Breast Dz

Question 1

High risk factors for breast CA (BCA)? (6)

Answer 1

65+yo
Atypical hyperplasia (confirmed)
BRCA genes
Lobular CA
Dense breasts
Hx/FHx (early ages)

Question 2

Medium risk factors for BCA? (3)

Answer 2

Postmeno high E2/testost
Chest radiation
Hx/FHx

Question 3

Best time for exam?

Answer 3

Follicular phase (closer to hormonal baseline)

Question 4

Key features of breast exam?

Answer 4

Systematic approach

Cover entire area

Question 5

Mammography views:

Screening?

Diagnostic?

Answer 5

2 craniocaudal (CC), 2 mediolateral oblique (MLO)

CC, MLO and other

Question 6

US used when? (5)

Answer 6

Inconclusive mammo
Young W
Dense breasts
Better diff b/w solid or cystic mass
Guiding needle bx

Question 7

MRI used when? (3)

Answer 7

Detection in high risk pts
Staging
NOT for mass eval

Question 8

Before MRI gadolinium dye used, check what?

Answer 8

Check baseline BUN, Cr

Contra for renal dz

Question 9

Fine Needle Aspiration Bx used when?

Answer 9

Initial eval of mass w/ low pretest CA probability

Question 10

Core Needle Bx used when?

Answer 10

get sample of larger/solid mass

Question 11

Mastalgia is?

Types?

Answer 11

Benign breast dz -> pain in the breast

Cyclic:
Luteal phase bilateral, diffuse pain
Fibrocystic ∆s

Noncyclic:
Unilateral or focal
(P) 2° to meds (hormones, SSRI, spirono)

Question 12

Mastalgia Management? (3)

Answer 12

(P) US or mammo
Non-steriod anti-inflamm
Danazol or tamoxifen if persistent

Question 13

Mastitis is?

Most C in?

Most C cause?

Answer 13

Infection in breast

Lactating W

S. aureus

Question 14

Mastitis presentation?

DDX?

Answer 14

hard, red, painful, swollen area

engorgement, galactocele, abscess, inflamm BCA

Question 15

Mastitis Tx?

Answer 15

Dicloxacillin or cephalexin

Keep breastfeeding

Question 16

Nipple d/c: Pathologic causes?

Presentation?

Answer 16

INTRADUCTAL PAPILLOMA
duct ectasia (dilation), CA, infection

Spontaneous, unilat
Bloody, serous or clear
a/w mass

Question 17

Nipple d/c: Physiologic causes?

Presentation?

Answer 17

Neurogenic stim
Meds: antihypTN, GI, hormones, opiates, psych

Bilat, multiduct
a/w stim

Question 18

Benign Breast Mass characteristics? (5)

Answer 18

Discrete margins
No skin ∆s
Smooth
Soft or firm
Mobile

Question 19

Malignant Breast Mass characteristics? (5)

Answer 19

Poorly defined margins
(P) skin ∆s
Hard
Immobile
Fixed

Question 20

Breast Cysts characteristics? (6)

Answer 20

Benign
U 35-50yo
Fluid-filled round/oval mass
∆s w/ hormone flux
Firm
\+/- tender

Question 21

Cyst management?

Answer 21

Simple: none

Complicated (<1% malig): Fine Needle Asp (FNA), imaging

Complex (1-23% malig): bx, excision

Question 22

Fibroadenoma characteristics? (5)

Answer 22

Benign
Solid, gland/fiber tissue
(P) ∆ w/ preg/E2
Firm
- tender

Question 23

Fibroadenoma management? (4)

Answer 23

Core needle bx

OR If US look benign, no bx. Repeat exam and US in 3-6 mo

(P) Excision/ablation

If ↑ size, EXCISION

Question 24

BCA presentation? (5)

Answer 24

1) Nonpalp (suspicious mammo)
2) Palp mass (most C)
3) Skin ∆s
4) D/C
5) Metastatic spread

Question 25

Invasive BCA: Ductal?

Answer 25

Most C breast malig (80%)

U palp mass or mammogram abnormality

Question 26

Invasive BCA: Lobular?

Answer 26

More likely bilateral
No microcalcifications
U palp mass or mammo abn

Question 27

Paget’s Disease of the Breast (PDB) characteristics? (7)

Answer 27

Rare
Scaly, raw, vesicular, ulcerated lesion,
Starts on nipple, spread to areola
+/- bloody d/c
U unilat
(P) Pain, burn, pruritis present before dz
MOST HAVE UNDERLYING BCA (in situ or invasive)

Question 28

Inflammatory BCA characteristics? (6)

Answer 28

Very aggressive
Very rare
Pain w/ rapid tender, firm enlargement,
Warm, thick skin w/ erythema, orange peel
Most w/ LN involvement
1/3 w/ distant metastasis

Question 29

BCA surgery based on? (7)

Answer 29

1) Tumor size
2) Metastases
3) LN involvement
4) E2 and PR status
5) Her2 NEU status
6) Oncotype recurrent score
7) BRCA status

Question 30

Breast-Conserving Surgery (BCS): Lumpectomy is?

Used when?

Answer 30

Removal of portion w/ or w/o axillary node bx

For Stage I or II
w/ Postop radiation

Question 31

Mastectomy types? (3)

Answer 31

1) Simple/Total: entire
2) Modified Radical: entire + axillary LNs
3) Radical: entire + ax LNs + pect mm

Question 32

Radiation types? (3)

Answer 32

1) External beam (5-7 wks)
2) Brachytherapy (wires in tumor)
3) To breast, chest, region LN, axilla

Question 33

Chemo used when? (5)

Answer 33

Primary and metastatic BCA,
Almost all w/ + lymph nodes,
High onco score (+E2/LN-)
Neoadjuvant (before surgery)
Adjuvant (after surgery)

Question 34

Endocrine therapy used when?

Types? (2)

Answer 34

Receptor Status = E2 and PR
Supplement to chemo/radiation
E2+ more responsive than E2-

SERM: Tamoxifen x 5yrs
Aromatase Inhib: Arimidex

Question 35

Her2/NEU Overexpression?

Tx used when/how?

Answer 35

1 in 5
CA grows faster and reoccur

Effective in early stages, metast dx
Herceptin target Her2 protein
Herceptin + chemo

Question 36

Metastasis: Lymphatic spread

Answer 36

Axillary -> internal mammary -> supraclavicular (too late)

Question 37

Metastasis: Hematogenous

Answer 37

Lungs/liver -> bone, ovaries, brain

Question 38

BRCA genes are?

BRCA+ mgmt?

Answer 38

tumor suppressors

watch, chemoprophy or surgical prophy

Question 39

BRCA 1 risks?

Answer 39

44-78% BCA by 70

24-40% ovarian CA by 70

Question 40

BRCA 2 risks?

Answer 40

33-54% BCA by 70
8-18% ovarian by 70
6% male CBA

Question 41

BCA f/u?

Answer 41

Hx/PE Q 3-6 mo x 5yrs, then annually

Initial mammo @ 6 mo post radio

Annual mammo if remaining breast

Question 42

Chemoprevention?

Answer 42

Recommended for at risk 35+ w/o prior BCA dx