Flashcards in Monday, 2-27-Normal and abnormal breast (Wootton) Deck (32):
__ is responsible for growth of adipose tissue and lactiferous ducts
__ is responsible for stimulation of lobular growth and alveolar budding
risk factors for breast CA (laundry list)?
-personal hx of breast CA
-hx of atypical hyperplasia
-high breast tissue density
-1st degree relatives w/ breast CA or ovarian CA
-early menarche (age <12)
-late cessation of menses (age>55)
-no term pregnancies
-recent and long term use of OCs
-personal hx of endometrial or ovarian CA
a palpable breast mass qualifies for what?
biopsy --> FNA/core/excisional
mammography is best win these women?
40 yrs and older
ACOG recommendations for mammography? Clinical exam?
mammo-age 40+ annually
cliical exam-age 20-39=1-3 yrs; age 40+=annually
this method is useful in evaluating inconclusive mammogram findings, best for evaluating young women (age <40) and others with dense breast tissue, allows to differentiate between cystic vs solid lesions, and used for guidance when doing core needle biopsy
this method is a useful adjunct to dx mammography in suspicious masses, used post-CA dx for further evaluation of staging, used with implants, and women at high risk for breast CA like BRCA carrieres
__ is useful in determining solid versus cystic masses
FNA biopsy-smaller needle (22-24 gauge)
-clear fluid=no further eval
-bloody=sent for cytology and need dx mammogram/US
this method is used to get tissue from larger solid masses for Dx and uses a large needle (14-16 gauge)
core needle biopsy
causes of cyclic mastalgia? noncyclic mastalgia? extramammary mastalgia?
cyclic-starts at luteal phase, ends after onset of menses
noncyclic: tumors, mastitis, cysts
extramammary: chest wall trauma, shingles, fibromyalgia
only FDA approved tx for mastalgia?
Danazol only FDA approved tx but unpleasant side effects
can also do SERMs, OCs or Depo provera, proper fitting bra, weight loss, exercise, decrease caffeine intake, Vit E supplements
concern with bloody nipple discharge?
considered CA until proven otherwise
-concern for intraductal carcinoma or invasive ductal carcinoma
-could be benign intraductal papilloma
-evaluate with breast ductography and requires ductal excision
when should you be concerned for malignancy of a breast mass?
- >2 cm in size
-poorly defined margins
-skin dimpling/retraction/color changes
fibrocystic changes, cysts, fibrosis, adenosis, lactational adenomas, galactocele, and fibroadenomas are what type of breast masses?
most common tumor in female breast that usually occurs in late teens to early 20s?
-solid , rubbery, mobile, typically solitary
epithelial hyperplasia, sclerosing adenosis, complex sclerosing lesions (radial scar) and papillomas are what type of breast masses?
Proliferative WITHOUT atypia-Benign
__ are intraductal growths seen in women 30-50 yrs old, cause serous or serosanguinous discharge and considered benign, proliferative without atypia
LCIS and DCIS are what type of breast masses?
Prolfierative lesions WITH atypia
tx of both LCIS and DCIS?
both tx with excision and then followed w/tx with SERMs
lifetime risk of developing breast CA? lifetime risk of dying from it?
age and race risk factors for breast CA?
majority after 50, white women at greater risk
FH and genetic risk factors for breast CA?
1st degree relative, esp if dx under age 40
BRCA1- about 1/2 early onset breast and 90% hereditary ovarian
BRCA2- about 35% early onset breast, much lower risk of ovarian ca
this type of breast CA makes up 70-80% of all breast CA, most common in women in their 50s, spreads to regional nodes
this type of breast CA is 5-15% of breast ca, more likely to be multipfocal and/or bilaterla
__ presents as superficial skin lesion around the nipple (3% of breast CAs)
__ breast CA makes up 1-4%, swelling and redness of underlying skin and induration of surrounding tissues
inflammatory breast CA
in breast CA tx, use __ status in addition to staging to determine prognosis
this receptor associated with worse prognosis and found in 20-30% invasive cancers
this hormonal tx is an estrogen antagonist, reduces risk of CA in contralateral breast as well
__ inhibitors prevent production of estrogen in postmenopausal women
aromatase (arimedex, femara)
__ acts on protein made by HER2/neu
-side effects: Heart failure