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80 Cards in this Set
- Front
- Back
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When a patient comes in with a breast complaint, what do you always want to know?
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Breast history
Family history History of estrogen exposure |
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What do you want to find out about a person's breast history?
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Abnormal mamogram
Previous biopsies and results |
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What are elements of an estrogen (or ob/gyn) history that you want to get from a person with a breast complaint?
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Age of:
menarche menopause Pregnancies Live births |
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What are the cancers in a family history that can indicate increased breast cancer risk for your patient?
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Breast cancer
Prostate cancer Ovarian cancer |
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Who is at red flags for breast cancer?
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Low age of breast cancer
Ashkenazi jewish descent 2 or more first degree relatives with breast/ovarian cancer Male breast cancer in the family |
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What puts people at higher risk for breast cancer?
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Prior history
History of abnormal histology Early menarche Late menopause Radiation exposure Hormone replacement Genetic predisposition |
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What are you looking for in the breasts on physical exam?
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Asymmetry
Skin changes Nipple discharge |
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What nodes should you check for mets in a person with a breast mass?
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Cervical
Supraclavicular Axillary |
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If someone comes in with nipple discharge or a palpable mass, what do you always do?
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Pathology report, every time!
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What should give you a HIGH clinical suspicion for breast cancer?
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If a certain element of the workup is out of line:
-history -physical -imaging -pathology |
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What are the imaging options for breast pathology?
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US
Mammogram mRI |
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What's the sensitivity of mammography?
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80-90%
IT DOES MISS THINGS. |
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What percentage of women will show negative imaging?
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10-20%
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What's the usefulness of mRI in breast pathology?
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Not really useful, quite frankly.
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What are the different ways that people can get a biopsy of breast tissue?
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Fine needle aspiration
Core needle biopsy Sterotactic core biopsy Wire localization biopsy |
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What are the disadvantages of a fine needle aspirate for a biopsy?
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Only tells you if it's malignant or benign
No information on receptor status False negative in up to 10% of specimens 25 needle |
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What information can you get from a core needle biopsy?
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All of the information you need:
-Differentiate between benign, carcinoma -Invasive or in-situ -Receptor status -Surgical planning |
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If you get a negative result on your core biopsy, what should you do?
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You should take another biopsy, just to make sure that you didn't get a false negative
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What are the indications for a stereotactic core biopsy?
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If there's a mass that's present on imabing but otherwise isn't visible.
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If we can't do a core, stereotactic, or other kind of biopsy, what do we do?
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Wire localization biopsy
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If there's an abnormal mammogram showing microcalcifications, what do we get? Palpable mass?
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Abnormal mammogram: stereotactic core needle biopsy
Palpable mass: core needle biopsy |
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What are the chances that a nonpalpable change on mamogram is cancer?
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10-20% chance of malignancy
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What are the chances that a newly present palpable mass is cancer?
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15%
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What are the chances that a palpable mass plus change on mamogram is cancer?
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50-80%
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What are the chances that a nipple discharge is cancer in the pesence of abnormal imaging?
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5%
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What's the most common breast neoplasm in adolescents and young adult women?
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Fibroadenoma
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When should you remove a fibroadenoma?
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Changes on exam and imaging
>2 cm in size |
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If someone has a mass in her breast, what do you always do?
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Biopsy
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What people show fibrocystic changes in their breasts/
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30-35% of women between 20 and 40
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What's the common presentation of a woman with fibrocystic change?
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Multifocal, bilateral
Premenstrual swelling and tenderness |
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Are fibrocystic changes in the breasts associated with increased cancer risk?
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No
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What's the treatment for fibrocystic changes in the breasts?
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NSAIDS
Oral contraceptives Evening primrose oil |
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What is a possible benign cause of nipple discharge?
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Intraductal papilloma
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What is one way that you can image the ducts of the breast?
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Ductogram
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What's the most common abnormality of the male breast?
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Gynecomastia
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What conditions is gynecomastia associated with?
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Hyperthyroidism
Cirrhosis Chronic renal failure Pulmonary malignancy Testicular tumors |
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What problems are common to breast-feedign women?
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Mastitis
Breast infection |
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What are the high-risk lesions of the breast?
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Atypical hyperplasia
Lobular carcinoma in situ |
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What's a chemoprevention medication offered for people at risk for breast cancer?
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Tamoxifen
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When should you give chemoprevention to people with atypical hyperplasia?
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When their 5 year risk of breast cancer is 1.7%
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If a woman has lobular carcinoma in-situ, what is the risk for cancer?
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20-25%
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What's the treatment of LCIS?
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Clinical surveillance: breast exam every 6 months, yearly mammogram
Chemoprevention Also, prophylactic bilateral simple mastectomies with or without reconstruction |
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What does DCIS stand for? What is it?
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Ductal carcinoma in situ
It's cancer. |
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What's the difference between pleomorphic LCIS and LCIS?
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Pleomorphic LCIS has a similar clinical outcome to DCIS and therefore is treated as such.
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What's the appearance of DCIS on a mammogram?
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Pleomorphic microcalcifications.
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When does DCIS become invasive?
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When it goes through the duct wall
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What are the therapies for DCIS?
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Mastectomy
Lumpectomy with radiation Radiation |
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Do you need to do a sentinel lymph node biopsy on DCIS?
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No.
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What's the difference in mortality between a lumpectomy and a mastectomy?
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No difference.
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Where do cancers recur in DCIS?
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In the lumpectomy bed.
Within 1 cm of the previous excision |
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What are receptors that are checked for in DCIS?
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Estrogen receptor
Progest receptor Hirtunu receptor |
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What receptors, if present, allow for hormonal therapy?
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Estrogen receptor
Progesterone receptor |
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What's Paget's disease of the nipple?
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DCIS in the nipple
Underlying carcinoma is present in 95% of people |
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What's the most common kind of invasive ductal carcinoma of the breast?
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Invasive ductal carcinoma
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Where do invasive ductal carcinomas met to?
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Axilla
Lungs Liver Bone Brain |
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What's the second most common kind of invasive breast cancer?
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Invasive ductal carcinoma
They're often imaging occult! |
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What are the components of surgical therapy for breast cancer?
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Breast: conservation or mastectomy
Axillary staging: necessary? If yes: -Senginel node biopsy -Axillary lymph node dissection |
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What are the margins that we want on a lumpectomy?
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2 mm
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What are mechanisms of breast reconstruction?
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1. Tissue transfer from the stomach; they get a tummy tuck at the same time they get breasts back!
2. Expander under the pectoralis; later take it out and put in the implant |
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What are the indications for axillary staging?
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1. If it's palpable.
2. I there's a mass in the breast, go for the sentinel nodes. |
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How do you find the sentinel nodes?
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Inject dye into the breast the night before the surgery. It will go to the sentinel nodes.
These are then the nodes that you take out during surgery. |
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What are the benefits of the using sentinel nodes?
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You can do much thinner slices on the nodes!
Better detection!!! |
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If someone has a positive sentinel node, is further surgery indicated?
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NO.
Studies have shown that there isn't added survival benefit; rates of axillary cancer are low, and the complications of lymphadema are quite serious |
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What are complications of lymphadema?
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Infection
Problems with arm function! THIS IS A SERIOUS CHRONIC DISEASE. |
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What's the risk of lymphedema in a sentinel node dissection? Axillary dissection?
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Sentinel: 7%
Axillary: 12-24%!!!! |
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If someone's had a nodal dissection on the R side, where do you do the IV? BP cuff? Everything?
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Where they didn't have the nodal dissection!!!
You don't want to exacerbate lymphedema |
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What are the indications for chemotherapy in breast cancer/
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Lymph node ositive
H2N positive (even if node negative) |
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What is a medication that we can give to people who have a breast tumor positive for H2N?
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Herceptin
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What should you do about a tumor if it is ER- and lymph node negative?
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Look at pathology, other factors
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What should you do if the tumor is ER positive but lymph node negative?
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Oncotype DX tests: look at certain markers in the cell to give a prognosis for metastasis.
It allows you to decide whether or not you need to put someone on chemo or not. |
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What are some common chemotherapeutic drugs?
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Anthracyclines
Cyclophosphamide Taxanes Trastusamab 5-FU |
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What are some hormonal therapies for breast cancer?
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Tamoxifen
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What are indications for radiation?
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Lumpectomy
Tumor involves chest wall, skin 4+ positive nodes Inflammatory breast cancer |
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Who do we give hormone therapies to?
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Anyone who is estrogen receptor positive for 5 years.
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What's the mechanism of tamoxifen?
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Estrogen receptor inhibitor
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What is the only hormonal option for pre-menopausal women with breast cancer?
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Tamoxifen
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What are hormonal options for women after menopause?
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Aromotase inhibtors
Faslodex |
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What's contraindicated in breast cancer treatment during pregnancy?
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Radiation!
Certain kinds of chemo. |
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What's the therapy for inflammatory breast cancer?
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Modified radical mastectomy with radiation. Chemo too.
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What should you do for breast cancer in males?
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Take it out.
IT's usually a late diagnosis Less than 1% of all breast cancers. |
