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29 Cards in this Set
- Front
- Back
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Notable risk factors for cancer
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Family history, menstrual history, reproductive history, lifestyle factors, hormone treatment, previous breast history
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Notable risks in family history
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First degree relatives with breast cancer (male or female)
Ovarian CA in first degree relatives Genetic testing- BRCA1/2 |
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Genetic testing indicated when
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1+ close family members with breast &/or ovarian CA
Male breast CA Ashkenazi + family member less than 50 with br/ovar CA Hx of bilateral breast CA or breast CA < 50 |
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Risk factors in menstrual history
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Menarche < 12
Menopause > 55 More cycling --> more risk |
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Risk factors in reproductive history
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Nullparity, first pregnancy @ > 30 years
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Risk factors in breast history
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Previous biopsy showing atypical ductal/lobular hyperplasia, LCIS or sclerosing adenosis
Or previous breast cancer |
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Risk factors pertaining to exogenous hormones
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Use for >5 yrs
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3 important lifestyle risk factors
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Smoking, alcohol, BMI > 25
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Why is fat considered a risk factor?
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Basically acts as an endogenous hormone. Cholesterol accumulation can lead to massive changes in hormone levels.
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3 components which should be considered when looking at risk of breast cancer
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Modifiable risk factors, non modifiable risk factors, Gail index calculation (5 yr & lifetime risk)
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American Cancer Society recommendations for breast cancer screening?
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Mammogram every year for women > 40
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Characteristic mammographic findings in a malignant mass
Benign findings |
New or spiculated mass, branching
Benign- fibroadenoma, fat necrosis, cyst often larger, less pleomorphic |
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In a breast ultrasound, how can we tell a mass from a cyst?
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Mass is hypoechoic (somewhat dark)
Cyst is anechoic (completely black) |
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Breast MRI is used when? What patients specifically?
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in addition to mammogram in high risk patients.
Pts with BRCA mutation, radiation exposure, Li Fraumeni syndrome (p53), Cowden syndrome (PTEN) |
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What is mutated in Li Fraumeni? What is its role? What is mutated in Cowden syndrome? What is its role?
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LF- p53 mutation, tumor suppressor (2-hit)
Cowden- PTEN mutation, tumor suppressor |
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Are most adenocarcinomas ductal or lobular? How are these further subdivided?
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85% ductal.
D & L are further classified as in situ & invasive. |
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Notable pathologic findings in DCIS vs LCIS
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DCIS- calcifications
LCIS- small uniform cells with mild atypia, no glands, no desmoplastic stroma, no CADHERINS |
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Her2/neu codes for what? What is the action of this gene product?
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EGFR which dimerizes and forms a tyrosine kinase which activates the cancer cell
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What are isoflavones used for?
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Cyst treatment
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What should be done if a person has a breast cyst?
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Aspirate, if turbid, send to cytology. If clear, probably ok.
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What should be done if a person has a solid mass?
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Core biopsy. If fibroadenoma & asymptomatic, follow up in 6 mos./ repeat US
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If a patient has multiple ducts with clear fluid, what should be done?
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Consider galactorrhea, check prolactin, workup sella turcica. Often NOT a breast surgical condition
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If a patient has single duct discharge what should be done?
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Mammo, US of subareolar area looking for mass. Consider intraductal papilloma or early DCIS.
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Rash/excoriation/edema of nipple. Should consider __________? What should be done.
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Paget's disease of the breast until proven otherwise.
Refer for biopsy. Get mammo/US to evaluate underlying abnormality |
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Contraindications to breast cancer surgery
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Previous radiation of chest wall, multicentric disease, active CT disease (SLE, scleroderma), BRCA1 or 2, cancer > 5 cm
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Indications for neoadjuvant therapy
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Non-resectable breast CA- locally aggressive, inflammatory, matted lymph nodes
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Double dye technique
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Used to identify positive central node & remove it
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N0
N1 N2 N3 |
0- 0 nodes
1- 1-3 nodes 2- 4-9 nodes 3- 10+ nodes |
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High risk recommendations?
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Close surveillance, chemoprevention (estrogen receptor antagonist like tamoxifen), bilateral mastectomies
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