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Clin Med- P > breast disorders/breast cancer > Flashcards

breast disorders/breast cancer Flashcards

1
Q

usual age of breast development?

A

10-12 years

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2
Q

lobule development in the breasts evident when ?

A

1-2 years after menses

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3
Q

tanner stages 1-5

A
  1. no glandular tissue, flat areola
  2. breast bud, wider areola
  3. breast fills, widens beyond areola
  4. increased size, areola& papilla form second mound (elevated)
  5. final adult size, areola flattens again against breast, projecting central papilla
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4
Q

what is “witch’s milk”?

A

Neonatal production of milk
First 2 hours to 2 days of life
Due to influence of maternal hormones

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5
Q

self breast exams useful? what does ACOG recommend?

A

low sensitivity and detectability BUT Despite this, breast self exam has potential to detect palpable breast cancer
ACOG encourages “breast self-awareness” for women ages 20 and older.

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6
Q

if youre going to do it, when should self breast exam be performed? why?

A

5-9 days after menses, when estrogen is lowest (follicular phase) . B/c in luteal phase, ducts are engorged and it may be harder to feel a lump

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7
Q

ACOG recommends clinical breast exams when?

A

every 3 years age 20-39, every year age 40+

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8
Q

clinical breast exam: If mass palpated, what should you tell the pt to do? why?

A

pt should put hands on her hips to help determine fixation

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9
Q

inspect breasts in ___ and ___ position

A

upright and supine

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10
Q

Breast CA most often found in what quadrant?

A

upper outer quadrant

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11
Q

mastitis: what is it? cause?

A

Usually breast-feeding

Sudden onset of pain and symptoms of inflammation and infection (induration, tenderness, warmth)

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12
Q

txt for mastitis

A

Antibiotics, warm compresses and
KEEP BREASTFEEDING!
Abx: depends on if its MRSA or not..

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13
Q

Abx for Postpartum mastitis and NO MRSA or abscess

A

Dicloxacillin 500 mg QID or Cephalexin 500 mg QID

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14
Q

Abx for postpartum mastitis and POSITIVE MRSA

A

Bactrim DS 1-2 tabs PO BID or Clindamycin 300 mg TID

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15
Q

what is mastalgia/mastodynia (breast pain): likely cause?

A

Usually not cancer

  1. Common- fibrocystic changes
  2. Hormonal changes: if cyclic pain
  3. just large, pendulous breasts not appropriately supported
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16
Q

txt for breast pain (mastalgia/mastodynia)

A

supportive bras (avoid underwire), decrease caffeine, can try evening primrose oil or Vit E

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17
Q

what is galactorrhea? what can cause this? (5)

A

milk production when not breast feeding

idiopathic, chronic breast stimulation, steroids, metabolic/hormonal, pituitary tumor

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18
Q

galactorrhea evaluation (3)

A
  1. Analyze the milky discharge checking for fat droplets
  2. B-HCG, prolactin levels, and TSH
  3. Mammogram, US, MRI as indicated
    to evaluate for a pituitary tumor (20% of cases)
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19
Q

those with galactorrhea from a pituitary tumor may have amenorrhea why?

A

highest serum prolactin levels

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20
Q

what is abnormal nipple discharge normally from?

A
  • Usually solitary papilloma; can be DCIS (ductal caricinoma in situ)
  • fibrocystic changes
  • papillomatosis (benign growths)
  • breast cancer or duct ectasia
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21
Q

bilateral discharge, is it worrisome?

A

NO, as long as theres no blood

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22
Q

lots of bloody discharge from nipple, what do you need to do?

A

sent for cytology

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23
Q

what is the likely cause of each?

  1. Straw-colored, clear
  2. Grossly bloody
  3. Staining of the bra, without discharge
A
  1. Straw-colored, clear- usually papilloma
  2. Grossly bloody- lesion in the duct- DCIS, fibrocystic change or papilloma
  3. Staining of the bra, without discharge- Paget’s disease
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24
Q

intraductal papilloma: who most commonly gets these? symptoms?palpable? what do you need to do to rule out cancer?

A
  • growth in the duct
  • Most common around perimenopause
  • Rarely palpable, but can cause bloody, serous or turbid d/c
  • Excision of the duct should be done to help differentiate from cancer
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25
Q

what is mammary duct ectasia ?

A

AKA comedomastitis or plasma cell mastitis

  • Blockage of a duct with chronic inflammation. (gets clogged with thick, cheesy, material and dilated)
  • may be palpable and have nipple retraction
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26
Q

dx of mammary duct ectasia ?

A

need excision to rule out cancer

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27
Q

who usually gets mammary duct ectasia?

A

peri-menopausal women (45-50)

28
Q

what is polythelia?

A

accessory nipple or supernumerary nipple condition

Can vary from just a hairy patch to full-blown breast development with glandular tissue

29
Q

are fibrocystic changes normal?

A

mostly yes! 60% of premenopausal women have them . can be cysts or just increased stromal tissue

30
Q

when do fibrocystic changes become worrisome?

A

Can be a “disease” when it occurs with severe pain, nipple discharge or degree of “lumpiness” to cause suspicion of cancer

31
Q

most common finding in fibrocystic changes and what causes this?

A

hyperplasia - decrease in progesterone or increase in estrogen (worse premenstrually when progesterone drops)

32
Q

txt for fibrocystic changes (3)

A
  1. Breast pain alleviated by thiazide diuretic or aspiration of a cyst
  2. Diet and lifestyle- low fat, no caffeine or nicotine
  3. Vit E and Evening primrose oil
33
Q

fibrocystic changes txt: if behavior, lifestyle and dietary changes dont help… 3 medical options

A
  1. tamoxifen (anti-estrogen)
  2. danazol (androgenic steroid)
  3. GnRH agonist
34
Q

what is the most common benign tumor of the breast?

A

fibroadenoma

35
Q

what is a fibroadenoma like?

A

sharply circumscribed, freely mobile, “rubbery”

36
Q

where in the world is breast cancer highest and lowest?

A

Highest rates in N. America and northern Europe, lowest in Asia and Africa

37
Q

what women have higher mortality despite having lower incidence? why?

A

African American, more advanced stage at diagnosis and higher stage-specific mortality

38
Q

MOST breast cancer still occurs in women with ….

A

NO KNOWN RISK FACTORS

39
Q

what 3 things could increase risk for a man having breast cancer ? (likely weeds)

A

genetic: kleinfelters syndrome (XXY)
testes: injury/disease/undescended
liver: cirrhosis and alcohol use

40
Q

general risk modifications for breast cancer (7)

A 
Decrease postmenopausal hormones
Have kids early in life
Breastfeed at least 6 months
Lose adult weight and then maintain
Limit alcohol consumption
Get regular physical activity
Get early detection
41
Q

4 types of breast cancer

A

Ductal (DCIS) – 80-85% (most are non-specific infiltrating)
Lobular - 10% (LCIS)
Paget’s
Inflammatory

42
Q

BRCA 1 or 2 most likely asscociated with breast cancer?

A

BRCA1

43
Q

3 primary mammographic signs of breast cancer

A
  1. mass (a spiculated / star shaped one)
  2. calcifications (1mm or less, sandlike)
  3. developing density
44
Q

secondary mammographic signs of breast cancer (6)

A 
Architectural distortion 
Skin thickening or retraction 
Nipple and areolar thickening 
Abnormal ductal patterns 
Lymphadenopathy 
Asymmetry of the breast tissue
45
Q

inflammatory breast cancer, what kind of cancer is it ? what are the signs?

A

Form of ductal cancer

Peau d’orange from blockage of lymphatics

46
Q

paget’s disease (breast cancer): how does it present?

A

Scaly, eczematous lesion of areola and nipple

  • Underlying breast mass or abnormal mammogram
  • Mammary adenocarcinoma (usually ductal)
47
Q

what causes nipple retraction?

A

tumor extension to the skin or ductal involvement

48
Q

breast cancer: if lymph nodes are negative for cancer, what is the survival rate?

A

high! 85%

49
Q

what pts do you do an oncotype Dx assay on?

A

for estrogen receptor positive, lymph node negative pts

50
Q

what is an oncotype Dx assay?

A

assay that quantifies the risk of disease recurrence and assesses the likely benefit from certain types of chemo
based on histology; analyzes a panel of 21 genes to determine a recurrence score

51
Q

what can sentinel node mapping cause? (adverse effect)

A

Axillary lymph node dissection can cause arm edema and damage to nerves, vessels

52
Q

what is a sentinel node biopsy?

A

inject tumor with blue dye, see what lymph it travels to (to see where else the tumor is spreading). remove lymphs

53
Q

what breast cancer pts get a mastectomy for treatment?

A

Mastectomy for those with 2 or more tumors, large masses, previous radiation, connective tissue dz or inavailability of radiation

54
Q

when would breast cancer pts get radiation therapy?

A

initial therapy for small tumors with intent to remove via lumpectomy, followed by more radiation
after removal of large tumors with unsure surgical margins

55
Q

success of chemo treatment depends on what factors? what age patients do better with it?

A 
depends on tumor characteristics, lymph node status, age and health of patient
younger women (<65 yo) do better
56
Q

adjuvant systemic therapy for cancer treatment is best for what patients?

A

most benefit for those with positive lymph nodes

57
Q

what is included in adjuvant system therapy for cancer? (4)

A
  1. SERMs
  2. Aromatase inhibitors
  3. immunotherapy
  4. targeted therapy for gene-specific breast cancers (HER2, BRCA, hormone-receptor)
58
Q

if there is a hormone-receptor positive tumor, what do you do to txt it?

A

remove the hormones! SERMs and aromatase inhibitors are good for this

59
Q

what do SERMs do? what is the main drug?

A

Binds competitively to estrogen receptor to inhibit estrogen’s effects
(tamoxifen)

60
Q

tamoxifen is good to txt ____ cancer but can cause ____ cancer

A

good for breast

bad for uterine (endomedtrium)

61
Q

what do aromatase inhibitors do and what is our main drug?

A

lowers estrogen levels (prevents conversion of androgens to estrogens)
- letrozole

62
Q

recurrence rate for cancer for lumpectomy vs mastectomy?

A

lower for mastectomy

63
Q

which cancer has high correlation with HER2 ? (weeds)

A

pagets

64
Q

what is carcinoma in-situ and what are the two types?

A

confinement of the cells to the ducts or lobules
LCIS: lobular carcinoma in situ
DCIS: ductal carcinoma in situ

65
Q

Two genes, ____ and ____, are tumor suppressor genes whose LACK has been previously associated with breast cancer progression
(maybe weeds)

A

RB and PTEN

66
Q

When both genes (RB and PTEN) were inactive, patients were_____ times more likely to have their ____ tumor progress to full blown invasive breast cancer.

A

five times

DCIS

Clin Med- P (124 decks)

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