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Breast Disorders Flashcards

(56 cards)

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1
Q

Incidence of breast cancer

A

1 in 8

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2
Q

Breast cancer screening?

A

Screen every 2-3 years from 20-39
Initial mammogram at 40 w/ repeat every 1-2 years 40-50; all over 50 should receive annual mammogram

High risk need 2x year screening starting at 25, initial mammogram at 30, yearly starting at 40

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3
Q

Breast cancer risk factors?

A
  • One or more first-degree relatives w/ breast cancer
  • Older age = greater risk
  • Personal hx of breast cancer, ovarian cancer, endometrial cancer
  • Obesity, postmenopausal
  • Hx of fibrocystic disease
  • Single > married, white, early menarche, late menopause
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4
Q

BRCA1 or BRCA2 associated w/ ovarian cancer?

A

BRCA1

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5
Q

Risks of mammography

A

Radiation and false (-) results (7-20%)

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6
Q

Classifications of mammography abnormalities?

A

Masses, Asymmetric densities, Microcalcifications

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7
Q

BI-RADS?

A 
0 - Needs additional eval
1 - Normal
2 - Benign, routine screening
3 - Probably benign, short initial f/u
4 - Suspicious - bx
5 - Highly suggestive of malignancy
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8
Q

1 cm non-palpable suspected DCIS. Next step?

A

Magnification mammography –> stereotactic core needle bx

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9
Q

If mass highly suspicious for malignancy what might be a better test than stereotactic needle bx?

A

Needle localization and open bx as it allows complete excision

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10
Q

DCIS manifestation on mammogram?

A

Incidental microcalcifications, possibly a mass … often multifocal

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11
Q

Can DCIS be infiltrative?

A

10-20%

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12
Q

Which form of DCIS has higher malignant potential

A

Comedo pattern (30% invasive)

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13
Q

Tx of diffuse/multicentric DCIS?

A

Simple mastectomy

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14
Q

Tx of smaller DCIS?

A

Wide excision and radiotherapy w/ pathology free margins

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15
Q

Effect of radiotherapy on DCIS

A

Local recurrence falls to 22% w/ wide excision and radiation. 4% w/ simple mastectomy over 10 yr period

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16
Q

Are nodal mets common w/ DCIS?

A

No, so nodal dissection not necessary except in comedo type an axillary SLNBx may be ok

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17
Q

LCIS or DCIS presenting younger?

A

LCIS

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18
Q

LCIS or DCIS more likely to be bilateral?

A

LCIS

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19
Q

Presentation of LCIS?

A

Incidental finding w/out mass, not usually visible on mammography

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20
Q

Risk of axillary mets in LCIS?

A

Very rare

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21
Q

Tx of LCIS?

A

Close observation w/ exam and mammography every 6 mo for several years

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22
Q

Presentation of sclerosing adenosis?

A

Clustered microcalcifications that can appear similar to invasive tubular carcinoma. Routine f/u

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23
Q

Associated risk of cancer in Atypical ductal hyperplasia?

24
Q

Dx of Atypical ductal hyperplasia

Study These Flashcards
A

Needle localization and excision

25
Suspected carcinoma: Work up?
Mammogram, US if cystic, aspiration if painful or enlarging, bx if solid (core needle or open)
26
40 yo menstruating woman w/ mass. Change in work-up? 28 yo woman?
No, any mass 35-60 is cancer until proven otherwise. Higher incidence of benign and greater risk of radiation from mammography, US may be appropriate initial study (98% fibroadenoma)
27
Woman w/ "lumpy breasts" that are tender prior to menstrual periods.
Fibrocystic disease and is usually bilateral.
28
Causes of fibrocystic disease. Malignancy risk? Management?
Estrogen sensitivity or dec. progesterone activity. Low risk but w/ atypia that increases. Can aspirate cysts if sxic.
29
14 cm lesion ... ? Malignancy risk?
Phyllodes tumor (giant cell fibroadenoma). Tumor behavior and an increased number of mitoses.
30
Clear nipple discharge from multiple ducts?
More likely to be fibrocystic disease
31
MCC of bloody nipple discharge?
Intraductal papilloma --> requires surgical bx, mammography, possible ductogram (radiographic dye) and should be excised
32
Staging DCIS
Mammogram, bx
33
Prophylactic lumpectomy in LCIS?
Doesn't make sense as LCIS inc. risk of breast cancer by ~1% each year. Bilateral mastectomy would be more likely.
34
Management of LCIS?
Observe, Q6 mo clinical exam, annual mammography, MRI?, Tamoxifen cuts risk by 56%
35
Paget's disease of breast? Dx?
DCIS spreading out through nipple causing ulceration. Punch bx.
36
DCIS tx? SLNBx?
1. Partial mastectomy + RADIATION +/- Tamoxifen - Appropriate for solitary tumor < 5 cm - Axillary node sampling 2. Total mastectomy +/- reconstruction + radiation SLNBx for mastectomy only
37
Favorable Histologic Types?
Tubular, papillary, mucinous, Paget's, presence of estrogen receptors
38
Less favorable histologic types?
Infiltrating ductal, infiltrating lobular, medullary, inflammatory
39
Supraclavicular node positive?
Stage IV disease
40
T staging
``` T1 = < 2 cm T2 = 2-5 cm T3 = > 5 cm T4 = any size w/ direct extension to chest wall or skin ```
41
N staging
``` 0 = no palpable nodes 1 = mets to movable nodes 2 = fixed, matted nodes ```
42
M staging
``` 0 = no distant mets 1 = Distant mets including supraclavicular ```
43
Clinical Stage I ... Dx
T1 N0 M0 --> SLNBx (Te99 injection), Lumpectomy
44
Clincal Stage II
T2 N1 M0
45
Clinical Stage III
T3 N1/2 M0
46
Clinical Stage IV
Any T Any N M1
47
Level I nodes
Lateral (axillary), Posterior (subscapular), Anterior (external mammary)
48
TRAM flap?
Trans Rectus Abdominus Muscle ... not successful in smokers or obese pts
49
Stage III and IV tx
Staging --> Neoadjuvant (pre-surgery) chemo beneficial in Stage III Stage IV surgery only for local control
50
Inflammatory breast cancer tx
Neoadjuvant chemo, modified radical mastectomy, adjuvant chemo, hormonal therapy, radiation
51
Development of coma input w/ hx of breast cancer
Hypercalcemia due to bony met and PTHrP should be highly considered
52
Breast cancer in pregnancy tx
Stage I/II mastectomy/lumpectomy is safe w/ radiation after delivery of child if lumpectomy. Mastectomy would not require radiation Stage III/IV needs rapid chemoradiation which may require abortion
53
Breast mass in a man
Bilateral mammogram, mastectomy w/ post-op radiation. Typically > 60 yrs old and survival about the same, though tend to present at later stage
54
Gynecomastia
Adolescents and 40-50 and resolves spontaneously in adolescents. Older men usually due to medications (diuretics, estrogens, isoniazid, marijuana, digoxin, alcohol
55
Invasive lobular carcinoma tx
Total mastectomy + SLNBx
56
Invasive ductal
Adjuvant therapy if > 1 cm, hormonal therapy

Surgery (7 decks)

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