Flashcards in Surgical Disease of the Breast Deck (10)
What are the types of breast cancer?
--Ductal carcinoma in situ (noninvasive)
--Invasive/infiltrating ductal carcinoma (most common type of breast cancer)
--Invasive/infiltrating lobular carcinoma
--Inflammatory breast cancer
--Paget disease of nipple
--Some other super rare kinds
What are some ways to classify breast cancer?
1. By grade:
grade 1 = well-differentiated
grade 2 = moderately differentiated
grade 3 = poorly differentiated
2. By receptors: estrogen receptor pos/neg; progesterone receptor pos/neg
3. By HER2 levels: normal or elevated
4. By genes, e.g. BRCA1 (helps with assessing likelihood of recurrence)
How is breast cancer staged?
TNM system for breast cancer:
--T: tumor size
--N: whether it's spread to axillary/regional lymph nodes
--M: whether there is distant metastasis
"Tis" is carcinoma in situ
T1 = tumor < 20mm
etc. (it's really detailed)
What are the signs and symptoms of malignant breast disease?
Breast mass (hard, immobile, single dominant lesion with irregular borders)
More advanced cancer: axillary adenopathy, skin findings e.g. erythema, thickening, dimpling
What is the workup for malignant breast disease?
Receptor testing (ER, PR)
What are the surgical options for malignant breast disease:
2. Breast conserving treatment (surgery + radiation)
What are the factors that make a patient ineligible for breast conserving treatment (surgery + radiation) and therefore they will need mastectomy?
Patients will need mastectomy in the following cases:
1. Multiple tumors
2. Diffuse malignant microcalcifications
3. Prior breast radiation
4. Persistently positive resection margins
5. Large tumor relative to breast size
What is the evaluation for a breast lump?
HPI/PE - assess the following:
change in breast appearance
new nipple inversion
cervical/clavicular/axillary lymph nodes
breast exam including tail
Imaging - get an ultrasound or a mammogram:
If young woman with clinically benign mass and no family history of breast cancer, get ultrasound
Otherwise, get mammogram
What is the workup for a breast mass?
1. Clinical breast exam
2. Mammogram or breast ultrasound
3. Fine needle aspiration, core biopsy, or