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Clin Med - Repro > Lecture 12 - Breast Disorder > Flashcards

Lecture 12 - Breast Disorder Flashcards

(48 cards)

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1
Q

Where are the majority of breast cancers?

A

upper outer quadrant

axillary tail

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2
Q

When is the best time to perform clinical breast exam?

A

during follicular phase (one week after menses)

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3
Q

Mastalgia

A

breast pain

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4
Q

Cyclic mastalgia

A 
related to menstrual cycle 
luteal phase (day 14 - 28)
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5
Q

What conditions can cause cyclic mastalgia?

A

luteal phase of menses
OCPs
fibrocytic breast disease

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6
Q

What is the treatment for mastalgia?

A

reassurance (assuming exam is normal and pain is cyclic)

support bra or sports bra; weight reduction

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7
Q

Mastitis

A 
infection of breast tissue -- mainly with lactating women 
breast pain 
swelling 
warmth 
redness

pathogen: MC staph aureus

tx:
if sxs >12-24 hours
dicloxacillin 500mg PO QUID x 10-14 days

if no improvement, r/o breast abscess with US
-consider inflammatory breast cancer

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8
Q

What are the sxs of mastitis?

A 
women 
breast pain 
swelling 
warmth 
redness
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9
Q

What is the MC pathogen of mastitis?

A

Staph Aureus

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10
Q

What is the treatment for mastitis?

A

if sxs >12-24hr
Dicloxacillin 500 mg PO QID x 10-14 d

if no improvement, r/o breast abscess with US
-consider inflammatory breast cancer

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11
Q

Nipple discharge affects ____% of women in their reproductive years

A

50-80%

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12
Q

Bilateral nipple discharge vs unilateral nipple discharge

A

bilateral is more commonly benign

unilateral is more commonly malignant

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13
Q

What characteristics of nipple discharge suggest benign?

A

bilaterally
multiductal
milky

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14
Q

What characteristics of nipple discharge suggest malignant?

A 
spontaneous
unilateral
uniductal
blood, straw colored, or clear stains clothes 
persistent
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15
Q

What labs should you order on a pt with nipple discharge?

A

TSH
Prolactin
B-hCG

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16
Q

If you think the nipple discharge is related to OCPs, how long after changing the OCPs should you re-evaluate?

A

3 cycles

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17
Q

What percentage of breast masses are benign?

A

80-85%

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18
Q

What is the most common presenting sx in pts dx’d with breast cancer?

A

breast mass

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19
Q

What is the biggest risk factor for the development of breast cancer?

A

age

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20
Q

Nipple retraction

Study These Flashcards
A

tumor is pulling on ligaments –this is different than nipple eversion

21
Q

CNB

Study These Flashcards
A

core needle biopsy

  • larger tissue specimen
  • image-guided (US)
  • local anesthesia
22
Q

Punch biopsy

Study These Flashcards
A

differentiate benign vs malignant skin changes (Paget’s disease)

23
Q

What is the first line imaging choice in women <30 and pregnant women with focal breast sxs?

24
Q

Who gets MRIs for breast masses?

Study These Flashcards
A

reserved for women of high-risk

good for implants

25
BIRADS
breast imaging reporting and data system 0-6 gives likelihood of malignancy and recommendation for follow up/biopsy
26
If a pt <30 comes in complaining of a breast lump and you don't find anything, what do you do next?
repeat exam in 2-3 months
27
What are cysts influenced by?
hormonal fluctuations occur during lobular development, menses, and lobular involution
28
Simple vs complex cyst?
simple - fluid only, benign complex - fluid + solid components - small risk of malignancy
29
What is the management of a simple cyst vs. complex cyst?
simple: aspirate cyst (FNA) observe 2-3 months (cycles) Complex: must be biopsied - image guided CNB surgical intervention based on pathology
30
Fibrocystic breast disease
MC benign breast condition associated with imbalance of progesterone and estrogen sxs: bilateral cyclic pain, breast swelling, palpable mass and heaviness; "lumpy breasts" premenopausal women affected 20-40 years dx: US FNA + pathology evaluation dx mammogram for women >30 y
31
Management of fribrocystic breast disease?
``` low fat diet avoid caffeine, coffee, soda, chocolate, EtOH manage contraception and HRT supportive bra medication as needed ```
32
Fibroadenoma
benign solid tumors containing glandular + fibrous tissue -proliferative - breast masses that you can define on exam - less likely to occur during menopause d/t decrease in hormones increase in size during pregnancy/estrogen therapy usually regresses after menopause
33
What age women get fibroadenomas?
reproductive age women
34
What do you feel on PE for fibroadenoma?
well-defined mobile mass
35
How do you dx fibroadenoma?
US mammogram CNB or excision
36
What is the management for fibroadenoma?
short term f/u with repeat sono/breast exam expectantly manage surfical excision
37
What is the leading cause of death in women 40-49?
breast cancer
38
What is the MC breast cancer?
ductal carcinoma makes up 80% of breast cancers
39
Hyperplasia with atypia
DCIS - ductal carcinoma in situ LCIS - lobular carcinoma in situ not cancer but predisposes to cancer
40
What are the risk factors of breast cancers?
``` Advanced age family hx personal hx early menarche late menopause late first pregnancy HRT radiation ```
41
BRACA
breast cancer susceptibility gene --tumor suppressors carriers have 45-65% chance of breast cancer by 70
42
What are they typical clinical features of breast cancer?
most often single, non-tender, firm, immobile mass | 45% in upper outer quadrant
43
Inflammatory breast cancer
``` dermal lymphatic invasion of tumor cells actue onset (sx <6 months) of erythema, edema, and peau d'orange appearance ``` ddx: mastitis
44
Paget's disease of the breast
ductal carcinoma presenting as eczematous lesion of the nipple
45
Breast conserving therapy
lumpectomy | depends on size of mass vs size of breast
46
Look over breast cancer treatment and screening
NOT DONE
47
What are the ACS guidelines for breast cancer screening?
offer mammograms at age 40-44 recommend annual screening 45-55 continue screening as long as life expectancy >10 years
48
What medical management is used to decrease RECURRENCE of breast CA coming back?
Adjuvant hormone therapy ``` SERM - selective estrogen receptor modulator -anti estrogen -Tamoxifen -AI treated for 5-10 years ```

Clin Med - Repro (18 decks)

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