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Foundations III-Women's Health > Breast Disorders > Flashcards

Breast Disorders Flashcards

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1
Q

What are the 3 components of the breast?

A

Skin
Subcutaneous tissue
Breast tissue (epithelial elements and stromal elements)

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2
Q

Ideally, when should you perform a breast exam? What are the 2 components of the breast exam?

A

7-9 days after onset of menses

inspection & palpitation

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3
Q

What are some abnormalities that may be seen on breast inspection?

A 
Asymmetry
Skin changes
Nipple asymmetry
Nipple inversion or retraction
Nipple discharge or crusting
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4
Q

When should you order a mammogram?

A

for screening

dx- initial study for new, palpable breast mass

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5
Q

What is evaluated in BI-RADS for mammogram?

A 
Shape
Margin
Orientation
Echogenicity
Homogeneity
Attenuation
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6
Q

BI-RADS scoring?

A

0: incomplete
1: negative
2: benign
3: probably benign
4: suspicious A-C
5: highly suggestive or malignancy
6: known biopsy proven malignancy

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7
Q

FU for pts with BI-RADS 1 or 2?

A

routine FU annual screening if 40 or older

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8
Q

FU for pts with BI-RADS score or 3?

A

probably benign

FU in 6 months for repeat mammogram

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9
Q

FU for pts with BI-RADS score of 4/5

A

biopsy to determine further work up

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10
Q

What is the initial study for young, low risk women with suspected fibroadenoma? Wha can be used for screening in high risk women?

A

US

MRI

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11
Q

What is a targeted US?

A

Palpable mass evaluation

Concurrent with diagnostic mammogram

Solid vs. cystic vs. mixed

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12
Q

What other diagnostic studies may be used to evaluated breast tissue?

A

breast tomosyntesis: 3D xray

Molecular breast imaging

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13
Q

What kind of breast biopsies can you perform?

A

skin punch biopsy

FNA > simple cysts

core needle biopsy > complex masses

surgical biopsy

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14
Q

Which pts are fibroadenomas usually seen in?

A

Young women

More frequent in black women

Usually a solitary mass

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15
Q

Presentation for fibroadenoma?

A

Round or ovoid, 1-5 cm

Rubbery

Discrete

Movable

Non-tender

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16
Q

How can you dx a fibroadenoma?

A

core needle biopsy

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17
Q

Tx for fibroadenoma?

A

Excision

Conservative treatment with monitoring

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18
Q

What is a phyllodes tumor?

A

Large fibroadenoma that grows rapidly

can be benign, borderline or malignant

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19
Q

Tx for phyllodes tumor

A

excision required

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20
Q

What is the MC breast lesion?

A

fibrocystic changes

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21
Q

Fibrocystic changes are most commonly seen in women…. y/o

A

30-50

increased risk with alcohol use

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22
Q

Fibrocystic changes are…dependent

A

estrogen

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23
Q

Clinical presentation for fibrocystic changes?

A

Painful, Multiple, usually bilateral

Rapid changes in size and appearance

Nodular breast tissue
Mobile
Tender

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24
Q

How can you dx fibrocystic changes?

A

mammogram and/or US

FNA

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25
Tx for fibrocystic changes
breast support +/- evening primrose oil, low fat diet, avoid caffeine, Vit E will subside with menopause
26
Risk factors for breast CA?
BRCA1/BRCA2 genes Personal and/or family history ovarian, peritoneal or breast cancer Radiotherapy to chest b/t age 10-30 Others: age, white race, postmenopausal obesity, tall stature, high estrogen levels, nulliparity, higher bone density, alcohol, smoking, DES exposure
27
Protective factors for breast CA?
``` Breastfeeding Higher parity Physical activity Oophorectomy ≤ 35 y/o Aspirin use ```
28
What screening tool can you use to determine risk of breast CA for average risk women?
Gail model if higher than 1.67 considered higher risk
29
USPSTF guidelines for mammogram in average risk women?
Age 40-49, individualize (grade C) Every 2 years, age 50-74 (grade B)
30
ACOG guidelines for mammogram in average risk women?
Age 40-49, shared decision making Recommend at age 50-74 Every 1-2 years ≥ age 75, shared decision making
31
screening guidelines for higher risk pts?
annual mammogram starting at 25 (or 5-10 yrs before dx of relative) supplemental breast MRI -6 months apart
32
Genetic testing in breast CA?
refer to genetic counselor if possible BRCA mutation carriers (Blood, saliva, buccal mucosa samples) BRCA1: 65% risk of breast cancer by age 70 BRCA2: 45% risk of breast cancer by age 70 other genes: ATM, CHEK2, PALB2
33
Who should undergo genetic testing for breast CA?
Any relative with BRCA 1 or 2 mutation Breast CA before age 50 Bilateral breast cancer Breast & ovarian CA in same woman or same family Multiple breast CA in same family 2+ primary types of BRCA 1 or 2 related cancers in single family member Male breast cancer Ashkenazi Jewish ethnicity
34
What is ductal carcinoma in situ?
Neoplastic lesions confined to breast ducts and lobules
35
What stage is DCIS?
always stage 0! confined within ducts
36
Px of DCIS?
excellent! 3% 20 yr mortality
37
What is the MC type of breast CA?
infiltrating ductal carcinoma?
38
Infiltrating ductal carcinoma arises from?
epithelial lining of the large or intermediate-sized ducts
39
Infiltrating lobular carcinoma arises from?
epithelium of the terminal ducts of the lobules
40
What are the molecular subtype of breast cancers?
Luminal A/B HER2-enriched Basal "triple negative) -ER/PE/HER2 neg
41
breast CA presentation
most due to abn. mammogram breast/axillary mass +/- skin changes -erythema, thickening, dimpling with metastasis -back/leg pain, abn pain, nausea, jaundice, SOB
42
Work up for breast CA?
Mammogram -spiculated soft tissue mass** US -solid v. cystic, vascular supply MRI Bx Liver enzymes
43
What imaging should you order to eval for metastasis?
Bone scan / MRI CT abdomen Abdominal MRI or U/S or PET-CT Chest CT / CXR
44
Tx for Breast CA?
Surg: - Lumpectomy + radiation therapy (breast conservation) - Mastectomy - Modified radical mastectomy - breast reconstruction
45
Medical therapy options for breast CA?
chemo + estrogen antagonists - Tamoxifen or Raloxifine for ER + cancers (take 5 yrs post surg) - Aromatase inhibitors - Trastuzumab: for HER-2 cancers
46
Follow up after breast CA tx?
Every 3-6 months x 2 years, then annually Annual mammogram and CBE indefinitely Most recurrences are within 5 years
47
Prophylactic options for BRCA 1 or 2 carriers without personal hx of CA?
BSO btwn 35-40 and done childbearing intensive screening chemoprevention with Tamoxifen
48
Which pts are most likely to get inflammatory breast CA (IBC) ?
black women rare invasive breast CA, highly aggressive
49
Presentation of IBC?
diffuse dermatologic erythema and edema (peau d’orange) ``` rapid presentation +/- mass Breast pain Tender, firm, or enlarged breast Itching of the breast Lymph node involvement 1/3 have distant metastasis ```
50
Pathology of IBC?
lymphedema caused by tumor emboli within the dermal lymphatics
51
Dx of IBC?
**Full-thickness skin punch biopsy: Dermal lymphatic invasion by tumor cells mammogram, lymph node US, core needle biopsy
52
Tx for IBC?
chemo followed by mastectomy with axillary node dissection and post mastectomy radiation poor px
53
Peak incidence of Paget disease of the breast (PDB)?
50-60 y/o
54
Presentation of PDB?
usually unilateral, occasional bloody DC, pain/burning and or pruritus scaly, raw, vesicular or ulcerated lesion that begins on the nipple and spreads to the areola
55
Pathology of PDB?
malignant, intraepithelial adenocarcinoma cells (Paget cells) occurring singly or in small groups within the epidermis of the nipple
56
Dx of PDB?
Full thickness wedge or punch biopsy of the nipple Bilateral mammogram
57
tx of PDB?
Mastectomy or BCT followed by radiation px with mass: 5 yr 20-60% w/out mass: 5 yr 75-100%
58
causes of nipple DC?
Usually benign Early endocrine dysfunction – hyperprolactinemia, hypothyroidism Meds – OCPs, tricyclics, antipsychotics Cancer – 5-15%
59
Nipple DC seen with fibrocystic changes of ductal ectasia?
Non-spontaneous Non-bloody Bilateral Green, yellow, or brown; sticky
60
Nipple DC seen with endocrine/meds?
Milky, bilateral, multiple ducts
61
Nipple DC seen with infectious cause?
purulent
62
What should make you worried about nipple DC?
Spontaneous Bloody Unilateral, uniductal Associated with a mass
63
Work up for nipple DC?
US, mammogram if >30 ductography MRI, MR ductography labs: HCG, PRL, renal tests, thyroid tests
64
Tx for nipple DC?
If medication related, reassurance Terminal ductal excision If malignancy, appropriate cancer surgery
65
Who is mastitis usually seen in?
primiparous nursing patient
66
Organism seen in mastitis? Causes?
s. aureus Can be hospital acquired infection Disrupted flow of milk causing engorgement Infection of the infant
67
Can mastitis occur in pt who is not lactating?
YES Periductal mastitis Idiopathic granulomatous mastitis
68
Presentation of mastitis?
Fever, Swelling, Painful, erythematous lobule in outer breast quadrant +/- other systemic symptoms +/- axillary lymphadenopathy
69
Dx for mastitis?
clinical! if refractory tx --> US
70
Tx for mastitis?
Continue breastfeeding or use breast pump Local heat Breast support Abx Monitor for abscess
71
What abx can you use for tx of mastitis?
Dicloxacillin 500 mg po QID Cephalexin 500 mg po QID Alternatively, clindamycin 300 mg po TID
72
Describe a breast abscess. What causes this?
Localized collection of pus in the breast tissue Secondary to untreated or refractory to treatment mastitis or cellulitis
73
Risk factors for breast abscess?
age > 30 years primiparity gestational age ≥ 41 weeks tobacco use
74
Presentation of breast abscess?
Localized, painful inflammation Fluctuant, tender, palpable mass Fever, malaise
75
Dx of breast abscess?
clinical findings & US breast milk US +/- blood cx
76
Tx of breast abscess?
I&D abx
77
What is physiologic gynecomastia?
Benign proliferation of glandular breast tissue in males Symmetrically distributed around areolar-nipple complex can be tender, usually bilateral
78
What can cause pathologic gynecosmatia?
drugs-exogenous estrogen hypogonadism tumors
79
What drugs are assoc. with gynecomastia?
``` Estrogens Spironolactone Cimetidine Ketoconazole Growth hormone Gonadotropins Antiandrogen therapies 5-alpha-reductase inhibitors ``` lots more!
80
Presentation of gynecomastia?
Mass or lump behind nipple Gradual enlargement ≤ 4 cm diameter Tender for about 6 months then gradually resolves
81
What should be included in PE for gynecomastia?
thyroid, abdomen, and genitalia at a minimum
82
dx of gynecomastia
usually clinical if pathologic: +/- HCG, testosertone, LH, DHEA, peds endo
83
Tx fo physiologic gynceomastia?
regress spontaneously in >70% +/- psychotherapy, surg
84
Tx for pathologic gynecomastia?
depends on etiology

Foundations III-Women's Health (13 decks)

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