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31 Cards in this Set
- Front
- Back
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Breast
-what is the functional unit of the breast which most of breast diseases arise? |
Terminal Duct Lobular Unit (TDLU)
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Benign Epithelial Lesions of the Breast
-classification (3) |
1. Non-proliferative fibrocystic changes
2. Proliferative fibrocystic changes without atypia 3. Proliferative fibrocystic changes with atypia |
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BRCA-1
-type of gene -associated with what cancers -change of developing cancer |
-tumor suppressor gene on chromosome 17 (DNA repair enzyme)
-associated with pre-menopausal breast/ovarian cancer -carriers have 85% chance of developing breast cancer |
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Carcinoma of the Breast
-classification (2) |
1. Non-invasive or in situ carcinoma
-ductal carcinoma in situ - Paget's disease -lobular carcinoma in situ 2. Invasive carcinoma -invasive ductal carcinoma (75%) -invasive lobular carcinoma |
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Ductal carcinoma in situ
-common presentation -characteristics (grade, necrosis) |
15-30% of breast carcinoma
-most common presentation is mammographic calcifications -can be low, intermediate or high grade -can have central necrosis -Paget's disease of the nipple |
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Paget's disease of the nipple
-definition -histology |
-Erosion/Inflammation of nipple/areola due to extension of neoplastic cells to epidermis along collecting ducts
-associated with underlying inraductal tumor in most cases -Paget's cells have abundant, clear cytoplasm and appear in the epidermis either singly or in clusters. -nuclei are atypical and often have prominent nucleoli |
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Lobular carcinoma in situ
-presentation -histology |
-almost always incidental, not associated with microcalcifications and no stromal reaction
-not a true neoplasm: carcinomas occur at equal frequency in both breasts -small cells with round nuclei filling the lobules |
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Inflammatory breast cancer
-definition -gross characteristics -microscopic characteristics |
-not a specific type of breast cancer
-advanced stage and poor prognosis -skin is thickened, erythematous and rough - orange peel appearance -microscopic dermal lymphatic invasion by underlying invasive carcinoma |
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Prognostic factors for breast cancer
-definition -factors (4) |
-determine the natural history of disease progression in the absence of therapy - they reflect the intrinsic biologic effect of the tumor
1. Axillary node status (most important) 2. Tumor size 3. Tumor grade 4. Hormone receptors |
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Predictive factors for breast cancer
-deifinition -factors (2) |
-cues that a particular tumor might respond to a specific therapy
1. HER-2 2. ER/PR status |
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What is the most significant prognostic indicator in breast cancer?
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Axillary lymph node status
-direct relationship between the number of involved nodes and risk for distant recurrence |
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Stromal tumors of the breast (2)
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1. Fibroadenoma (common, regression occurs postmenopausally)
2. Phyllodes tumor of the breast |
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Digital mammography
-indications (3) |
Women who fit any of these categories
1. Under age 50 2. Of any age with heterogeneously (very dense) or extremely dense breasts 3. Pre- or peri-menopausal women of any age - women who had a LMP w/in 12 months of their mammograms |
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Breast MRI
-indications |
Always in addiction to mammogram
1. BRCA1 or BRCA2 genes 2. A 1st degree relative with BRCA1 or BRCA2 mutation 3. Lifetime risk of breast cancer between 20-25% 4. Had radition to the chest between ages of 10-30 5. Li-Fraumeni syndrome or Cowden syndrome or any family members with either. |
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Palpable breast mass
-biopsy techniques used (3) |
1. Fine needle aspiration (FNA) - painless, rapid and convenient
2. Core biopsy - hand held or ultrasound guided 3. Open surgical biopsy |
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Nonpalpable breast mass
-biopsy techniques (3) |
1. Stereotactic core biopsy
2. Ultrasound guided core biopsy 3. Open needle localized excisional biopsy |
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Mastalgia
-what is it? -is it cancerous? -how do you treat it? |
Breast pain that is cyclic and though to be hormonal - usually resolves at menopause
Not cancerous and treatment is conservative - discontinue caffeine and decrease dietary fat |
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Fibrocystic changes of the breast
-what is it? -is it cancerous? -how do you treat it? |
Wide spectrum of clinical and histological findings (breast nodularity) - usually presents with breast pain, swelling and tenderness which may be associated with focal areas of nodularity, induration or gross cysts
Frequently bilateral, usually cyclic Rule out cancer, treat pain, drain cyst if necessary |
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Nipple discharge
-Physiologic -Galactorrhea -Pathologic -treatment |
Physiologic is usually bilateral, non-bloody, from multiple ducts and nonspontaneous
Galactorrhea (strictly milk) can be drug induced or from a pituitary adenoma Pathologic is usually unilateral, from a single duct, bloody (needs biopsy) and spontaneous - 6-12% will have carcinoma (intraductal papilloma) -Biopsy is there is a mass -Excise duct if discharge is guaiac + and there is no mass |
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Breast Duct Ectasia
-what is it? -is it cancerous? -how do you treat it? |
Subareolar ductal dilatation with fibrosis and inflammation filled with debris, secretions and keratin - mean age 55, associated with smoking
Nipple dischage, nipple inversion are somewhat common Mass occurs 47% of the time and presents as an abscess 12% of the time Treatment can be antibiotics, local care and heat, but usually requires terminal duct excision |
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Fibroadenoma of the breast
-what is it? -is it cancerous? -how do you treat it? |
Most common lesion in women less than 30 - smooth round, firm, mobile, nontender, well-circumscribed and usually solitary
Hormonally dependent may increase in size with birth control or pregnancy No increased risk of breast cancer 33% regress spontaneously, observe if mass is small and woman is less than 25 - core biopsy if it occurs during pregnancy or woman is older than 25 |
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Mondor's disease
-what is it? -is it cancerous? -how do you treat it? |
Thrombophlebitis of the superficial thoracoepigastric vein - presents with pain and palpable cord
Not cancerous Treat with NSAIDs for pain relief |
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Sclerosing Adenosis
-what is it? -is it cancerous? -how do you treat it? |
Presents as breast mass or breast pain - mammography has area of increase density or microcalcification
Diagnosed by stereotactic biopsy if inconclusive excisional biopsy |
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Radial Scar and Complex Sclerosing Lesion of Breast
-what is it? -is it cancerous? -how do you treat it? |
Histologically identical but differ in size - usually a mammographic or incidental finding on biopsy
Can mimic cancer therefore must be biopsied |
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Ductal Carcinoma in situ - stage 0 breast cancer
-presentation -characteristics -treatment |
Usually found on screening mammogram as microcalcifications
Can be multicentric and diffuse, does not spread to lymph nodes Treatment: -simple mastectomy indicated if multicentric or > 5cm or patient choice -lumpectomy w/ negative margins and radiation therapy -if estrogen receptor positive, Tamoxifen for 5 years |
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Lobular Carcinoma in situ
-presentation -characteristics -treatment |
Incidental finding usually lacks clinical and mammographic signs - usually in premenopausal women.
Multicentric, bilateral (30%) Treatment: -complete excision not indicated, does not lower future risk of breast cancer |
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Invasive ductal carcinoma
-characteristics |
Most common breast carcinoma (75%)
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Invasive lobular carcinoma
-characteristics (2) |
5-10% of breast cancer - can present as a mammographically silent mass
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Inflammatory breast cancer
-characteristics |
Most aggressive with rapid onset, 90% with positive node at time of diagnosis - can be mistaken for mastitis
+/- associated with a breast mass |
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Breast cancer
-staging (0 - IV) |
0: Carcinoma in situ
I: Tumor < 2cm , no axillary nodes involved II: Tumor >2cm or axillary nodes involved III: Tumor >5cm or penetrated chest wall or multiple nodes IV: Distant metastasis |
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Surgical treatment options for breast cancer stage 0-II
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1. Breast Conservation Therapy (BCT) - lumpectomy with negative margins followed by radiation therapy
2. Simple/total/complete mastectomy 3. Modified radical mastectomy 4. Axillary Lymph Node Dissection - removes nodes in I, II and III if grossly involved 5. Sentinel Lymph Node biopsy |
