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Breast Masses
N/A
57
Medical
Professional
08/25/2011

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Cards

Term
What percentage of breast masses are benign?
Definition
90%
Term
What are the most common breast masses?
Definition
cysts
fibroadenomas
Term
What are the most uncommon breast masses?
Definition
carcinoma
fat necrosis
galactocele
lipoma
Term
What causes of breast masses are usually bilateral?
Definition
infiltrating lobular carcinoma
cysts
Term
What causes of breast masses are usually unilateral?
Definition
fibroadenoma
DCIS
Paget's disease
Term
What type of tumor can either be benign or malignant?
Definition
phyllodes tumor
Term
What is the most common type of dominant breast lump?
Definition
breast cyst
Term
What age group has the highest incidence of breast cysts?
Definition
35-50 year olds
rare in postmenopausal women
Term
What components of the history are common in women with breast cysts?
Definition
tender mass
assocaited with UOQ pain-->axilla
size and pain may increase with menses
Term
What physical exam findings are consistent with breast cysts?
Definition
firm, well-circumscribed, freely mobile, fluid-filled sac
Term
How is a diagnosis of a breast cyst made?
Definition
ultrasound/mammogram
FNA (ultrasound guided)
Term
What is the treatment for breast cysts?
Definition
FNA

surgery if bloody, doesn't resolve, or recurs
Term
What is the most common form of benign breast mass?
Definition
fibroadenoma
Term
What components of the history are common in a pt. with a fibroadenoma?
Definition
usually painless
may increase at end of menstrual cycle
Term
What physical exam findings are consistent with fibroadenomas?
Definition
painless
solid, well-circumscribed, freely mobile
round, lobulated, or discoid
"rubbery" in texture or hard
Term
How is a diagnosis of fibroadenoma made?
Definition
ultrasound/mammogram
excision/biopsy
Term
What is fat necrosis associated with?
Definition
prior trauma

MVA, assault, surgery, radiation
Term
What is the most common cancer among American women next to skin cancers?
Definition
breast cancer
Term
What are the odds for a woman developing breast cancer at some point in her life?
Definition
1 in 8
Term
What percentage of women with breast cancer have a family history of breast cancer?
Definition
30%
Term
What is the earliest, non-invasive form of breast cancer?
Definition
carcinoma in situ (CIS)
Term
What is the second leading cause of cancer death in women, exceeded only by lung cancer?
Definition
breast cancer
Term
The chance that breast cancer will be responsible for a woman's death is about 1 in ____.
Definition
35
Term
What percentage of new diagnoses of breast cancer have no risk factors?
Definition
75%
Term
What risk factors are associated with breast cancer?
Definition
-1st degree relative with breast CA
-genetics BRCA1/BRCA2 gene
-personal hx of breast CA
-whites > blacks (blacks have higher mortality rate due to late detection)
-prior bx with atypical hyperplasia
-age > 50
-menses < 12, menopause >50
-DES therapy
-nulliparity or 1st pregnancy > 30 yo
-OCP or HRT use
-EtOH, obesity
Term
What are the controversial risk factors associated with breast cancer?
Definition
antiperspirant
underwire bras
smoking
induced abortion
breast implants
night work
Term
What physical exam findings are consistent with breast cancer?
Definition
-palpable, hard, firm mass with diffuse margins often fixed to the chest wall
-may or may not have pain
-nipple retraction or discharge
-change in breast size or configuration
-lymphadenopathy
Term
What diagnostics are used for breast cancer diagnosis?
Definition
comprehensive mammogram
FNA (only for cystic lesions)
core needle biopsy (for solid lesions)
mammotome
open/excisional bx
sentinel lymph node bx
Term
abnormal cells in the lining of a milk duct that haven't invaded the surrounding breast tissue
Definition
ductal carcinoma in situ (DCIS)
Term
Some experts consider DCIS a ____________ condition.
Definition
precancerous
Term
What is the prognosis for DCIS?
Definition
almost all women can be successfully treated and no evidence suggests that it affects a woman's life span

if left untreated, it may eventually develop into invasive breast cancer
Term
abnormal cells are contained within a lobule of the breast but haven't invaded the surrounding breast tissue
Definition
lobular carcinoma in situ (LCIS)
Term
What is the controversy surrounding LCIS?
Definition
whether it is an early form of breast cancer or is just a marker for the future development of cancer
Term
What do experts agree on about LCIS in terms of prognosis?
Definition
pts. with LCIS are at an increased risk of developing invasive breast cancer in either breast in the future
Term
If a pt. has LCIS in the right breast, what type of cancer is most likely to develop in the right breast?
Definition
invasive lobular carcinoma
Term
If a pt. has LCIS in the right breast, what type of cancer is most likely to develop in the left breast?
Definition
either invasive ductal carcinoma or invasive lobular carcinoma
Term
What type of cancer accounts for the majority of invasive breast cancers?
Definition
invasive ductal carcinoma (IDC)
Term
What happens in IDC?
Definition
cancer cells form in the lining of the milk duct, break free of the ductal wall, and invade surrounding breast tissue
Term
What type of spread is typical of IDC?
Definition
lymphatic and hematogenous
Term
What type of breast cancer can be mistaken for mastitis?
Definition
inflammatory breast cancer
Term
What is HER2/neu?
Definition
receptor seen on path report

If cancer is HER2/neu +, it will respond to Herceptin.
Term
What is ER/PR status?
Definition
done on path report to show if cancer is estrogen/progesterone sensitive

If the cancer is ER/PR +, it will respond to Tamoxifen.
Term
What cancer markers are used in breast cancer?
Definition
CEA
CA 27-20
Term
What blood work should be ordered for a metastatic work up in a pt. with breast cancer?
Definition
CBC
CMP
CEA
CA 27-20
Term
What imaging studies should be done for metastatic work up in a pt. with breast cancer?
Definition
total body bone scan
CT chest/abdomen with and w/o contrast
(occasionally do whole body CT)
PET scan
Term
What does TNM classification stand for?
Definition
tumor, nodes, metastases
Term
What is the 5 year survival rate for a pt. with Stage 0 (DCIS) breast cancer?
Definition
100%
Term
What is the 5 year survival rate for a pt. with Stage 1 breast cancer?
Definition
100%
Term
What is the 5 year survival rate for a pt. with Stage 2 breast cancer?
Definition
81-92%
Term
What is the 5 year survival rate for a pt. with Stage 3 breast cancer?
Definition
54-67%
Term
What is the 5 year survival rate for a pt. with Stage 4 breast cancer?
Definition
20%

usually have mets
Term
What is the most commonly used anti-estrogen drug for breast cancer treatment?
Definition
tamoxifen (Nolvadex)
Term
What medication can be used in a women who is at high risk of getting breast cancer but who has not had it before?
Definition
tamoxifen
Term
What class of drugs stops estrogen production in postmenopausal women?
Definition
aromatase inhibitors

letrozole (Femara)
anastrozole (Arimidex)
exemestane (Aromasin)
Term
Are aromatase inhibitors effective in premenopausal women? Why or why not?
Definition
no, because they cannot stop the ovaries of premenopausal women from making estrogen
Term
What drug targets the HER2/neu protein?
Definition
trastuzumab (Herceptin)
Term
What drug targets tumor angiogenesis?
Definition
bevacizumab (Avastin)
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