GYN Oncology, Breast

Question 1

What are the categories of benign breast lesions?

Answer 1

1. Nonproliferative
2. Proliferative
3. Atypical hyperplasia

Question 2

What is an example of a nonproliferative benign breast lesion?

Answer 2

Breast cyst

Question 3

What is an example of a proliferative benign breast lesion?

Answer 3

Fibroadenoma
Intraductal papilloma

Question 4

What is an example of atypical hyperplasia benign breast lesion?

Answer 4

Atypical ductal hyperplasia
Atypical lobular hyperplasia

Question 5

What is a breast cyst?

Answer 5

benign fluid filled sac in the breast

Question 6

What is a fibroadenoma?

Answer 6

Benign tumor of the breast composed of glandular and stromal connective tissue

Question 7

What is a intraductal papilloma?

Answer 7

Benign breast lesion that consists of wart like lump that develops in 1 or more milk ducts

Question 8

What is atypical ductal hyperplasia?

Answer 8

Atypical ductal hyperplasia is a premalignant proliferative breast lesion with high risk of ductal carcinoma in situ or invasive breast cancer

Question 9

What is atypical lobular hyperplasia?

Answer 9

Atypical lobular hyperplasia is a premalignant proliferative breast lesion with high risk invasive breast cancer

Question 10

What is BIRADS category 0?

Answer 10

Incomplete, additional testing needed

Question 11

What is BIRADS category 1?

Answer 11

Negative, 0% likelihood of cancer, routine imaging

Question 12

What is BIRADS category 2?

Answer 12

Benign, 0% likelihood of cancer, routine imaging

Question 13

What is BIRADS category 3?

Answer 13

Probably benign, 0-2% likelihood of cancer, 6 month follow up

Question 14

What is BIRADS category 4?

Answer 14

Suspicious
4A= low, >0%<10%
4B= >10%<50%
4C= >50%<95%
Tissue diagnosis

Question 15

What is BIRADS category 5?

Answer 15

Highly suggestive of malignancy
>95% likelihood of cancer
Tissue diagnosis

Question 16

What is the lifetime risk of breast cancer?

Answer 16

12%

Question 17

Are breast self exams recommended?

Answer 17

Not in average risk women due to risk of false positives

Question 18

What is the breast screening protocol by ACOG?

Answer 18

Screening from age 40-75 either annual or biennial
Clinical breast exam >40y/o

Question 19

What is the breast screening protocol by American Cancer Society?

Answer 19

Annual screening from 40-54
Biennial screening 55- until 10 years before anticipate death
Clinical breast exam not recommended

Question 20

What should you known about women with dense breast?

Answer 20

Mammogram less sensitive
Dense breast confer increased cancer risk

Question 21

What is lobular carcinoma a marker for?

Answer 21

Future malignancy

Question 22

How do you determine what imaging to perform for the workup of a breast mass?

Answer 22

<30y/o= ultrasound
>30y/o = mammogram

Question 23

When is it appropriate to aspirate a breast mass?

Answer 23

Only if its cystic

Question 24

When should you do an excision or biopsy for a breast mass?

Answer 24

1. Suspicious solid palpable breast mass
2. Non-palpable suspicious mammogram finding
3. Aspiration with bloody fluid or mass that fails to resolve
4. Mass associated with bloody nipple discharge or ulceration

Question 25

What is the management for atypical hyperplasia/lobular carcinoma in situ?

Answer 25

Mammogram annually if over 30 Clinical breast exam q6-12 months Breast self awareness Risk reduction recommended with tamoxifen

Question 26

In a patient with nipple discharge, when should you be concerned for underlying pathology?

Answer 26

Spontaneous discharge Persistent discharge Expressed on exam single duct Clear/serous or bloody

Question 27

What kind of symptoms do you see with inflammatory breast cancer?

Answer 27

Skin thickening Edema peau d' orange persistent erythema nipple excoriations skin ulcerations

Question 28

What is positive receptor status in breast cancer associated with?

Answer 28

Better response to hormonal therapy Tumors more often well differentiated and slower growing

Question 29

What are the adjuvant therapies for breast cancer?

Answer 29

1. Tamoxifen 2. Raloxifene 3. Aromatase inhibitors 4. Herceptin

Question 30

What kind of Breast cancer patients can you use tamoxifen in?

Answer 30

ER+/Unknown Pre or post menopausal

Question 31

What kind of Breast cancer patients can you use raloxifene in?

Answer 31

ER+ Postmenopausal

Question 32

What kind of Breast cancer patients can you use aromatase inhibitors in?

Answer 32

ER+/Unknown Postmenopausal

Question 33

What kind of Breast cancer patients can you use Herceptin in?

Answer 33

Her2/Neu+ Pre or post menopausal

Question 34

What is the risk of tamoxifen therapy?

Answer 34

VTE

Question 35

What is the risk of raloxifene therapy?

Answer 35

VTE

Question 36

What is the risk of aromatase inhibitor therapy?

Answer 36

Bone loss

Question 37

What is the most common cause of bloody nipple discharge?

Answer 37

Benign intraductal papilloma

Question 38

What is the most common cause for a solid breast mass?

Answer 38

Fibroadenoma

Question 39

What is Paget disease of the breast associated with?

Answer 39

Underlying intraductal or invasive carcinoma of the breast

Question 40

When is breast MRI indicated?

Answer 40

1. BRCA 1,2 mutation 2. First degree relative of BRCA 1,2 3. Lifetime risk of breast cancer is >20% 4. Chest radiation between 10-30y/o