Surgery - Breast Flashcards Preview

Surgery > Surgery - Breast > Flashcards

Flashcards in Surgery - Breast Deck (59):
1

US for breast best to detect masses of what size?

> 1cm in diameter

2

Acute mastitis
- causes
- description
- tx

Usually due to S. aureus. It is a cellulitis (vs breast abscess needing drainage)

Need to r/o breast cancer!

Dicloxacillin
Cephalosporins

Cont breast feeding as can dec progression of mastitis to breast abscess

3

Mammo guidelines

- Should start at age 40
- DO NOT DO before 20 (breast too dense) or lactation (all is milk)

4

Fibroadenoma
- description
- management

Young women (< 35 yo)
Firm, mobile, rubbery mass
Increase size/tenderness with menstruation

FNA
Sonogram
OPTIONAL removal

5

Giant juvenile fibroadenomas
- description
- management

Young adults
Rapid growth

YES remove
To avoid deformity and distortion of breast

6

Cystosarcoma phyllodes
- description
- management

30-50 yo
LARGE bulky mass that is mobile and arises from lobular tissue
Most benign, but can turn malignant

Core or incisional bx
YES remove

7

Fibrocystic disease
- description
- management

30s-40s
Tender + grow w/ menstrual cycle
Usually not increase risk of carcionma
Diff histo types:
- fibrosis
- cystic
- sclerosing adenosis (microcalcificatiosn on mammo)
- epithelial hyperplasia

Mammo if no dominant or persistent mass
If persistent mass --> aspiration (not FNA)
If aspiration doesn’t disappear --> formal bx needed

8

Intraductal papilloma
- description
- management

Young women
Grows in lactiferous ducts
No increased cancer risk
Bloody nipple discharge

Mammogram to ID other lesions – will not show papilloma b/c too tiny
Galactogram (dx and for surgery resection)

9

Breast abscess
- description
- management

In lactating women

I & D
Bx of abscess wall

10

Treatment for breast cancer during pregnancy

No radiation
No chemo in 1st trimester
OK to keep pregnancy

11

DCIS
- description
- management

Can’t mets
Usually looks like microcalcifications on mammo
comedo has highest malignant potential

Diffuse lesions: Total simple mastectomy + Sentinel node bx

1 lesion: Lumpectomy + radiation

12

Breast cancer – resectable
- what do you do?

How about if not resectable?

Resectable:
Lumpectomy + axillary sampling + postop rad
Modified radical mastectomy + axillary sampling (sentinel lymph nodes)

Not resectable:
Chemo

13

Breast Cancer mets
- where does it go?
- dx?
- Tx?

Brain
<3 vertebral pedicles

14

Tx breast cancer in premenopausal? postmen?

Pre = tamoxifen

Post = anastrozole

15

Breast Cancer stage I

Tumor ≤ 2cm in diam
(-) mets
(-) nodes

16

Breast Cancer stage IIA

Tumor ≤ 2cm in diam + mobile axillary nodes
OR
Tumor 2-5 cm in diam, (-) nodes

17

Breast Cancer stage IIB

Tumor 2-5cm in diam + mobile axillary nodes
OR
Tumor > 5 cm, (-) nodes

18

Breast Cancer stage IIIA

Tumor > 5cm + mobile axillary nodes
OR
Any size + fixed axillary nodes, (-) mets

19

Breast Cancer stage IIIB

Peau d’orange OR
Chest wall invasion/fixation OR
Inflammatory cancer OR
Breast skin ulceration OR
Breast skin satellite mets OR
Any tumor + ipsilateral internal mammary lymph nodes

20

Breast Cancer stage IIIC

Any size tumor, (-) mets
+ supraclavicular, infraclavicular, or internal mammary lymph nodes

21

Breast Cancer stage IV

Distant mets (including ipsilateral supraclavicular nodes)
- Loves: lymph nodes, lung/pleura, liver, bones, brain

22

Metastatic breast cancer to bone - test to dx?

MRI

23

Mammo results w/ strong correlation with breast cancer

(1) breast calcifications that are
(a) smaller than 2 mm,
(b) punctate, microlinear, or branching,
(c) clustered along ducts or concentrated in clusters >5 calcifications per square centimeter;

(2) stellate-shaped lesions;

(3) masses with ill-defined borders or nodular contours;

(4) solitary dominant masses that are significantly larger than any other mass in either breast; and

(5) areas of increased noneffacing tissue density or distorted breast architecture.

24

What do breast cysts look like on mammo?

How do you confirm the nature of theses cysts?

Round, well-circumscribed densities

Confirm w/ breast US

25

Breast cyst suspicion - what do you do?

Aspirate and cytologic exam of cyst fluid

If lesions don't disappear w/ aspiration ---> excise

26

BRCA 1 and 2 - associations

BRCA 1 - breast + ovarian

BRCA 2 - breast

27

Breast cancer screening for non-high risk pts

Monthly breast self exam @20

Mammo @ 40 q 1-2 yrs until 50
Mammo @ 50 q 1 year

28

Breast cancer screening for high risk pts

Initial mammo at 30 q 1-2 yrs until 40
Mammo @ 40 q 1 year

29

Diffuse + multicentric DCIS - tx?

Simple masectomy w/ or w/o reconstruction

30

Small breast lesion - cancer - tx?

Wide excision
+
Radiotherapy

31

LCIS - chance to develop into invasive cancer over 20 years?

15-20%

It is incidental finding in histopath

It is a malignant disease marker

32

Tx LCIS

close observation

Exam + mammo q 6 months for the next several years

33

What things are essential to est in breast cancer?

Dx
Completely eradicate primary tumor
Determine if lymph node involvement
Determine if mets present

34

Arterial supply to breast

Venous return

Internal mammary
Lateral thoracic artery

Veins:
- axillary
- internal mammary veins

35

What is a modified radical mastectomy

Remove
- breast tissue
- skin
- axillary lymph nodes

Spares
- pec major

36

Simple masectomy

Removes:
- breast tissue
- nipple-areolar complex
- skin

37

Borders of the breast for masectomy

Superior - clavicle
Inferior - inframammary fold
Medial - sternum
Lateral - latissimus dorsi
Posterior - pec major

38

Borders of axilla

Superior - axillary v
Posterior - Long thoracic N
Lateral - latissius dorsi
Medial - pec minor

39

Levels of axillary lymph nodes

1 - lateral to pec minor

2 - deep to pec minor

3 - medial to pec minor

higher level of involvement, worse prognosis

40

How do you evaluate sentinel node?

INject blue vital dye or

Technetium - 99 labeled sulfur colloid

around primary tumor - will go to axillary lymph nodes

Gammaprobe will ID radiotracer

41

Contraindications to reconstructiton after mastectomies

Primary lesions involving chest wall
Extensive local or regional disease
Stage 3 or 4 cancer

42

Tx Stage 0, 1 (< 1cm) stage tumors

Lumpectomy
axillary sampling
Radiation

43

Tx Stage 1 w/ larger tumors (1-2 cm)

Lumpectomy
axillary sampling
post-op radiation
adjuvant therapy (based on ER status and menopause)

44

Tx Stage 2 cancer

Lumpectomy
axillary sampling
post-op radiation
adjuvant therapy (based on ER status and menopause)

OR

modified radical masectomy

45

Development of coma in pt w/ hx of breast cancer - what should you be suscpicious abotu?

Hyperacalcemia!!!

46

Who gets offered chemotherapy?

Stage 2 or greater

they ahve a 33-44% risk of recurrence of disease at 20 years w/ locoregional control only

Usually do"
- 5-FU/doxorubicin/cyclophosphamide
- Taxol
- trastuzumab

47

How long do you give antiestrogen therapy for pts w/ ER or PR + tumors?

5 years

48

What are the benefits of neoadjuvant therapy? Does it make a difference?

This is chemo before surgery

Improvements in breast conservation rate + better cosmetic results

NO shown survival difference

49

Tamoxifen s/e

uterine cancer

50

DCIS vs invasive ductal - what is difference?

Both from ductal hyperplasia

But DCIS is without basement membrane penetration

Both are more likely to be unilateral breast (vs bilateral in lobular)

51

Paget's disease

Eczematous patches on nipple

Usually has undelrying DCIS

52

Reasons for gynecomastia in men

Hyperestogenism
- cirrhosis
- testicular tumor
- puberty

Kleinfelter's

Drugs: SDCAK
Spironolactome
Digitalis
Cimetidine
Alcohol
Ketoconazole

Steroids

53

Tx inflammatory carcinoma of breast

Chemo first

Then radiation + masectomy

54

Causes of bloody nipple discharge

Next step

Intraductal papilloma
Ductal ectasia
Carcionma

--> B/l mammo + US

55

Ddx of nipple discharge (all kinds)

Pregnancy
Infections (mastitis/abscess)
Pituitary adenoma
Meds (metoclopramide, TCAs, OCPs)
Hypothyroidism
Fibrocystic changes
Intraductal papilloma (usually unilateral)
Diffuse papillomatosis (serous discharge, increased risk of cancer)
Carcionma

Can use ductogram for some to figure out if the etiology is in duct!

56

How do you tell if there is a bit of blood in a discharge?

Hemoccult test

57

When can you do a ductogram?

ONLY if they have active discharge

IF abnormal, need surgical bx
If normal, may suggest underlying carcionma

58

Most common factor increasing risk of breast cancer

having 1 or more 1st degree relatives who have had breast cancer

59

Atypical ductal hyperplasia
- characteristics
- management

Hyperplasia of ducts of lobules
Looks like DCIS
Assoc cancer risk is 4-5x higher

Management:
- core bx --> shows atypical ductal hyperplasia --> needle loc + excision