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74 Cards in this Set
- Front
- Back
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Most frequent complication of mastectomy and axillary lymph node diessection. How can you prevent it?
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Seromas beneath the skin flaps (30% of cases). Can be prevented with drains.
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Under what circumstances are adjuvant chemotherapy indicated for node-negative women?
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Indicated in women with cancers between 0.6cm - 1.0 cm AND with unfavorable prognostic indicators
(blood/lymph vessel invasion, high nuclear/histologic grade, HER-2/neu overexpression, negative hormone receptor status). |
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Adjuvant therapy for hormone receptor-negative cancers.
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Chemotherapy.
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Adjuvant therapy of choice for hormone receptor-positive cancers.
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Tamoxifen.
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What are characteristics of nipple discharge caused by cancer?
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Spontaneous, unilateral, localized to a single duct, occurs in women age >40, bloody, or associated with a mass.
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What are characteristics of nipple discharge caused by a benign process?
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Bilateral, multiductal in origin, occurs in women age <39, milky or blue-green in color.
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Treatment of breast cancer in pregnant women (by trimester).
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1st - 2nd trimester: modified radical mastectomy (due to deleterious effects of radiation on the fetus)
3rd trimester: BCT with radiation postponed until after delivery |
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Rate of male breast cancer.
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1% of all breast cancers
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Most common type of male breast cancer.
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Infiltrating ductal CA
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Phyllodes tumor
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Tumor consisting of mainly connective tissue, mixed with gelatinous, solid, and cystic areas.
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Are phyllodes tumors maligant?
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Can be classifed as benign, borderline, or malignant.
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Treatment of phyllodes tumors.
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Complete excision (mastectomy if large). Axillary dissection is not recommended as axillary lymph node metastasis is rare.
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Treatment of inflammatory breast cancer.
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Neoadjuvant therapy, MRM, adjuvant therapy.
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Hormones that have trophic effects on the breast tissue.
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Estrogen (initiates development), progesterone (differentiation), and prolactin (milk production).
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Gynecomastia
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Enlargement of breast tissue in male.
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Presentation of gynecomastia.
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Puberty: unliateral and typically occurs between ages 12-15; caused by excess estradiol.
Senescent gynecomastia: bilateral; caused by decrease in testosterone. |
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Most common organism(s) recovered from nipple discharge in an infected breast.
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Staph. aureus
Streptococcus species |
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Treatment of breast infections.
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Local wound care, warm compresses, IV antibiotics (PCNs or cephalosporins)
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Hidradenitis suppurativa
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A chronic inflammatory condition that originates within the accessory areolar glands of Montgomery or within the axillary sebaceous glands.
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Treatment of hidradenitis suppurativa.
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Abx therapy with I&D of fluctuant areas.
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Mondor's disease
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Variant of thrombophlebitis involving superficial chest and breast veins.
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Presentation of Mondor's disease.
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A thrombosed vein that presents as a tender, cord-like structure.
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Treatment of Mondor's disease.
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Anti-inflammatory medications and warm compresses.
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Age range for fibroadenoma.
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Women age 15-25.
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Risk factors for developing breast cancer.
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Any increase in estrogen exposure increases the risk of breast cancer:
early menarche, nulliparity, late menopause Also: number of first degree relative with breast cancer, race, number of breast biopsies, age at first live birth |
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Most commonly used model for determining risk of breast cancer.
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Gail model
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Effects of post-menopause HRT.
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Reduces the risk of CAD and osteoporosis by 50%, but increases the risk of breast CA by 30%.
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Is breast cancer painful?
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Usually not. Breast pain is usually associated with benign disease.
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Management of a young woman (<45 y.o.) with a palpable breast mas and equivocal mammographic findings.
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Ultrasound and biopsy.
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Screening vs diagnostic mammography.
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Screening mammography is used to detect unexpected breast cancer in asymptomatic women.
Diagnostic mammography is used to evaluate women with abnormal findings such as breast mass or nipple discharge. |
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FNA vs core needle biopsy (CNB).
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FNA allows for histologic/cytologic diagnosis.
CNB allows for grading of cancer (architecture is preserved). |
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What is the single most important predictor of 10- and 20-year survival rates in breast cancer?
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The number of axillary lymph node involved with metastatic disease.
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Treatment of LCIS.
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Observation with/without tamoxifen - LCIS is considered a marker for increased risk rather than an inevitable precursor of invasive disease.
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Is there any benefit of excising LCIS?
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No. The disease diffusely involves both breasts and risk of invasive cancer is equal for both breasts.
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Treatment of DCIS.
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Limited disease: lumpectomy + adjuvant radiation.
Widespread disease (two or more quadrants): mastectomy. |
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Recurrence and mortality rates for lumpectomy + adjuvant radiation vs mastectomy.
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Mortality rates are the same for both (<2%), but recurrence rate for lumpectomy is greater (9%).
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Treatment of Stage I breast cancer.
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Lumpectomy + adjuvant radiation.
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Treatment of Stage II breast cancer.
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Lumpectomy + adjuvant radiation.
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Treatment of Stage III breast cancer.
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Surgery + adjuvant radiation + chemotherapy.
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Treatment of Stave IV breast cancer.
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Palliative and supportive:
Chemotherapy, Sx for sequelae (brain mets, pleural/pericardial effusion, symptomatic visceral mets), bisphosphonates. |
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Breast conservation therapy (BCT).
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Lumpectomy + sentinal lymph node biopsy (SLNB) + adjuvant radiation.
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Relative contraindicatios for BCT.
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1. History of radiation to the chest wall
2. Positive surgical margins or unknown margins following re-excision 3. Multicentric disease 4. Scleroderma or other connective tissue disease |
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Next step in management of positive/unknown SLNB.
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Axillary LN dissection.
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Indication for adjuvant endocrine therapy (tamoxifen).
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Hormone-positive cancers greater than 1 cm in size.
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Contraindications for SLNB.
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1. Palpable LAD
2. Prior axillary surgery 3. Chemotherapy or radiation therapy 4. Multifocal breast cancer |
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What three nerves are most at risk of injury during an axillary dissection?
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Long thoracic (serratus anterior),
thoracodorsal (latisimus dorsi), and intercostobrachial (T2 sensory). |
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The axillary lymph nodes are classified according their relationship with what structure?
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Pectoralis minor muscle
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What percentage of breast cancers are hereditary?
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5-10%
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What risk factors are included in the Gail model for breast cancer risk?
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Age, race, number of breast biopsies, age at menarche, age at first live birth, number of first degree relative with breast cancer.
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What level of risk according to the Gail model requires further evaluation?
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A risk greater than 1.7% at 5 years deserves to be addressed.
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What intervention can be used for women with a Gail risk greater than 1.7%?
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Tamoxifen
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Role of BRCA 1 and 2.
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The protein product is involved in DNA damage repair.
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Cancers associated with BRCA2 mutation.
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Breast, ovarian, melanoma, colon, prostate, pancreatic, biliary, stomach
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Lifetime risk of breast cancer in women with BRCA2.
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60-85%
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Lifetime risk of ovarian cancer in women with BRCA2.
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10-20%
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What is the relative risk of developing breast cancer in women taking OCP?
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RR = 1.24
However, the risk returns to normal after 10 years of discontinued use. |
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Diagnostic test of choice for a newly found breast mass.
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Ultrasound
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False negative/positive rate of mammogram.
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10-15% false negative rate.
10% false positive rate. |
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What regions are difficult to examine with mammography?
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Deep lesions against the chest wall, lateral in the tail of the breast, inferior in the inframammary fold.
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Indications for breast MRI.
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1. Tumor staging to determine extent of diseae.
2. Differentiating scar tissue from cancer recurrence. 3. Evaluating axillary metastasis of unknown origin. |
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Organism and treatment for breast cellulitis associated with lactation.
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Gram + cocci.
Treat with oral abx, warm packs, and emptying of the breast. The infant can still be breast fed. |
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Most common cause of bloody discharge.
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Intraductal papilloma (a benign condition, but still requires investigation to rule out cancer).
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Are phyllodes tumors benign or maligant?
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75% are benign.
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Next step in management of a new breast mass.
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Ultrasound ALL new breast masses, regardless of patient age or suspicion for cancer.
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First step in management of breast mass in MEN.
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Breast exam and ultrasound (similar to any new mass in women).
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Tietze's syndrome.
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Chostochondral joint pain.
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Percentage of mastalgia caused by breast cancer.
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7-24%
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Treatment of mastalgia.
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Reassurance and pain medication.
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Effect of tamoxifen on estrogen receptors.
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Antagonist in breast tissue; agonist in endometrial tissue.
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Risk of endometrial cancer with Tamoxifen.
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1%
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Most common SE of Tamoxifen.
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Hot flashes and sleep disturbances.
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Overall effect of Tamoxifen.
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Decrease breast cancer, increase endometrial cancer, increase bone density, increase venous embolism, improves lipid profile.
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Rate of decrease in breast cancer for women taking Tamoxifen.
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~50% decrease in risk.
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What is the rate of malignant transformation of LCIS? What is the most common cancer that develops?
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1% per year, indefinitely.
The most common type of cancer that develops is infiltrating ductal carcinoma. |
