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Flashcards in The breast algorithm Deck (17)
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1
Q

What are the benign breast diseases

A
  1. ) Fibroadenoma
  2. ) Fibrocystic disease
  3. ) Intraductal papilloma
  4. ) Fat necrosis
  5. ) Mastitis
2
Q

What is fibrocystic disease

A

Only occurs in women age 30 to 50 that is exaggerated stromal tissue response to hormones and growth factors, and associated with trauma and caffeine use

3
Q

What are the symptoms of fibrocystic disease

A

Cyclic bilateral mastalgia and swelling with symptoms most prominent just before menstruation

Mammography is limited in this case, just use ultrasound to differentiate cystic from solid mass

4
Q

Breast algorithm: It is divided into two parts - nonsuspicious and suspicious mass. A non-suspicous mass is when their age is less than 35, it is movable and changes size with cycle and no fam hx. What is the work up for a non-suspicious mass

A

Always do FNA to see if it is cystic or solid

  1. ) If it is cystic, FNA will drain fluid and relieve symptoms, however if bloody fluid comes out or residual mass then must do excisional biopsy
  2. ) If it is solid, must proceed to cytology and determine if it is benign or malignant
5
Q

Breast algorithm: It is divided into two parts - nonsuspicious and suspicious mass. A suspicious mass is when their age is greater than 35, family hx, firm and rigid, axillary adenopathy. What is the work up for suspicious mass

A

Must do mammography or exisional biopsy

6
Q

What is the treatment for fibrocystic disease

A
  1. ) Caffeine restriction

2. ) OCPs - reduce hormonal fluctuations

7
Q

What is fibroadenoma

A

Benign slow growing breast tumor with both epithelial and stromal components that is round, rubbery, discrete, mobile, and non-tender

Happens before menopause but this time it does not fluctuate with menstrual cycle

8
Q

What is the workup for fibroadenoma

A

Ultrasound or needle biopsy to differentiate cystic from solid

Excisional biopsy if uncertain after that (same as above algorithm)

9
Q

What are the two diseases that cause bloody nipple discharge

A
  1. ) Intraductal papilloma

2. ) Mammary duct ectasia

10
Q

What are some risk factors for breast cancer

A
  1. ) Nulliparity
  2. ) Early menarche, late menopause (exposure to estrogen)
  3. ) High fat and low fiber diet
11
Q

What are some late manifestations of breast cancer, and signs of metastasis

A

Late findings: Ulcerations, supracalvicular lymphadenopathy, edema of arm

Metastatic disease: Axillary notdes fixed to skin, infraclavicular node invovlement

12
Q

What is the screening guidelines for breast cancer

A
  1. ) Premenopausal before age 30: Ultrasound
  2. ) Postmenopausal after age 30: Mammography to check for increased density with micro-calcifications and irregular borders
13
Q

What are the three ways for which you can biopsy suspicious lesions

A
  1. ) FNA - high false negatives
  2. ) Core needle biopsy - larger sample, can test receptor status
  3. ) Open biopsy - accurate diagnosis
14
Q

What are some clues to suggest that the breast cancer has metastasized

A

ESR elevated, alkaline phosphatase elevated (liver or bone invovlement), increased calcium

15
Q

The pharmacalogic treatment for breast cancer depends on whether hormone receptors are present.

A
  1. ) Hormone receptor positive - tamoxifen
  2. ) HER2/neu receptor psoitive - trastuzumab - monoclonal antibody
  3. ) ER negative: Chemotherapy
16
Q

What are the surgical options for breast cancer

A
  1. ) Breast conserving: Lumpectomy plus axillary disection with radiation - has some contraindications on page 351
  2. ) Radical mastectomy with axillary disection

Stage 4 disease should be treated with radiotherapy and hormonal therapy

17
Q

What are the breast cancer stages

A
  1. ) Stage 1: Tumor size less than 2cm
  2. ) Stage 2: Tumor size 2 to 5 cm
  3. ) Stage 3: Axillary node involvement
  4. ) Stage 4: Distant metastasis