L81/L82 - Mammography and BC treatment Flashcards Preview

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Flashcards in L81/L82 - Mammography and BC treatment Deck (24):
1

Screening Mammorgraphy is for who? When do women get them? When do you get them earlier? 

ASYMPTOMATIC PATIENTS 

 

Annual screening begins at age 40 for asymptomatic women w/ average rate of breast cancer 

 

Results sent in a letter to patient and physician

 

Earlier screening if:

Familty Hx 1st degree relative - 5-10 yrs before age of their dx 

BRCA1/2 Start at 30

After Mantle Radiation - 8 years after treatment but not before age 25

2

What are the 2 standard mammorgram views for a Screening mammorgram of each breast? 

MLO view - Medio-lateral-oblique 

- pectoral muscle to nipple - good for inf/sup lesions

- gets inframammillary fold and axilla

- might midd medial breast

CC view - Cranio-Caudal 

- gets medial breast tissue 

3

What is/who gets a diagnostic mammogram? 

SYMPTOMATIC PATIENTS > 30 yo

 

anyone w/ new symptoms, history, or followup abnormal screening or benign lesions 

Uses different views - 4 standard instead of 2 - spot compression and magnification for calcifications 

INTERPRETED IN REAL TIME at the time of exam 

4

What if you see calcifications or other findings but they are non-palpable? 

then use the SAME imaging modality to biopsy lesion!!!! 

5

When do you do a breast ultrasound? 

US for EVERY patient w/ a clinical problem 

and for under age 30!!!! 

 

ex. 30 yo with lump then order US

6

Suspicous findings on mammography? 

Spiculated masses

Pleomorphic microcalcifciations w/ linear or branching patterns (linear implies necrotic tissue in ducts...bad!) MUST biopsy

 

Neodensities and architectural distortions 

 

Ill-defined margins 

7

What are the official indications for a braeast ultrasound? 

All palpable breast and axillary lumps 

eval of new mammograpphic findings (masses, asymmetries, distortions, calficications)

Nipple discharge - serous or blood, unilateral or spontaneous

Focal Pain

 

*STUDY OF CHOICE in women < 30 yo, PRegnant/lactating for eval of lumps 

 

Screening breat US in women w/ dense breasts on mammography or intermediate risk for BC

8

Sonographic features of bresat cancer? 

irreulgar margins, ill-defined masses - most are hypoechoic

Posterior acoustic shadowing

*Taller - than - wide or antiparallel orientation

Increased vascularity

Cyst w/ mural nodule

Unilateral axillary adenopathy

9

Indications for BReast MRI?

Screening for HIGH RISK Patients

Diagnostic Exam for: 

- newly diagnosed or history of BC

- breast implant rupture - SILICONE IMPLANTS

MRI is MOST sensitive TEST!!! 

10

Indications for breast MRI in newly diagnosed BC? 

to get extent of disease in young patients/dense breasts

 

Screen for Contralateral Brest cancer

 

Status post-lumpectomy

Response to neo-adjuvant CTX

VERY sensitive - Angiogenesis!!! 

11

3 facts TO KNOW ABOUT MRI?

1) should BEVER be first line diagnostic imaging

2) must be read in conjunction w/ mammography

3) most problems solved w/out MRI

12

RF for breast cancer? 

Reproductive - estrogens etc

Breast feeding protective!!! 

High breast tissue density

Confirmed hyperplasia

BRCA and family history

Prior radiation therapy

Obseity, Lack of exercise, ETOH 

13

Treatment options for early stage BC?

Local therapy - surgery or radiation to breast + axilla LN

Systemic Adjuvant therapy - CTX, hormonal, Abs, etc 

14

what LN are not sampled surgically? 

Internal Mammillary LN

15

What are the different levels of LN - matters for Sentinel LN biopsy? 

Level 1: Lateral to Pec minor

Level 2: deep to pec minor

Level 3: Medial to Pec Minor

Level 4: Interpectora/Rotter's nodes

16

Different types of reconstructive flaps? 

TRAMP-Flap  = tranverse rectus abdominus myocutaneous

DIEP- deep inferior epigastric perforator

SIEA = superficial inferior epigastric artery

Latissimus Dorsi flap

Inferior gluteal perforator flap 

 

 

17

Pros and Cons of TRAM-FLAP?

Feels like normal tissue

Get a tummy tuck!!!

 

Risk of HERNIA!

18

Who needs radiaiton therapy? 

all patients w/ Lumpectomy or PArtial mestectomy

19

When / Why would radiation therapy delayed? 

started after CTX completeled 

20

Difference btween STage 1 and 2 Breast cancer? 

STage 1 < 2 cm and LN negative

Stage 2 2-5 cm and LN involvement at surgery

21

What kinds of patients get more absolute benefit from adjuvant chemotherapy? 

Younger Premenopausal women < 50 yo 

 

AND

 

ER negative disease get more benefit from CTX than ER+ 

22

What is required to treat pts w/ Trastuzumab? 

evidence of HER2 overexpression defined as 3+ ICH or FISH amplicifcation ratio > 2

23

What are adjuvant CTX to give w/ Trastuzumab? Effects? 

Adriamycin + Cyclophosphamide + Taxol 

*Cardiotoxic effects

 

vs

 

Taxotere + Carboplatin-AUC 

non-cardiotoxick 

24

ER+ Tumor treatment in pre vs post menopausal women!

Post-menopausal women - Aromatase inhibitors

Pre-menopausal women - Tamoxifen