Repro 20-22

Front 1

Nonproliferative Lesions breast lesions

Back 1

Cysts, Papillary apocrine change, Epithelial calcifications, Mild hyperplasia-usual type

Front 2

Proliferative breast lesions without Atypia

Back 2

– Moderate/florid hyperplasias
– Intraductal papillomas
– Sclerosing adenosis
– Radial Scar
– Fibroadenomas

Front 3

Atypical breast Hyperplasias

Back 3

- proliferative lesions that possess some, but not all features of carcinoma insitu
– ADH (features similar to DCIS)
– ALH (features seen in LCIS)

Front 4

Fibroadenomas

Back 4

– Pseudoencapsulated, demarked, ovoid
– Mobile, multilobulated

Front 5

Adenomas

Back 5

– Well circumscribed tumors of benign epithelium elements with sparse stroma
– Tubular, Lactating, Nipple

Front 6

Mammory Duct Ectasia

Back 6

- Dilated, thick walls, fibrotic stroma, rupture, leakage of pasty secretion into surrounding tissue -> inflamm and fat necrosis
– Sx are Pain, nipple inversion, greenish D/C

Front 7

Granulomatous Mastitis

Back 7

– Immune response
– firm tender nodules, capsule
– varying imflamm, fibrosis
– needs surgery

Front 8

Mondor’s Disease

Back 8

- phlebitis of the breast

Front 9

Diabetic Mastopathy

Back 9

- Autoimmune, painful mass development with fibrotic nodularity

Front 10

Cellulitis

Back 10

- from SA
- overweight, large breasted, previous surgery, radiation, sebaceous cysts are RFs

Front 11

Hydradenitis

Back 11

– extensive, painful “Boils” – from weird sweat glands in black smokers

Front 12

Tx of Lactiational Infections

Back 12

– Dicloxcillin, Flucloxacillin, Augmentin, Erythromycin, Clindamycin – Tetracycline, Cipr and Chloremphenicol shouldn’t be used – Continue Breastfeeding – Post I&D w/ General anesthesia: stop

Front 13

BRCA1

Back 13

– 17q21 for breast, ovarian
– 1/200-400 w/ 85% lifetime risk
– its in > half by age 50
– 1/2 of “inherited” cancers (10% of cancers)
– also increased risk of ovarian and colon cancers

Front 14

BRCA2

Back 14

– 13q breast in women and men
– 70% of inherited not due to BRCA1
– 30-40% lifetime risk

Front 15

Mucinous (Colloid) Carcinoma

Back 15

– Older women
– Malignant cells in pools of mucin
– Better prognosis

Front 16

Tubular Carcinoma

Back 16

– Younger women – Well differentiated, characterized by haphazardly arranged tubules – Excellent prognosis

Front 17

Inflammatory Carcinoma

Back 17

– Invasive carcinoma involving superficial dermal lymphatic spaces
– Erythema and induration of skin – dimpling
– Poor prognosis finding

Front 18

Sentinel Lymph Nodes Identified by

Back 18

Radioactive technetium-labeled sulfur colloid and Isosulfan blue dye

Front 19

Herceptin

Back 19

– Recombinant humanized anti-HER2 antibody
– Inhibits growth of breast cancer cells that overexpress c-erbB-2
– Enhances tumoricidal effects of chemo

Front 20

genes w/ high penetrance for breast cancer

Back 20

BRCA1, BRCA2, P53, Ataxia Telangiectasia mutation (ATM) – PTEN, NBS1, LKB1

Front 21

DCIS Management

Back 21

– Can be detected on screening MAMM w/ prognosis favorable
– Mastectomy or Lumpectomy + radiation OK
– tamoxifen + lumpectomy + rad decreases recurrence of DCIS & invasive

Front 22

Tamoxifen

Back 22

– best pre-menopausal women
– Selective ER modulator that blocks effects of E at tumor ERs
– E-like effects in other tissues such as bones and the endometrium, and on lipids

Front 23

Tamoxifen SE’s

Back 23

– altered menses, hot flashes, nausea, fatigue vaginal discharge, cataracts
– risk of thromboembolism, stroke, and uterine cancer (1:160)
– most thromboembolic events and strokes were non-fatal
– most endometrial cancer are early stage and curable

Front 24

Ovarian suppression

Back 24

– can be given w/ tamoxifen to pre-menopausal pts
– surgical by bilateral oopherectomy
– with radiotherapy, or w/ Gn-RH agonists like goserelin or leuprolide
– it reduces risk of recurrence
– Benefit of ovarian suppression + tamoxifen unknown

Front 25

Anastrozole

Back 25

– aromatase inhibitor
– in post-menopausal
– more osteoporosis, but lower risk of thromboembolism and stroke

Front 26

Letrozole

Back 26

– aromatase inhibitor
– in post-menopausal
– more osteoporosis, but lower risk of

Front 27

Exemestane

Back 27

– aromatase inhibitor
– in post-menopausal
– more osteoporosis, but lower risk of

Front 28

AC therapmy

Back 28

– 3rd and 4th gen chemo regemins for breast cancer
– (better, more SE)
– every 3 weeks X 4 cycles

Front 29

Adriamycin

Back 29

– topoisomerase II inhibitor and DNA intercalating -> strand breaks
– causes myelosupression, NandV, mucositis and alopecia, fatigue
– rare risk of leukemia and cardiac toxicity

Front 30

Cyclophosphamide

Back 30

– Alkylating agent binds DNA, cross-links, cell death
– Causes myelosupression, NandV
– Rare tox of hemorrhagic cystitis and SIADH

Front 31

Dose Dense Therapy with AC + Taxol

Back 31

– AC x 4 cycles, then Taxol x 4 cycles
– Given every 2 weeks from theory that 3 wks allows cancer cells to recover, and GFs that allow every 2 wk
– good in in LN (+) pts
– Paclitaxel may cause peripheral neuropathy, myalgias, and allergies

Front 32

Her2

Back 32

– does cell signaling and prolif
– Overexpression means more aggressive cancer (in 25 - 30%)

Front 33

Trastuzumab

Back 33

– (Herceptin)
– a monoclonal Ab against HER2-neu protein

Front 34

Bevacizumab

Back 34

goes against VEGF and should be used for angiogenesis of breast cancer

Front 35

Bisphosphonates

Back 35

– inhibit osteoclast activity and monthly infusions help
– for breast cancer mets