Lecture 12: Breast Disorders Flashcards by Lindsay Christ

When should the CBE be performed? (what phase)

Follicular phase

- one week after menses

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3 causes of Cyclic breast pain (mastalgia)

Hormonal changes w/menstrual cycle
OCPs
Fibrocystic breast Dz

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What phase/days of the menstrual cycle is a/w Cyclic breast pain

Luteal phase

day 14-28

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Large, pendulous breasts  
Mastitis 
BCA (inflammatory) 
Poorly-fitting bra
Pregnancy 
Ductal ectasia

Causes of Non-cyclic breast pain

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What does extramammary mean?

pain referred from source outside breast (chest wall)

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Tx for mastalgia if exam is normal and pain is cyclic?

Meds for pain?

reassurance (+/- adjust OCP)

support/sports bra, wt loss

Pain meds: NSAIDs, acetaminophen

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Med Tx for Severe Sxs of mastalgia?

Danazol, Tamoxifen, or Bromocriptine

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When is mastitis MC,

normally d/t?

in lactating women

d/t nipple trauma (primigravida)

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Main Sx of Mastitis?

Otehers?

Main = UNILATERAL BREAST PAIN (esp in 1 quad)

Others: breast swelling, warmth, tenderness; nipple d/c

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MC pathogenic cause of mastitis

Staph Aureus

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When should ABX tx for mastitis be started?

What is main ABX?

Pt edu for mothers while taking ABX?

Sxs lasting > 12-24hrs

Dicloxacillin

Mothers CAN continue to nurse/pump while on ABX

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3 Nipple D/c Characteristics that are likely benign?

Nipple d/c that is:

Bilateral
Milky/clear
Multiductal

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Nipple D/c Characteristics: 
Spontaneous 
Unilateral 
Uniductal 
Bloody, straw colored, or clear 
Stains clothes 
Persistent

Malignant nipple d/c characteristics

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Management for Physiologic nipple discharge w/no breast stimulation?

f/u in 2-3 mo

+/- endo referral

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What is next step if find malignant nipple d/c, abn findings on US/mammo, or no resolution of Sxs after modifications in meds/lifestyle?

Refer to nipple specialist

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are most breast masses/tumors benign or malig?

Benign

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What is the MC presenting Sx in pts w/ BCA?

Breast mass

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What type of Dx test/Bx used for breat cysts?

FNA w/Bx

also used for low probability CA

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What is problem w/FNA Bx

Skill depedent–> High amt false negatives and non-Dx samples

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Other Bx methods other than FNA

What type of Bx is specifically used for Paget’s Dz

CNB (core needle Bx)
Incisional Bx
Excisional Bx
Punch Bx (Paget’s dz)

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What type of Bx is for a larger tissue specimen, uses only LA and is US guided

CNB

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What can an US determine for breast masses

when is US 1st line Dx test?

whether mass is cystic or solid

1st line in women < 30 w/focal breast Sxs

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What dx test used for SCREENING women w/no sxs?

Mammogram

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When is SURVEILLANCE mammo used?

F/u in pts w/ Hx of BCA

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When is MRI used to evaluate breast masses?

1. screening for high risk women 2. assess silicone implants 3. eval suspicious findings

At what BIRADS categ is Bx recommended

Categ 4 or 5 --> Bx

At what BIRADS categ is the mass definitely malignant

Categ 6

in pts < 30: 1. w/no mass on CBE what is next step? 2. w/w/indeterminate mass on CBE 3. suspicious mass what is next step? in pts > 30: what is the only difference in next step?

1. repeat exam in 2-3 mo 2. US 3. Dx mammo + directed US w/Bx (FNA) pts > 30: indeterminate exam --> Dx mammo +/- directed US

What 3 types of breast tumors are benign?

1. Simple cyst 2. Fibroadenoma 3. Fibrocystic changes

What 3 types of findings indicate hyperplasia w/out atypia (not cancerous)

1. Epithelial hyperplasia 2. Intraductal Papilloma 3. Sclerosing adenosis

What are breast cysts influenced by?

hormonal fluctuations | (lobular dev/involution, menses

Difference b/t simple and complex cysts? When should a mammo be performed

Simple - ONLY FLUID - benign Complex - Fluid + SOLID - Small risk of malig mammo: > 30 or complex cyst

Tx for simple cyst

Aspirate w/FNA observe 2-3 mos, selfi limited (will resolve on own)

Tx for complex cyst intervention depends on?

Must be Bx surgical intervention based on pathology

What is Fibrocystic Breast Dz & what is it d/t?

fluid filled breast d/t exaggerated response to hormones (progesterone & estrogen) - menstrual hormone changes

Sxs of Fibrocystic Breast Dz? What is not seen in this dz?

1. bilateral cyclic breast pain/tenderness 2. multiple, mobile, well demarcated lumps 3. breast size incr/decr w/menstrual hormonal changes usu no axillary involvement or nipple d/c

What is typical dx tool? What is seen w/Dx FNA

US (mammo if >30) FNA --> straw colored fluid

When can FNA fluid removal be performed for Fibrocystic Breast Dz?

if pt is symptomatic

Most Fibrocystic Breast lumps resolve on own what can be done to manage Sxs?

Diet → Low fat, Avoid: caffeine, coffee, soda, chocolate, ETOH Manage contraception (stop, less estrogen) & HRT Supportive bra

What is a fibroadenoma? makeup?

BENIGN, SOLID TUMOR makeup: glandular + fibrous tissue (collagen)

Smooth, well-defined/circumscribed, NT, rubbery, mobile mass

Fibroadenoma

How does the size of Fibroadenoma change over time?

Gradually incr over time - may incr w/preg or estrogen therapy - decr after menopause *doesnt change w/menses

Differences b/t fibrocystic breast dz and fibroadenoma?

Fibrocystic breast dz - fluid filled - size change w/menses Fibroadenoma - solid tumor - doesnt change w/menses

Tx for most fibroadenoma?

Observation → most resorb w/time | - Short-term f/u w/ repeat US or CBE

MC type of BCA

Ductal carcinoma (infiltrative/invasive)

2 types of NON-invasive BCA (hyperplasia w/atypia)

1. DCIS (ductal carcinoma in situ) | 2. LCIS (lobular carcinoma in situ)

2 types invasive BCA Which one a/w lymphatic mets (esp axillary)

1. Ductal carcinoma→ a/w lymphatic METS (esp axillary) | 2. Lobular carcinoma

What is the biggest risk factor for BCA?

AGE

What ethnicity is at very high risk for having BRCA 1/2 mutation?

Ashkenazi Jewish women

How is estrogen exposure linked to BCA?

more/longer estrogen exp = incr risk - early menarche - late menopause - late age 1st pregnancy - HRT, OCPs

MC location for BCA

Upper outer qudarant

Main Sxs of BCA

Single, NT, firm/fixed/immobile mass

1. Unilateral nipple d/c 2. Dimpling (if Cooper’s lig involved) 3. Breast pain 4. Skin thickening 5. Nipple inversion 6. Changes in breast size/contour 7. Skin discoloration,ulceration, redness, retraction

Sxs of BCA

What is Inflammatory BCA d/t?

lymphatic invasion of tumor cells

Main sign w/Inflammatory BCA? what is it d/t?

Peau de orange appearance of breast d/t lympahtic obstruction note: a/w poor prognosis

Main sign w/Paget's Dx?

Chronic eczematous rash of nipple and areola | may ooze

Difference b/t Inflammatory BCA and Pagets Dz

Inflammatory BCA - lump uncommon Pagets Dz - lump common

What is seen on mammo that is highly suspicious for BCA?

microcalcifications & spiculated masses

What is considered breast conserving therapy?

Lumpectomy

Which type of mastectomy spares pect muscles and axillary content?

Simple/total mastectomy

Which type of mastectomy removes everything (breast, overlying skin, pectoralis major and minor, and entire axillary contents)?

Radical mastectomy

What types of CA can hormonal therapy tx? 2 Types of hormonal tx?

Txs estrogen/progesterone-receptor (+) CA and HER2 (+) CA 1. SERM (selective estrogen rec modulator) 2. Monoclonal Ab Tx

SERM drugs? note: can also be used for BCA prevention in high risk pts

1. Tamoxifen 2. Aromatase inhibitors (Letrozole, Anastrozole)

Risk w/Tamoxifen? type of drug/MOA?

endometrial CA, DVT anti-estrogen: blocks it from binding to rec

when are aromatase inhibitors helpful? MOA?

AI useful in post menopausal woemn MOA: reduces estrogen production

Monoclonal Ab Tx drug? | used for what types of CA?

Trastuzumab/herceptin for CA w/HER2 (+)

Tx for early stage CA

Lumpectomy or mastectomy + radiation *Evaluation of axillary nodes* - look for METs

what LN impacted 1st by BCA

sentinel nodes

Lecture 12: Breast Disorders Flashcards

(68 cards)