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31 Cards in this Set
- Front
- Back
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What is fibroadenoma?
What population is it found in? |
Benign tumor, usually presents as palpable mass (feels like rubbery round ball)
Usually found in women from teens to early 40s
Rounded in outline and easily movable
About 10% will disappear per each year follower |
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What is a breast cyst?
What population is it found in?
How is it diagnosed? |
Fluid filled cavity
Found in women usually in their 40s
Fine needle aspiration or ultrasound for diagnosis
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What are the prerequisites for a successful cyst aspiration? |
Non-blood fluid is obtained, don't need to send to pathology
The lump disappears
Re-examination 6 weeks later shows no mass |
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What is fibroadenosis and microcysts in fibrocystic change? |
Found in women in 20s to 40s
Disappears after menopause
Usually diffuse and ill-defined
Usually cyclic with menses
Painful and prominent before menses
Resolves with menses
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What is a Phyllodes tumor? |
A fibroepithelial tumor of unpredictable behavior
Tend to be benign but can have a malignant phyllodes tumor -malignant tumor spreads hematogenously, likely spread to lungs
Can become very large, tend to recur in same spot |
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What are options for treating breast pain? |
Caffeine abstinence, other dietary manipulation, evening primrose oil |
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What is intraductal papilloma? |
Small growth in a duct
Cause spontaneous bloody nipple discharge
Single papillomas without atypia carry a 3-fold risk factor and carry a 4-fold risk factor When there is atypical hyperplasia in the papilloma
Remove if atypical → higher association with cancer |
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What is Lobular Carcinoma In Situ (LCIS)? |
An incidental biopsy diagnosis
A marker → don't necessarily need to treat with surgery, patient is just at an increased risk for cancer
8-10x risk factor for invasive carcinoma in the same or opposite breast
Treatment may be a lumpectomy with or without chemoprevention (tamoxifen or riloxifine) |
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What is atypical ductal hyperplasia? |
Atypical lesion
Usually incidental biopsy finding
Associated with a 13% subsequent development of breast cancer (4x risk factor)
Need to rule out an associated breast cancer
If diagnosed on a core needle biopsy, need to perform lumpectomy or rule out DCIS |
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What is a Ductal Carcinoma In Situ (DCIS)? |
Diagnosed with increasing frequency due to mammography
There is a risk for the subsequent development of invasive cancer in the breast
Stage 0 or early stage breast cancer
Treatment: lumpectomy + radiotherapy or mastectomy if DCIS is extensive
DCIS can become invasive breast cancer |
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What is Paget's Disease? |
Eczematoid lesion of the nipple caused by malignant cells
Cells arise from the ducts and invade the surrounding nipple epithelium
Nonpalpable Paget's is usually due to DCIS
Palpable mass usually indicates invasive ductal carcinoma
Often diagnosed through punch biopsy of skin
Treatment: mastectomy |
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When is a mammography an appropriate evaluation tool?
What are the mammography screening recommendations? |
Appropriate in evaluating a problem in any women over 30
ACR recommends screening mammography to start at age 40 and annually thereafter -only people to start earlier are those with a first degree relative with a history of breast cancer |
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When should diagnostic mammograms start being done on a patient with a family history of breast cancer? |
10 years earlier than the age at which their first-degree relative was diagnosed with breast cancer |
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What is breast tomosynthesis and what are its benefits? |
3D imaging of the breasts
Tissue superimposition hides pathologies in 2D Tissue superimposition mimics pathologies in 2D Good for dense breasts |
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How is ultrasound used in breast imaging? |
Main use is to distinguish solid from cystic lesions
Not a screening tool, not a substitute for mammography
Useful in palpable masses
Can be used for image guided biopsies |
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How is MRI used in breast imaging? |
Provides food physiologic and morphologic information
Contrast enhanced MRI with gadolinium has a high sensitivity for detecting breast cancer -can detect smaller tumors than mammograms -costs 15x more than mammogram |
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All solid masses require __________ |
a tissue diagnosis (usually FNA or core needle biopsy) |
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What is the major risk factor for breast cancer? |
Age |
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What is Li-Fraumeni syndrome? |
p53 mutation
Autosomal dominant
Breast cancer, ovarian cancer, osteosarcoma, liposarcoma, leukemia, gastric cancer, uterine cancer and brain tumors -if people have obscure cancers in their family history → worry about this |
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What are three genetic factors that have been linked to breast cancer? |
BRCA1 mutation BRCA 2 mutation p53 mutation (i.e. Li-Fraumeni syndrome) |
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What can be done to treat estrogen receptor-positive breast cancer? |
Cell proliferation controlled by estrogen
Tamoxifen inhibits estrogen receptor |
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What is the Luminal A classification of breast cancer? |
ER +, low/intermediate grade |
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What is the Luminal B classification of breast cancer? |
ER+, high grade |
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What is the HER2 overexpressing classification of breast cancer? |
HER2 overexpression, ER +/-, high grade |
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What is the basal-like classification of breast cancer? |
ER-, PgR-, high grdae, "triple negative" |
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What is the effect of lumpectomy vs. masectomy on disease-free survival? |
There has been no difference in disease free survival |
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What are the benefits of sentinal lymph node biopsy? |
Associated with slightly fewer side effects
Outpatient procedure
No need for a drain
A negative sentinel lymph node indicates a >95% chance that the remaining nodes are cancer free |
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What are the most useful post-surgical chemotherapies for patients with estrogen receptor negative tumors? |
Adriamycin + Cytoxan and/or taxane
-Major side effect of adriamycin: cardiac doxicity |
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What drug is used for HER2 positive breast cancers? |
Herceptin (targeted theray)
Main side effect: cardiac toxicity |
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What drugs are used to treat estrogen receptor positive tumors? |
Antiestrogen therapy
-tamoxifen or aromatase inhibitors
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What is the most important prognostic factor of breast cancer? |
Stage |
