Breast Disorders (Lauren 🌭) Flashcards by Lauren F

What is the difference between a “Screening” Mammogram and a “Diagnostic” Mammogram?

Screening mammogram- has 2 views. Used when you have no specific concern, your patient is just the right age for a mammogram

Diagnostic mammogram- more than 2 views. Used when you have a specific concern

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What are the 2 views used in a screening mammogram

Craniocaudal CCO (top to bottom)

Mediolateral Oblique MLO (side to side)

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What are some additional mammogram views that are used when you have a specific concern?

Spot compression- pushing excess tissue away from the nodule

Cleavage view- exactly what it sounds like. Helps you see the medial tissues better

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Can you get a mammogram if you got dem fake tittttttayyyyssss

Yes, the technician just has to push the implants back towards the chest wall

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Malpractice cases of delayed breast cancer diagnoses usually involve women who:

Are under age 50 who receive false negative results, or didn’t receive diagnostic mammograms they should have

Who do they sue: PAs and DOCTORS not the radiologists!!!

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Do you want me to put stuff that said FYI on the slide, yet she went over anyways?

Sure why not

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FYI:

What “score” will the radiology report of a mammogram have?

BI-RADS score:

0: radiologist needs more views to determine the score

1-2: 👍

3-6: not what you want

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In general, why do we use mammograms for older women and not for younger women?

Younger women have denser breasts with less fat and more breast tissue, and mammograms can’t see through them very well

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When do we use ultrasound to evaluate breasts?

Young women***

Dense breast tissue

To differentiate between a SOLID and CYSTIC mass

Guiding core-needle biopsies

Inconclusive mammogram results

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When would we use MRI to look at some breasts

Detecting breast cancer in high-risk women

Staging breast cancer

Hmmmm….something seems to be missing here…

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What do we NOT use MRI for when were looking at boobs

NOT recommended for evaluation of a breast mass****

Can’t tell if something is benign or malignant

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What is the difference between Fine-needle Aspiration and Core-Needle Biopsy?

FNA: smaller needle for mass you probably think is benign

Core Needle Biopsy: used to obtain samples from larger, solid breast masses

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Would you use FNA or Core needle biopsy to determine if a palpable lump is a simple cyst?

Fine needle aspiration.

Stick it in there and if clear fluid comes out, youre good its just a cyst

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What are some important questions to ask if a woman presents to you with concerns about a breast lump

Nipple discharge?

Size changes?

Associated with Menstrual Cycle?**

Risk factors in increase likelihood of malignancy

Location, duration, how it was discovered

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What is mastalgia?

Breast pain (can be cyclic or non cyclic)

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What is cyclic breast pain?

FIBROCYSTIC changes that happen in BOTH breasts during the luteal phase of your menstrual cycle

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What may cause non-cyclic breast pain?

Medications (hormonal BC, HRT SSRIs, spironolactone)

Large, pendulous breasts can cause ligamentous pain

(Can be in just one breast, or focal, unlike cyclical pain)

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If you don’t palpate a mass, but your patient is complaining of focal pain in her breast, what is your next step?

Younger than 30: ultrasound

30 or older: ultrasound AND mammogram

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Who gets mastitis?

Breastfeeding women

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How does mastitis present?

Hard, red, tender, swollen area in one breast

Fever

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Which organism most commonly causes mastitis?

Staph aureus

***

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What is a VERY important thing that should be on your DDx when you think a patient has mastitis?

Inflammatory Breast Cancer***

DO NOT MISS THIS

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What is the treatment for mastitis?

Dicloxicillin or cephalexin

Continue Breastfeeding!!! (Want to get milk out of there. It is safe for the baby)

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What are some characteristics of breast masses that usually indicate it is benign?

Well defined margins

No skin changes

Smooth

Soft or firm

Mobile

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What are some characteristics of breast masses that are more likely to be malignant?

Poorly defined margins Skin changes 🍊 Hard Immobile Fixed (to chest wall or outer surface of breast)

What is this: | FLUID FILLED round or ovoid breast mass that is influenced by hormone fluctuations

Breast cyst

What is the peak age of women who get breast cysts?

35-50

Are breast cysts always solitary?

No you can get clusters of cysts that may palpate as an ill-defined mass

How do you manage breast cysts?

Simple cysts: no intervention needed. FNA if symptomatic Complicated cysts with <1% chance of malignancy: FNA or do imaging every 6 months Complex cysts with a 1-23% chance of malignancy: biopsy/excision (There was no information about what made a cyst simple/complicated)

What is this: | Benign SOLID tumor containing glandular and fibrous tissue

Fibroadenoma

What age is the peak incidence of fibroadenoma?

15-35*** | Younger than cyst

Are fibroadenomas painful?

No | Cysts, however, might be painful

Do fibroadenomas fluctuate in size every month?

No | can increase in size during pregnancy and if you use estrogen

How do you treat fibroadenoma?

Core needle biopsy (it’s a SOLID tumor) OR if benign features on ultrasound, 3-6 month repeat If it increases in size***: mandatory excision

If a fibroadenoma is rapidly growing, what should you consider in your differential?

Phyllodes tumor

What is a phyllodes tumor?

A rare, rapidly growing tumor that is usually benign

Breast Cyst of Fibroadenoma: Well-defined mobile mass

Both

Breast Cyst of Fibroadenoma: May fluctuate in size

Breast cyst

Breast Cyst of Fibroadenoma: Peak incidence at 35-50

Breast cyst

Breast Cyst of Fibroadenoma: Peak incidence at 15-35

Fibroadenoma

Breast Cyst of Fibroadenoma: may be tender

Breast cyst

Breast Cyst of Fibroadenoma: Firm or ballotable

Breast cyst

Breast Cyst of Fibroadenoma: Firm

Firboadenoma

Breast Cyst of Fibroadenoma: Fluid filled

Cyst

Breast Cyst of Fibroadenoma: Solid

Fibroadenoma

If your patient presents with a breast mass and your examination suggests that it is a ~suspicious~ mass, what is your next step?

Mammogram AND ultrasound No matter how old they are!!

What characteristics of nipple discharge are usually associated with a Pathological (bad) cause?

Spontaneous*** Unilateral** Single duct** Bloody** (always concerning) Associated with a mass

What are possible causes of Pathologic (bad) nipple discharge?

Intraductal papilloma****!!**!*!***! Duct ectasia (painful) Cancer Infection

What characteristics are associated with physiologic (normal) nipple discharge?

Bilateral Multiple ducts Associated with stimulation

What is the most common cause of pathologic (bad) nipple discharge?

Intraductal papilloma****** | A benign, warty tumor that develops from the duct wall and grows into the lumen, but MAY turn into DCIS

FYI: | What kinds of medications did Ms. Shamblen specifically say can cause nipple discharge

Antipsychotics

Nipple discharge that is bloody is (concerning/NBD)

Always concerning- refer to surgeon

Nipple discharge that is unilateral from a single duct is (concerning/NBD)

Always concerning. Refer to surgeon

In the US, 1 in ___ women will develop invasive breast cancer over the course of her lifetime

What are the 2 strongest risk factors for breast cancer?

Being female Age (65+)

What two tumor suppressor genes are associated with hereditary breast and ovarian cancer when mutated?>

BRCA1 BRCA2

What are your options if you do a 23andme test and you find out you have a BRCA mutation?

Increased surveillance Chemoprevention (tamoxifen in women over 35) Mastectomy

If you do a 23andme test and you find out you do not have a BRCA mutation, are you good to go

No it does NOT mean that you will NOT get breast cancer

Which is worse for women: BRCA1 or BRCA2?

BRCA 1

Which is worse for men: BRCA1 or BRCA2

BRCA2 Men have breasts too!!!

What do we recommend now instead of monthly self breast exams?

“Breast awareness”

What is a Clinical Breast Exam?

PA or Doctor does a breast exam

What time of the month is the best time for your PA to do a Clinical Breast Exam?

Follicular phase of menstrual cycle

What does the USPSTF think about clinicians teaching women how to perform a self breast exam?

Not recommended

What does the USPSTF think about the benefits of doing a clinical breast exam beyond screening mammograms in women over 40?

Current evidence is insufficient to assess the benefits of doing a CBE (I’m not totally sure what this means and this probably wont be on our test)

True or false: All major groups agree about doing a clinical breast exam

False

True or false: All major groups agree on “Breast Awareness”

True

What are the recommendations for doing screening mammograms in women who are at average risk?

Consider it at 40-49 Screen all women at 50+ Stop screening at age 75 Screen every 1-2 years (This slide also said FYI but it seems kind of important i don’t know what to do!!)

Who is recommended to get an annual MRI screening for breast cancer?

BRCA mutation First degree relative has BRCA Lifetime risk >20-25% or greater (THIS SAID FYI REALLY BIG BUT SHE ALSO PUT A STAR ON THIS UPTODATE CHART 🤯)

What are the clinical presentations of breast cancer?

Palpable mass (MOST COMMON**)*** Nonpalpable suspicious lesion on mammogram Skin changes Nipple discharge Metastatic spread

What does “in situ” mean?

It means the lesions have not penetrated the basement membrane (noninvasive)

What are the two types of noninvasive (in situ) breast carcinomas?

Lobular LCIS Ductal (DCIS)

DCIS or LCIS: Treated as a malignancy because it has potential to develop into invasive cancer

DCIS | ******

DCIS or LCIS: Does NOT become an invasive cancer if left untreated

LCIS *******

What does DCIS look like on mammography?

**clustered pleomorphic calcifications*** *******

80% of DCIS are (palpable/nonpalpable)

Non-palpable

What are the specific findings on mammogram and ultrasound for LCIS?

There aren’t any | ******

True or false: LCIS is an indicator for increased risk of invasive breast cancer

True | However it will not turn into one

What is the treatment for DCIS?

Breast conserving surgery with radiation or mastectomy +/- sentinel node biopsy Hormone therapy if estrogen and progesterone positive- Tamoxifen, Arimidex

What is the treatment for LCIS?

No treatment recommended (not a true cancer) Lifelong close surveillance If you really wanted to, you could do chemoprevention with Tamoxifen or Arimidex If you really wanted to, you could do a bilateral prophylactic mastectomy

What is the MOST COMMON breast malignancy?

Infiltrating Ductal Carcinoma ******************** ************ ⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️

What is the most common presentation of Infiltrating Ductal Carcionoma and Infiltrating Lobular Carcinoma?

Palpable mass Or Mammography abnormality

Which is more likely to be bilateral: Infiltrating Ductal Carcinoma or Infiltrating Lobular Carcinoma

Lobular

True or false: Infiltrating Lobular Carcinoma is usually hormone (estrogen) positive

True

What ultrasound findings would make you very concerned that a breast lesion is Invasive

Taller than it is wide*****

Is a “Stellate Lesion” on mammogram good or bad

Pretty sure its bad

What is this: Scaly, raw, vesicular or ulcerated lesion that begins on the nipple and spreads to the areola

Paget Disease of the Breast | *****************

What might happen before Paget Disease becomes clinically apparent?

Pain, burning, or itching may present

Is Paget Disease common?

No, very rare

What does Paget Disease have to do with breast cancer?

88% of women with Paget Disease have an underlying breast cancer

What is the rarest but most aggressive form of breast cacner

Inflammatory Breast Cancer | *************

What are the clinical features of Inflammatory BReast Cancer?

Pain Rapidly progressing, tender, firm, enlarged breast Skin is warm, thickened, peau d’orange appearance, and erythematous*** Almost all have lymph node involvement at presentation 1/3 have distant metastasis at presentation

Which type of breast cancer is specifically associated with a peau d’orange appearance

Inflammatory Breast Cancer

What are the two paths that breast cancers can take to metastasize?

Lymphatic spread Hematogenous spread- lung, liver, bone, ovaries, and brain

Which lymph nodes does breast cancer usually spread to first

Axillary lymph nodes

What other lymph nodes may breast cancer spread to other than axillary?

Internal mammary nodes Supra clavicular nodes is a late finding

What is the treatment for breast cancer?

Surgery (lumpectomy vs mastectomy) Radiation Chemotherapy Endocrine therapy

What is a lumpectomy?

“Breast Conserving Surgery” Just the part with the cancer is removed +/- selective sampling of axillary nodes

True or False: Multiple clinical trials have shown that breast conserving surgery (lumpectomy) with radiation is the appropriate treatment for Stage I or II breast cancer

True

What is the difference between simple, modified radical, and radical mastectomy?

Simple (aka Total)- entire breast including nipple and areola Modified Radical- entire breast including nipple and areola plus axillary lymph nodes Radical- entire breast, lymph nodes, and pectoralis muscle

Are radical mastectomies performed often?

Rarely performed now

What are the two forms of radiation for breast cacner?

External beam- lasts 5-7 weeks Brachytherapy- seeds/wires placed on tumor for shorter time

All patients with (+) lymph nodes get what kind of tratemnet?

Chemotherapy

What is the difference between neoadjuvant and adjuvant chemotherapy?

Neoadjuvant- given before surgery to shrink the tumor; might allow for breast conservation surgery Adjuvant- after surgery, kills cancer cells left behind

Do we do endocrine/hormone therapy for all breast cancers?

No, only cancers that are Estrogen Receptor (+) or Progesterone Receptor (+)

What are the options for Endocrine/Hormone therapy for ER(+) and PR(+) cancers?

SERM- tamoxifen x 5 yrs Aromatase inhibitors- Arimidex (Anastrozole)

Can a patient do Endocrine/Hormone therapy instead of chemo+radiation?

No, they are a supplement to chemo and radiation

What’s the big deal with this HER2/neu overexpression thing?

Its a protein that promotes growth that 20% of breast cancers have increased amounts of and we can target it

What is Herceptin?

A drug that targets the HER2/neu protein. Can be used in addition to chemo

What imaging would you use to differentiate between a solid and cystic mass in the breast

Ultrasound

Breast Disorders (Lauren 🌭) Flashcards

(110 cards)