Term
| estrogen vs progesterone: role in breast development? |
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Definition
Estrogen = duct development
Progest = lobular development |
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Term
| Est vs progest: cyclic changes? |
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Definition
Estrogen = breast swelling
Progest = glandular maturation |
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Term
| artery and nerve to serratus anterior? |
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Definition
long thoracic n
lateral thoracic artery |
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Term
| From where does ICB nerve originate? |
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Definition
| lateral cutaneous branch of 2nd intercostal nerve (sensation to medial arm/axilla) |
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Term
| where is ICB n located during ax dissection? |
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Definition
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Term
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Definition
| Most commonly injured nerve with MRM/ALNDx |
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Term
| what vein allows direct breast mets to spine? |
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Definition
| Baston's plexus: valveless vein plexus |
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Term
| ratio or axillary vs internal mammary node drainage of breast? |
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Definition
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Term
| N status of supraclavicular disease? |
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Definition
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Term
| MCC primary axillary adenopathy>? |
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Definition
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Term
| coopers ligaments of breast = |
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Definition
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Term
| sxs of periductal mastitis? |
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Definition
| (aka plasma cell mastitis), noncyclical mastodynia, erythema +/- nipple retraction, creamy discharge +/- subareolar abscess |
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Term
| path findings periductal mastitis? |
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Definition
| dilated mammary ducts, inspissated secretions, periductal inflammation. |
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Term
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Definition
| if not bloody, if no retraction...give abx, reassure, continue breast feeding. |
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Term
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Definition
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Term
| breast feeding and abscess? |
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Definition
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Term
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Definition
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Term
| Cause of neonatal breast enlargement? |
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Definition
| circulating maternal estrogens (resolves spontaneously) |
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Term
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Definition
| (accessory breast tissue) axilla |
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Term
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Definition
| (accessory nipples = MC breast anomaly) located form axilla to groin |
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Term
|
Definition
-hypoplasia chest wall and shoulder
-amastia
-no pec muscels |
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Term
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Definition
| fibrosystic disease (pain before menstrual period) |
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Term
| most refractory type of mastodynia? |
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Definition
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Term
| Mondor's disease definition? |
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Definition
| superficial vein thrombophlebitis of breast (painful, cordlike feel) |
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Term
MC location mondors?
Tx mondors? |
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Definition
Lower outer quadrant
NSAIDS |
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Term
| types of fibrocystic disease a/w Ca risk? |
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Definition
| Atypical ductal or lobular hyperplasia (need resection) |
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Term
| treatment of atypical hyperlasia (ductal or lobular) = |
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Definition
| resection (dont need negative margins) |
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Term
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Definition
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Term
| Dx study for itnraductal pap? |
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Definition
-contrast ductogram
-needle loc for subareolar resection |
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Term
| Fibroadenoma: lesion description? |
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Definition
-painless, slow growing, well circumscribed, firm and rubbery, not fixed
-changes size with period, bigger in preg |
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Term
| fibroadenoma path findings? |
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Definition
fibrous tissue with epithelial cells
Popcorn lesions (large, coarse calcs) |
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Term
| criteria for obesrvation fibroadenoma? |
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Definition
1. < 40, clinical characterists c/w fibroa. (if >40, excise it)
2. US/Mammo c/w dx
3. FNA/CNbx showing fibroadenoma
(if enlarging-->excisional bx) |
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Term
| Worrisome type of nipple dc for Ca? |
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Definition
-serous discharge (esp if only from one duct, or spontaneous).
-Spont dc, regardless of color/consistency
Tx = excisional bx |
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Term
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Definition
| 50% (5% get it in contralat breast) |
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Term
| Most aggressive DCIS subtype? |
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Definition
| Comedo pattern (tx = simple mastectomy) |
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Term
| Risks factors for inc recurrence of DCIS? |
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Definition
1. comedo subtype
2. lesions > 2.5 cm |
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Term
|
Definition
| soild, cribiform, papillary, comedo |
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Term
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Definition
| Lumpectomy (1 cm margins), XRT, +/- hormone therapy. (NO ALND/SLNB) |
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Term
| scenarios requiring simple mastectomy with DCIS? |
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Definition
-Comedo
-Multicentric/multifocal
-too large for lumpectomy
*in these cases, get SNLB* |
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Term
|
Definition
40% (MC type is ductal)
5% have synchronous Ca at time of Dx
(is a MARKER for Ca..is not itself premalignant) |
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Term
|
Definition
| resection (no neg margins needed) |
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Term
| List indications for Excisional Bx after CNbx--> |
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Definition
-Atypical hyperplasia
-Radial scar
-LCIS
-Papillary lesions
-Phyllodes tumor
-no concordance between imaging and histo
-non diagnostic specimen (includes lack of calc in histo when imaging shows calc) |
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Term
|
Definition
1/8 (12%)
5% in women with no risk factors |
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Term
| Mortality dec with breast ca screening? |
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Definition
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|
Term
| % breast Ca with negative mammo and US? |
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Definition
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Term
| Symptomatic breast mass w/u? |
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Definition
<40 y/o = U/S and CNBx
>40 y/0 = bilateral mammo, U/S, Cnbx |
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Term
| Breast cyst findings requiring excisional bx? |
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Definition
-bloody
-clear but recurrent
-complex |
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Term
| What is provided by CNBx vs FNA? |
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Definition
CNbx = architecture
FNA = cytology (just cells) |
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Term
|
Definition
| 90% (inc with inc age due to dec breast density) |
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Term
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Definition
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Term
| Mammo findings suggestive of Ca? |
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Definition
| Irregular borders, Spiculated, multiple clusterd/smal/thin/linear/crushed/branching calcs, ductal asym, distortion of architecture. |
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Term
|
Definition
1 = negative (routine)
2 = benign (routine)
3 = prob benign (short interval f/u mamo)
4= suspiciuos (CNBx)
5- Highly suggestive (CNBx) |
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Term
|
Definition
4 = suspicious lesion
4a = 15%
4b = 35 %
4c = 80% ca risk |
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Term
| if BIRADS 4 lesion that would merit 6 month f/u? |
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Definition
| Benign AND concordant lesions |
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Term
| standard breast screening regimen? |
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Definition
-Mammo q2-3 years after age 40
-yearly after 50 |
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Term
| high risk breast ca screening regimen? |
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Definition
| 10 years before first degree relative dx. |
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Term
| Node levels of ax dissection? |
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Definition
1 = lateral to pec minor
2 = beneath bec minor
3 = medial to pec minor |
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Term
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Definition
| between pec major and minor |
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Term
| Most important prognostic staging factor in breast ca? |
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Definition
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Term
| nodes +ve and survival 5YSR in breast Ca? |
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Definition
0 nodes = 75%
1-3 = 60%
4-10 = 40% |
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Term
| MC met location breast Ca? |
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Definition
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Term
| Tumor types with imc risk for multicentricity? |
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Definition
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Term
| what factors cause greatly increased Breast CA? |
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Definition
-BRCA
->2 primary relatives
-DICS/LCIS
-Fibrocystic dsease w/atypical hyperplasia |
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Term
| factors a/w moderate inc breast Ca risk? |
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Definition
-hx prior breast ca
-radiation hx
-1st degree relative with ca
-age >35 first birth |
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Term
| low level inc risk factors for breast Ca? |
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Definition
-early menarche
-late menopause
-nulliparity
-benign proliferative dz
-obesity, etoh,
-hormone therapy |
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Term
|
Definition
Breast: 60% for both
Ovarian: 1 = 40%, 2 =10%
Male Ca: 1 = 1%, 2= 10% |
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Term
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Definition
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Term
|
Definition
-q1 mammo and MRI at 25 y/o
-q1 pelvix exam, U/S, CA-125 at age 25 |
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Term
| Criteria for prophy mastectomy? |
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Definition
Family hx +/- BRCA OR LCIS....AND 1 of:
-anxiety, poor health care access/follow-up, difficult lesions, pt preference |
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Term
| MC pop with receptor +ve tumors? |
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Definition
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Term
| Which hormone receptor positive subtype has best prog? |
|
Definition
Progesterone > estrogen
(best = both) (10% is neg for both) |
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Term
| How does HER2 affect prognosis? |
|
Definition
| worse prog stage for stage if +ve |
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Term
|
Definition
Ductual, poorer prog
(<1% of all breast ca)
Tx MRM |
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Term
| % of all Ca that are ductal? |
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Definition
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Term
| Subtypes of Ductal breast Ca? |
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Definition
-Medullary (inc lymphocytes, smooth borders, bizarre cells)
-Tubular (more favorable prog)
-mucinous (colloid. favorable)
-Scirrhotic (worse prog) |
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Term
| % of breast Ca that are lobular? |
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Definition
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Term
| clinical traits of lobular breast Ca? |
|
Definition
-no calcs
-inc infiltration
-inc bilateral, multifocal, multicentric |
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Term
| Feature that gives worse prog to lobular breast ca? |
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Definition
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Term
| Stage given to inflamm breast ca? |
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Definition
| stage 4 (average survival 36 months) |
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Term
| cause of oragne peel breast ca? |
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Definition
| dermal lymphatic invasion |
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Term
|
Definition
neo-adj Chemo, MRM, adjuvant chemo/XRT
(BCT Contraindicated) |
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Term
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Definition
lumpectomy, + ALND/SNLB + post op-XRT
(need 1 cm margins) |
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Term
| % breast tissue remaining after subq (simple) mastectomy? |
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Definition
1-2%
use for DCIS/LCIS only, not Ca |
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Term
|
Definition
remove all breast tissue
Level 1 and 2 dissection |
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Term
|
Definition
-tumors in separate quadrants
-persistently +ve margins
-Pregnancy(can be possible if 3rd tri)
-hx of radiation to affected area
-diffuse calcs |
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Term
|
Definition
-hx of scleroderma/SLE
-large tumor @small breast |
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Term
| size indication for SLNB? |
|
Definition
tumors > 1 cm
more accurate when primary tumor still present |
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Term
| type of adverse rxn to blue dye? |
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Definition
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|
Term
| During SNLB..No radiotracer/dye is found. Next step? |
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Definition
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Term
|
Definition
-multicentric dz
-neoadj therapy
-clinically +ve nodes
-hx axillary surgery
-inflamm/locally advanced dz |
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Term
| ALND complications and time-frames? |
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Definition
-ax v thrombosis: early post-op
-lymphatic fibrosis: swelling over 18 months |
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Term
|
Definition
| hyperesthesia of inner arm/lat chest wall |
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Term
|
Definition
| 5,000 rad for BCT and XRT |
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|
Term
|
Definition
-preg
-scleroderma (severe fibrosis/necrosis)
-Hx XRT
-SLE(relative)
-active Rheumatoid (relative) |
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|
Term
| INdications for XRT after mastectomy? |
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Definition
-advanced nodal dz = >4 nodes, extracapsular invasion, fixed nodes (N2), internal mammary nodes (N3).
-Skin/chest wall involvement
-T3 (>5cm), T4 tumor |
|
|
Term
BCT and XRT
-requirements
-recurrence % and recurrent tx? |
|
Definition
-1 cm neg margins
-10% local recurrence (MC w/in 2 y)
-restage->salvage MRM |
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Term
|
Definition
| TAC (taxanes, adriamycin, cycloP) for 6-12 weeks |
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Term
| What pts dont get chemo despite + nodes? |
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Definition
post-meno women with + estrogen receptors.
-->get hormonal therapy with aromatase inhibs (anaztrozole) |
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Term
| Pre vs post menopause and choice of hormone therapy? |
|
Definition
pre = tamoxifen
post = anastrozole (aromatase inhib) |
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Term
| scenarios that mandate post op chemo? |
|
Definition
- positive nodes
- > 1cm and neg nodes
(unless ER/PR positive..then can get hormone therapy) |
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|
Term
| % dec recurrence with hormone therapy? |
|
Definition
|
|
Term
|
Definition
| --|estrogen, progest receptors |
|
|
Term
|
Definition
| block peripheral conversion of test to estrogen. |
|
|
Term
|
Definition
-1% blood clot risk
-0.1% endometrial Ca risk |
|
|
Term
| beneficial SE of tamoxifen? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| beneficial se of aromatase inhibs? |
|
Definition
dec thromboembolic events,
dec endometrial Ca compared to tamoxifen |
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|
Term
| % risk decrease for Breast CA with trastuzumab? |
|
Definition
|
|
Term
|
Definition
| HER2/neu positive if >1 cm, or node positive |
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|
Term
|
Definition
|
|
Term
| MCC death in pts with recurrent breast Ca? |
|
Definition
|
|
Term
|
Definition
XRT
sx = pain, swelling, erythema, |
|
|
Term
| Occult breast CA definition/tx? |
|
Definition
breast Ca presenting as axillary mets with unknown primary
-tx = MRM (70% ultimately have breast ca) |
|
|
Term
|
Definition
| MRM if present with cancer. Otherwise simple mastectomy w/SLNBx if DCIS (must include nipple areolar complex) |
|
|
Term
Phyllodes tumor
-% malig
-metastatic route
-Tx |
|
Definition
-10%
-hematog only (non-nodal)
-WLE 1 cm margins (NO ALND) |
|
|
Term
|
Definition
| stromal and epithelial elements (mesenchymal tissue) |
|
|
Term
Stewart-Treves syndrome
-def |
|
Definition
lymphagniosarcoma 2/2 chronic lymphedema after ax dissection
-p/w dark purple nodule 5-10 years post-op |
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