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Breast Disorders Flashcards

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1
Q

3 components of breast anatomy

A

Skin
Subcut. tissue
Breast tissue

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2
Q

What are the 2 components of breast tissue

A

Epithelial

Stromal

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3
Q

When performing the breast exam what body parts are examined

A

breast
neck
chest wall
axillae

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4
Q

What days are ideal to perform a breast exam

A

Ideally performed 7-9 days after onset of menses

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5
Q

What are the 2 components of performing breast exams

A

inspection

palpation

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6
Q

What are different positions to have women in during breast exam?

What are you examining

A

Upright
Hands above head
Hands on side
Leaning forward

Skin retractions

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7
Q

What are abnormalities during a breast exam

A 
Asymmetry
Skin changes
Nipple asymmetry
Nipple inversion or retraction
Nipple discharge or crusting
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8
Q

What are the 2 positions to have women in on an exam table while doing breast exams

A

Sitting upright

Supine

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9
Q

What lymph nodes do you palpate on breast exam

A

axillary
supraclavicular
infraclavicular
cervical (anterior and posterior)

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10
Q

What screening is recommended for breast exams

A

mammogram

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11
Q

What is BI-RADS grading system criteria

A

0: incomplete (not a good enough review)
1: Negative (routine f/u)
2: Benign (routine f/u)
3: Probably benign (short-interval f/u)

4: Suspicious
4A: Low suspicion for malignancy
4B: Moderate suspicion for malignancy
4C: High suspicion for malignancy

5: Highly suggestive of malignancy
6: Known biopsy-proven malignancy

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12
Q

Who are ultrasounds reserved for during breast screenings?

A

Initial study young, low-risk woman with suspected fibroadenoma

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13
Q

Who are MRI with IV gadolinium dye reserved for during breast screenings?

What is a concern about using these

A

High risk women

***but high false positive rate

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14
Q

What population are fibroadenomas most seen in?

Which race is this most frequent in

A

Young women
More frequent in black women
Usually a solitary mass

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15
Q

How are fibroadenomas diagnosed

A

Core needle biopsy

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16
Q

Treatment for Fribroadenomas?

A

Excision

Conservative treatment with monitoring

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17
Q

What are Phyllodes tumor and where do they originate from?

A

Large fibroadenoma that grows rapidly

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18
Q

What is the ideal treatment for Phyllodes tumor?

A

Excision

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19
Q

What is the MC breast lesion

A

Fibrocystic conditions

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20
Q

What age group do fibrocystic conditions occur in?

A

Age 30-50

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21
Q

Clinical presentation of Fibroadenomas

A 
Round or ovoid, 1-5 cm
Rubbery 
Discrete
Movable 
Non-tender
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22
Q

What hormone can cause fibrocystic conditions?

What can cause an increased risk of Fibrocystic conditions?

A

Estrogen dependent

Alcohol use

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23
Q

Clinical presentations of Fibrocystic changes?

A 
PAINFUL
Tender
Multiple cysts
Bilateral 
Rapid changes in size 
Nodular "rope" breast tissue
Mobile
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24
Q

Diagnosis of Fibrocystic changes?

A

Mammogram and/or ultrasound

FNA

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25
Treatment for Fibrocystic changes
Breast support Will subside with menopause Evening primrose oil? Low fat diet? Avoid caffeine? Vitamin E?
26
MC female cancer in U.S?
Breast cancer
27
Which genes are associated with breast cancers?
BRCA1/BRCA2 genes
28
What are HIGH risk factors for Breast cancer
Personal/Family history of ovarian, peritoneal or breast cancer BRCA 1/2 genes Radiotherapy to chest between ages 10-30
29
Protective factors for breast cancer
``` Breastfeeding Higher parity Physical activity Oophorectomy ≤ 35 y/o Aspirin use ```
30
What screenings are recommended to det. risk of breast cancer in Average risk women?
Gail model calculator
31
General screening guidelines for high risk patients
Annual screening mammogram, starting at age 25 (or 5-10 years before age of diagnosis in affected relative) Supplemental screening breast MRI Scheduled 6 months apart
32
What percent likely does postivie BRCA1 indicate for breast cancers
65% risk of breast cancer by age 70
33
A positive BRCA2 indicates what percent likely of breast cancer
45% of breast cancer by age 70
34
USPSTF recommendations for breast cancer screenings
Age 40-49, individualize (grade C) Every 2 years, age 50-74 (grade B)
35
ACOG recommendations for breast cancer
Age 40-49, shared decision making Recommend at age 50-74 Every 1-2 years ≥ age 75, shared decision making
36
Which type of carcinomas are the MC type of breast cancer?
Infiltrating ductal carcinomas
37
MC subtype of breast carcinomas
Luminal A/Luminal B ***Estrogen-positive cancers
38
What are Ductual carcinoas in situ?
Neoplastic lesions confined to breast ducts and lobules
39
What are skin changes associated with breast cancers
Erythema Thickening Dimpling (pea d'orange)
40
What are signs and symptoms of a metastasized breast cancer
``` Back/leg pain Abdominal pain nausea jaundice SOB cough ```
41
How do breast cancers first present?
majority presents due to abnormal mamograms
42
What imaging is preferred to diagnose breast cancer? What findings suggest BC?
Mammogram – soft tissue mass/density and clustered microcalcifications ***Spiculated soft tissue mass
43
What treatment is preferred for breast cancers
Lumpectomy + radiation therapy (“breast conservation therapy”)
44
What medications can you use for Estrogen postive breast cancers
Tamoxifen or Raloxifene
45
What is a side effect of taking Trastuzumab for HER-2 cancers?
heart failure, respiratory problems, life-threatening allergic reactions
46
Follow up recommendations for Breast cancer treatments
Every 3-6 months x 2 years, then annually Annual mammogram and CBE indefinitely
47
What is the classic characterisitic of Inflammatory Breast cancer?
Diffuse erythema and edema (peau d'orange)
48
Clinical presentation for IBC?
Rapid presentation | breast pain
49
How are IBC diagnosed
Full-thickness skin punch biopsy Dermal lymphatic invasion by tumor cells
50
Treatment for IBC
Chemotherapy followed by mastectomy with axillary node dissection and post-mastectomy radiation
51
How can Pagets Disease of the breast be characterized as?
scaly, raw, vesicular or ulcerated lesion that begins on the nipple and spreads to the areola
52
Clinical presentation of Pagets disease of breast
Unilateral Bloody disharge Pain, burning, and pruritis***
53
Diagnosis of PDB?
Full thickness wedge or punch biopsy of the nipple Bilateral mammogram
54
Treatment of PDB
Mastectomy or BCT followed by radiation
55
Causes of Nipple disharge
``` Usually benign Early endocrine dysfunction – hyperprolactinemia, hypothyroidism Medications – OCPs, tricyclics, antipsychotics Cancer – 5-15% ```
56
What would indicate nipple discharge from fibrocystic changes
Non-bloody Bilateral Green, yellow, or brown; sticky
57
What would indicate Milky, bilateral nipple discharge
Endocrine/Meds
58
What would indicate purulent nipple discharge
Infections
59
Bloody nipple discharge would indicate what?
breast cancer
60
labs needed to diagnose nipple disharge
HCG Prolactin Renal tests Thyroid function tests
61
Treatment for nipple discharge
If medication related, reassurance Terminal ductal excision If malignancy, appropriate cancer surgery
62
What is the causative organism of mastitis What is the main cause of Mastitis?
S. aureus Can be hospital acquired infection Disrupted flow of milk causing engorgement Infection of the infant
63
Treatment for Mastitis?
Continue breastfeeding or use breast pump Local heat
64
What antibiotics can be used to treat Mastitis?
Dicloxacillin 500 mg po QID Cephalexin 500 mg po QID BOTH CAN BE 1st Line Alternatively, clindamycin 300 mg po TID
65
MC pathogen that causes abscess of the breast? How else can it be caused?
S. aureus Secondary to untreated or refractory to treatment mastitis or cellulitis
66
Diagnosis for beast abcess?
Clinical findings and ultrasound Breast milk cultures +/- blood cultures
67
Treatment for Breast abscess?
Drainage and antibiotics Ultrasound guided needle aspiration or surgical drainage (I&D)
68
What are pathological reasons for Gynecomastia
Drugs (estrogens) Hypogonadism tumors
69
Treatment for Gynecomastia?
Regresses spontaneously in > 70% of patients after 1 year Rare regression if persists over 1 year or after age 17 Psychotherapy as needed Consider surgery

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