is a risk factor for breast cancer?

A

prior radiation tx to chest wall d/t prior cancer

69
Q

what does ACOG recommend about BSEs? if do BSE, when do them?

A

recommends them for high risk pts

If high risk and do BSE -> should do at the same time every month during menstrual cycle

70
Q

breast cancer screening methods?

A

BSEs (only if high risk pt)

Clinical Breast Exam (CBE)

Mammography

71
Q

when does ACOG recommend to do CBE?

A

20-39 y/o q2-3 years, annually thereafter

72
Q

screening methods for suspicious lesion on mammography?

A

US

Stereotactic bx (US guided bx)

Open Excision bx

MRI guided bx

73
Q

can non-suspicious breast mass be ruled out as benign on exam?

A

NO!!!

74
Q

what must you remember to exam on PE for breast cancer?

A

breast “tail” and axillary LNs, sternal border

75
Q

what is the Breast cancer screening METHOD OF CHOICE for asymptomatic women?

A

Mammogram

76
Q

what’s so good about Mammogram screening for breast cancer?

A

detects early cancer before symptom onset

detects cancer before LN spread in 80% of cases

detects cancer 2 years BEFORE a palpable mass is felt

77
Q

what are findings on mammogram that are suggestive of breast cancer?

A

Clusters of 5-8 microcalcifications in a linear distribution usually in one area of the breast

Soft tissue masses - e.g. speculated lesion, ill-defined lesions

78
Q

at what age is mammogram most sensitive?

A

> 50 d/t less dense, fibrotic and greater fatty breast tissue

79
Q

when do you start screening for breast cancer with mammogram?

A

age 40

80
Q

when do you stop screening for breast cancer?

A

75 y/o

81
Q

frequency of screening for breast cancer?

A

q1-2 years

82
Q

if have abnormal mammogram screening but UNCLEAR IF MALIGNANT, what do you do?

A

Dx mammogram
-mag views and spot compression views

Targeted US

83
Q

a non-palpable mass on mammogram is followed by what test?

A

US - to see if it’s cystic or solid (solid = cancer)

84
Q

any suspicious mass on mammogram screening whether palpable or non-palpable requires additional what?

A

additional screening

85
Q

if have palpable mass on screening, what’s the preferred next step?

A

core bx - helps determine surgical plan

86
Q

if have non-palpable mass on screen, what’s the next step?

A

stereotactic bx

87
Q

benign lesions of the breast are categorized into what 3 groups?

A
  • Non-proliferative
  • Proliferative w/out atypia
  • Proliferative with atypia
88
Q

tx of benign proliferative w/atypia?

A

excision bx and breast cancer chemoprevention

89
Q

what are the 2 main types of breast cancer?

A

Non-invasive type:
-ductal carcinoma in situ (DCIS)

Invasive type:
-infiltrating ductal

90
Q

sx’s of breast cancer?

A

painless, persistent mass

91
Q

suspicious sx’s of breast cancer?

A

bone pain, HA, seizures, double vision

92
Q

PE for breast cancer?

A
  • Examine all four quadrants of the breast
  • Dimpling
  • Nipple retraction

Skin changes:
-Erythematous, edema, peau d’orange

  • Assess axilla, supra and infraclavicular area
  • Assess nipple discharge
93
Q

what skin change is a sign of breast cancer?

A

peau d’orange

94
Q

what is the most useful entry in the pts clinical record for evaluation of breast cancer?

A

location and size of mass

95
Q

early sx’s of breast cancer?

A

Immobile, fixed, ill-defined margins, hard

Painless

96
Q

early breast cancer mammography abnormalities?

A

linear calcifications

97
Q

late sx’s of breast cancer?

A

fixed mass, nipple retractions, asymmetric breast enlargement or shrinkage, pain, BLOODY DISCHARGE

PEAU D’ORANGE

98
Q

what is the criteria for normal LNs?

A

movable, non-tender <5mm are usually normal

99
Q

LNs that present with what are of concern?

A

hard, immovable, >1cm may denote mets

axillary LN involvement and/or supra/infraclavicular LNs denote mets

100
Q

breast cancer staging?

A

mammogram, bx, TNM staging, biomarkers, alk phos, LFTs, CBC

101
Q

when do you do PET scan for breast cancer?

A

stage 3 or greater

102
Q

what helps determine rate of recurrence of breast cancer?

A

mammaprint or oncotype diagnostics (genomic health)

103
Q

what LNs are first targeted by breast cancer tumor invasion and tell you if you need to remove other LNs?

A

sentinel LNs

104
Q

if sentinel LNs are positive, what must be removed?

A

axillary LNs

105
Q

what tumor biomarkers is breast tissue sampled for?

A

ER, PR, and HER-2

106
Q

ER+ and PR+ respond to what tx? has better what then ER/PR - tumors?

A

hormonal tx

better prognosis

107
Q

HER-2 positive is worse than survival than?

A

ER+/PR+

108
Q

what staging status of breast cancer has a poor response to therapy?

A
  • ER and PR negative
  • Over expression of HER-2
  • Triple negative breast cancer (negative ER/PR, negative HER)
  • Poor general health
  • Positive LNs
109
Q

tx for breast cancer is what type of approach?

A

multidisciplinary approach

110
Q

surgery options for breast cancer tx?

A

lumpectomy, radical mastectomy, modified radical mastectomy, simple masectomy

111
Q

lumpectomy is C/I when?

A

> 2 tumors in different quadrants, large tumor, persistently positive margins, diffuse cancer

112
Q

difference b/w radical mastectomy and modified radical mastectomy?

A

radical mastectomy removes muscles around mass and LNs

modified radical mastectomy removes breast tissue and LNs but spares musculature

113
Q

when after surgery do you do radiation therapy for tx of breast cancer? indications?

A

5-7 weeks after surgery

indications:

  • Breast conserving surgery
  • Large tumors >5cm
  • +LN involvement
114
Q

what are the indications for hormone tx for breast cancer?

A

ER/PR+

115
Q

hormone therapy options for tx of breast cancer?

A

Tamoxifen (SERM - anti estrogen in the breast)

aromatase inhibitors (anastrozole, exemestane, letrozole)

116
Q

how long is Tamoxifen given? used in who?

A

10 years or may do 5 year then switch to aromatase inhibitors

used in pre-menopausal women

117
Q

adrs of Tamoxifen?

A

DVT, uterine cancer

118
Q

what hormone therapy drug is superior to Tamoxifen (SERM)? given for how long?

A

Aromatase inhibitors

given for 5 years

119
Q

adrs of aromatase inhibitors? C/I in who?

A

bone loss, myalgia, and arthalgias

C/I in pre-menopausal women

120
Q

what are the targeted therapy indications for tx of breast cancer? what is the targeted therapy?

A

HER+

targeted therapy = Trastuzumab (Herceptin)

121
Q

Herceptin is given with what?

A

conventional chemo

122
Q

who must you be cautious with when giving Herceptin?

A

cardiac disease pts b/c increases risk of CHF 5x

123
Q

when is adjuvant chemo offered for tx?

A

after surgery, before radiation

124
Q

results of adjuvant chemo is best in what women?

A

LN positive women (metastatic breast cancer)

125
Q

indications for adjuvant chemo?

A

LN positive, ER/PR negative, triple negative, HER-2+

126
Q

when is neoadjuvant chemo given?

A

before surgery

127
Q

if HER2+ what’s the tx? if HER2- what’s the tx?

A

If HER-2 positive then get chemo and Herceptin, if negative, then only get chemo

128
Q

what is a common adr of chemo drugs?

A

peripheral neuropathy

129
Q

what is the only tx option for triple negative breast cancer pts?

A

chemotherapy

130
Q

when should pts be referred for hospice?

A

when prognosis is <6 months

131
Q

prognosis of male breast cancer?

A

poorer prognosis than women b/c present with metastatic disease

132
Q

sx of male breast cancer?

A

same as female breast cancer, but includes gynecomastia

133
Q

tx for male breast cancer?

A

modified mastectomy followed by radiation therapy

hormonal therapy: tumors are usually ER positive (Tamoxifen)

chemotherapy

134
Q

most important tx for male breast cancer?

A

hormonal therapy with Tamoxifen

135
Q

sx’s of metastatic breast cancer?

A

seizures, HA’s, back pain, spontaneous bone fractures, dyspnea, cough, hypercalcemia

Clin Med 3 - Exam 3 (Women's Health) (9 decks)

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