Dx Of Breast Disease; Mgmt Breast Cancer

Front 1

What are post-menopausal breast changes?

Back 1

Breast atrophies without estrogen, glandular tissues atrophy and replaced by fat. Makes breast much less dense.

Front 2

With decreased ____, glandular breast tissue atrophies

Back 2

estrogen

Front 3

During what age do most breast cysts occur?

Back 3

peri-menopausal

Front 4

What is the key factor in breast exam?

Back 4

TIME spent on systemic palpation of entire breast, including axillary tail.

Front 5

What are "occult" mammographic abnormalities?

Back 5

Non-palpable changes. If they're cancer, they're smaller, which means they're more likely to be curable.

Front 6

What must breast discharge be like if it's pathologic?

Back 6

SPONTANEOUS (elicited nipple d/c isn't pathologic) and UNILATERAL

Grossly bloody - usually papilloma
Unilateral
Only galactorrhea (milk) needs endocrine evaluation

Front 7

T/F Focal breast pain is uncommon as a presenting breast cancer symptom.

Back 7

T, but about 10% of women have it.

Front 8

T/F In patient with a palpable breast mass, mammogram and ultrasound are helpful but may not establish dx.

Back 8

T

Front 9

Signs/Sx of breast cancer

Back 9

Occult mass or calcifications
Breast mass or “thickening”
Spontaneous nipple discharge
Skin dimpling
Nipple retraction or scaling
Skin erythema or peau d’orange
Focal breast pain – 10%

Front 10

Fibrocystic breast change: defn

Back 10

Variation of normal.

condition of breast tissue affecting an estimated 30-60% of women. It is characterized by noncancerous breast lumps in the breast which can sometimes cause discomfort, often periodically related to hormonal influences from the menstrual cycle.

Front 11

What is the most worrisome fibrocystic breast change?

Back 11

Atypical ductal hyperplasia (ADH): associated with to 10x risk of breast cacner.

Front 12

Fibroadenoma: defn

Back 12

Smooth, mobile, growth in young women (teens, 20s). Remove if there's rapid grwoth, symptomatic, >2 cm size, or to rule out cancer in older women

Front 13

Intraductal papilloma

Back 13

Retroareolar mass
Causes Nipple discharge

Front 14

Duct ectasia: what is it?

Back 14

Dilated central millk ducts that cause nipple discharge of varying colors.

Front 15

Cystosarcoma phyllods: defn

Back 15

rapidly growing breast tumor, similar to fibroadenoma. About 10% truly malignant.

Front 16

Mammogram: screening guidelines

Back 16

Annual screening after age 40
For high risk patients, start before family members developed cancer.

Front 17

How are suspected cysts managed?

Back 17

Mammogram
Ultrasound

OR

Needle aspiration, especially if symptomatic
If cystic by sonogram and no symptoms, follow

Front 18

Mammograms are most important for evaluation (occult, palpable) masses.

Back 18

Occult. but it SHOULD be done before biopsy in age >30.

Front 19

What are mammographic signs of cancer?

Back 19

Masses, calcifications, dilated ducts, architectural distortion, skin changes, asymmetry.

Front 20

Appearance of cystic mass on U/S

Back 20

Dark middle with bright echo

Front 21

Appearance of cancerous mass on U/S

Back 21

taller than wide (because it can't be squashed); Have acoustic shadows behind mass. Irregular shape.

Front 22

most useful test for high risk women and why?

Back 22

MRI. complex, v. expensive. Will see "enhancing" areas of high blood flow. Can show response to treatment or find occult lesions in women with metastatic cancer in lymph nodes

Front 23

What types of biopsy should be taken for palpable lesions?

Back 23

Fine Needle Aspiration (FNA) or Core Needle Biopsy, NOT open biopsies

Front 24

Fine Needle Aspiration (FNA) : pros

Back 24

quick answer (20-30 mins)
Minimal bleeding
Avoids psych trauma of one-step procedure (frozen section followed by definitive surgery without further patient input.)

Front 25

Fine Needle Aspiration (FNA) : Cons

Back 25

False negatives rates up to 20%, such that most palpable masses should be surgically biopsied if FNA is negative

Front 26

Triple negative test

Back 26

1) Clinical exam is not suspicious (No definite mass)

2) Mammogram is negative

3) FNA cytology is negative

Then there is very low risk of cacner.

Front 27

T/F Palpable masses are dependent on the findings of mamamography to determine when to biopsy

Back 27

F

Front 28

Core needle biopsy: pros

Back 28

Primary method of dx in most patients

Provides more material for marker studies (ER, HER-2/neu), Can make definitive call on invasion.

Advantages also similar to the advantages of FNA.

Front 29

Core needle biopsy: cons

Back 29

Requires local anesthetics

More painful

24-48 hour turnaround

Front 30

When should surgical biopsy be used?

Back 30

ONLY after attempting dx by needle biopsy (core or fine) fails to be conclusive

Front 31

What is BIRADS?

Back 31

Breast Imaging-Reporting and Data System, a quality assurance tool originally designed for use with mammography.

Varies from zero (incomplete) to 6 (certainly cancer)

Front 32

How should occult breast lesions be handled?

Back 32

Image guided, minimally invasive biopsy, based on more accurate localizations.

Front 33

If core biopsy shows ductal or lobular hyperplasia with ATYPIA, then what?

Back 33

There's a 30% chance there's also cancer present, and lesion should be surgically excised.

Front 34

Lobular carcinoma in situ (LCIS) : What is it?

Back 34

Condition in which abnormal cells form in the lobules or milk glands in the breast. Not cancer itself, but have a higher chance of developing cancer.

Front 35

What is the triad of error of missed BC dx?

Back 35

Young Age

Mass found by patient

Negative mammogram

Front 36

What are genetic factors increasing risk of BC?

Back 36

BRCA1
BRCA2
Li-Fraumeni (p53)
Cowden disease
Ataxia telangiectasia

Front 37

Cowden disease: defn

Back 37

Cowden disease (multiple hamartoma syndrome) causes hamartomatous neoplasms of the skin and mucosa, GI tract, bones, CNS, eyes, and genitourinary tract.

Front 38

What does the Gail model do?

Back 38

Formula for risk of developing breast cancer based on presence of risk factors.

Front 39

Chemoprevention of breast cancer

Back 39

Tamoxiden or Raloxifene

Estrogen receptor blockers.

Reduced recurrence of ER+ BC but ALSO reduced incidence of contralateral breast cancer almost by half.

Front 40

Options for Mutation-Positive or Other High Risk Women (3)

Back 40

1) Intensive screening
2) Chemoprevention
3) Prophylactic mastectomies +/- oophorectomies

Front 41

Anti-___ therapy can cause regression of breast cancers that express hormone receptors

Back 41

estrogen

Front 42

lifetime incidence of breast cancer

Back 42

13% in women (1 in 8)

Front 43

Why is it suspected that incidence of breast cancer has declined slightly?

Back 43

Bc of declining use of HRT after menopause.

Front 44

What was the original view of bc metastasis?

Back 44

There was gradual progression and contiguous spread to nodes, systemic spread occurs later.

Front 45

What is the modern view of bc mets ?

Back 45

Lymph node mets are predominantly embolic; therefore they're indicators of, not necessarily SOURCES of distant mets.

Front 46

What were the implications of the demonstration that resecting clinically negative axillary lymph nodes does not alter survival?

Back 46

Brought recognition that lymph node spread is a marker for systemic spread, but not necessarily the SOURCE of the spread.

Front 47

Mastectomy vs. Breast Conservation Therapy: Which is better?

Back 47

NO DIFFERENCE for most patients.

Front 48

Segmental mastectomy is aka

Back 48

lumpectomy

Front 49

If segmental mastectomy/lumpectomy is performed instead of mastectomy, what must also be done?

Back 49

radiation

Front 50

advantages of breast conservation therapy (BCT)

Back 50

psychologic

cosmetic

It may encourage earlier diagnosis bc patients are less afraid of mutilation.

Front 51

What are true contraindications for BCT?

Back 51

1) Diffuse malignant calcifications ; Two or more separate foci of cancer in separate quadrants

2) Prior breast irradiation

3) Inability to achieve tumor free margins on resection, but repeat BCT may be feasible

4) Psychologic or social factors that make radiation therapy inaccessible.

5) Patient choice

Front 52

T/F Pregnancy is a contraindication for BCT

Back 52

F. Delaying radiation therapy until after delivery. Chemo can be given safely during 2nd and 3rd trimesters.

Front 53

What is done if Tumor too large relative to breast in order to still perform BCT?

Back 53

Can do chemo to shrink

Front 54

Interstitial radiation is aka

Back 54

brachytherapy

Front 55

T/F Radiation is absolutely necessary after BCT

Back 55

T

Front 56

How is Ductal Carcinoma in Situ (DCIS) managed?

Back 56

Everything from excision and observation to total mastectomy may be appropriate for individual patients. Tamoxifen. Use molecular markers to predict risk of recurrence.

Front 57

T/F DCIS patients need axillary node dissection

Back 57

F

Front 58

What is axillary dissection used for?

Back 58

Primary a staging procedure which indicates prognosis.

Front 59

What is lymphedema?

Back 59

Blocking of lymph channels, causing chronic swelling. never fully goes away.

Front 60

What is sentinel lymph node biopsy?

Back 60

A technique to ID those patients with positive axillary lymph nodes, while avoiding the morbidity of axillary node dissection.

Front 61

What is hormonal adjuvant therapy?

Back 61

For tumors that express estrogen and progesterone receptors.

Tamoxifen

Aromatase inhibitors (postmenopausal only!)

Front 62

In what women can aromatase inhibitors be used?

Back 62

postmenopausal ONLY

Front 63

What can be used instead of tamoxifen or aromatase inhibitors in premenopausal women?

Back 63

oophorectomy

Front 64

What is cytotoxic adjuvant chemo?

Back 64

Multi-drug regimens. Decreases recurrence rates, improves survival.

Front 65

T/F molecular profiling is dramatically altering prognostic assessments

Back 65

T

Front 66

Trastuzumab: MOA

Back 66

Monoclonal antibody that targets HER2 protein