Breast disorders Flashcards
(42 cards)
When is a breast exam best done?
5-7 days after menstruation
always, always utilize different positions and movement
What are breast imaging techniques?
Mammogram/XR
US for cyst or solid lesions
MRI Is NOT ROUTINE
What are pathology techniques for the breast?
FNA for cell analysis
**core biopsy –> small tissue analysis
open/excisional biopsy for a larger tissue analysis
What are the mammogram recommendations?
biennial screening mammography for women 40-74
What are the high-risk mammogram recommendations?
clinical encounter every 6-12 months from point of risk identification with additional genetic counseling and breast awareness
start screening with MRI at age 25 years or 10 years before youngest affected family member (but not <25) and start mammogram at 30 (not before) or 10 years before youngest affected family member
annually!
continued for as long as woman is in good health
any suspicious mass requires what?
mammogram –> biopsy
What genes are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer?
BRCA1/2 gene
What’s the most common location of breast cancer?
upper right quadrant in axillary area
Painful breast mass with fluctuation of mass size, commonly with multiple lesions
Worse during pre-menstruation as cysts get larger
Potential nipple discharge
fibrocystic condition
What are RF for fibrocystic conditions?
Women 30-50
Postmenopausal women with HRT
Estrogen use
Alcohol use
Microscopically: cysts, adenosis-lobules larger than usual, fibrosis
Ductal epithelial hyperplasia
Papillomatosis
(increase risk of breast cancer)
<30 + consistent with dx → US
If unsure after US → biopsy
>30 → mammography + US
Rare for need of excisional biopsy
Dominant mass and/or other concerning signs → US or mammogram + biopsy
fibrocystic conditions
how do you treat fibrocystic conditions?
Avoid trauma, wear a good bra, decrease fat intake, (no caffeine, tea, chocolate), vitamin E
No clear medications: oil of evening primrose, danazol for severe pain
Cyst aspiration can reduce pain and confirm diagnosis
– if no fluid collected or bloody, persistent, recurrence → biopsy
Round or ovoid, rubbery, discrete, movable, non-tender, 1-5cm
Often incidental finding
Does NOT change significantly with menstruation
fibroadenoma
fibroadenomas are more common in what age group?
w/n 20 years of puberty
fibroadenomas are: benign/malignant
benign
Imaging (mammogram or US based on signs and age) → core needle biopsy
– fibrous tissue + collagen array in “swirl”
fibroadenoma
how do you treat a fibroadenoma?
No treatment generally needed
Uncertain diagnosis or lesion continues to grow, >3-4cm = excision
Non-lactating breast –
Bilateral + non-bloody = physiologic
Single duct has a higher chance of being malignant:
Spontaneous, unilateral, serous, serosanguinous discharge (duct ectasia, papilloma, intraductal cancer) = pathologic
galactorrhea
Generally benign - duct ectasia, intraductal papilloma, carcinoma
LOTS of drugs can cause this - dopamine inhibitors (opioids, OCPs, anti-HTN, antidepressants/psychotics)
Elevated prolactin → endocrine disorder, CKD, liver
galactorrhea
If routine screening mammography UTD → stop med and see if discharge stops
PE: try to find affected duct with pressure around areola
LABS: test discharge, thyroid, prolactin, pregnancy
IMAGING:
<30 = US
>30 = mammogram + US
galactorrhea
how do you treat galactorrhea?
If no localization, mass, blood, normal med eval → examine every 3-4 months + order mammogram and US
Stop medication and see if discharge stops
Bloody = excise (even if no mass present)
Single duct → refer to surgeon for evaluation
what are symptoms worrisome for malignancy in gynecomastia?
asymmetry, location not immediately below areola, unusual firmness, nipple retraction, bleeding or discharge
PE: distinguish true glandular (tender) from softer fat (diffuse and nontender), testes, penis
Pubertal = tender discoid enlargement 2-3 cm below areola
LABS: liver, renal function
Endocrine testing, prolactin, serum beta-hCG and estradiol to screen for malignancy
→beta-hCG levels = testicular tumor or malignancy
Karyotype for Klinefelter syndrome
Unclear cases require bilateral mammography + chest CT
Suspicious mammogram → US-guided FNA
High serum hCG or estradiol ⇒ confirm with repeated testing ⇒ testicular US, if normal ⇒ CT of adrenal glands, others if needed
gynecomastia
how do you treat gynecomastia?
Pubertal gynecomastia generally resolves spontaneously in 1-3 year
Drug induced resolves within months once offending drug is removed
SERM therapy for true glandular gynecomastia = raloxifene
Aromatase inhibitor - anastrozole
Testosterone therapy for those with hypogonadism
Surgery for persistent or severe
