Term
Mondor Dz
# pathogenesis
# presentation
# epidemiology
# important anatomical structures |
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Definition
# superficial thrombophlebitis of a anterior chest wall vein
# pain and tenderness over lateral breast, eventually develops a palpable cord
# both men and women
# lateral thoracic v., thoracoepigastric v., superficial epigastric v. |
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Term
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Definition
# NSAIDs and warm compresses.
# mammography |
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Term
| Appearance of radial scar on mammography |
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Definition
| long, thin, radiating spicules with a translucent central area of fat |
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Term
| Histologic description of radial scar |
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Definition
| Fibroelastic core from which ducts and lobules radiate |
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Term
| Clinical importance of radial scar |
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Definition
| Risk factor for cancer and marker for cancer in either breast |
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Term
| Management of radial scar identified on mammo |
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Definition
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Term
| Management of LCIS when discovered on bx |
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Definition
# close clinical f/u in most pts
# in pts with strong family hx, B/L mastectomy and recon
# middle ground would be tamoxifen b/c it reduces risk of breast cancer |
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Term
| Characterization of breast cancers a/w BRCA1 and BRCA2 |
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Definition
# BRCA1: poorly differentiated and hormone receptor neg
# BRCA2: well-differentiated and hormone receptor positive |
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Term
| Additional cancers a/w BRCA1 |
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Definition
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Term
| Additional cancers a/w BRCA2 |
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Definition
| Prostate, melanoma, pancreatic, stomach, gall bladder and bile duct |
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Term
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Definition
# higher lifetime risk of breast cancer than men with BRCA1
# tend to present with breast cancer at a later stage than women with BRCA2 and breast cancer |
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Term
| Lifetime risk if breast cancer in women with BRCA1 and BRCA2 |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Amount of risk reduction a/w prophylactic B/L simple mastectomies in BRCA+ women |
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Definition
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Term
| Ovarian cancer in BRCA+ women |
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Definition
| 40% lifetime risk in BRCA1 and ~19% in BRCA2 |
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Term
| Increased-risk family hx of breast cancer |
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Definition
# 3 first- or second-degree relatives with breast cancer at any age
# 2 first-degree relatives with breast cancer with 1 being <50 yo at dx
# combination of breast and ovarian ca in first- and second-degree relatives
# male relative with breast ca
# 2 or more first0 or second-degree relatives with ovarian at any age
# Ashkenazie woman with a first-degree relative with breast or ovarian ca
# Ashkenazie woman with 2 second-degree relatives with breast or ovarian ca. |
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Term
| Indications for mastectomy in DCIS |
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Definition
# multicentric dz
# when local excision have repeatedly yielded positive margins
# large palpable lesions ( >4 cm) |
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Term
| Management of multicentric DCIS in the same breast |
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Definition
| Mastectomy (mandatory) +/- SLNBx because subsequent SLNBx may be challenging if pt is s/p mastectomy |
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Term
| Indications for SLNBx in DCIS and rationale |
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Definition
# High grade DCIS
# DCIS with comedonecrosis
# evidence of microinvasion
# b/c 10% of pts will have micrometastasis in the LNs |
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Term
| BI-RADS categories and recommendations |
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Definition
# 0- assessment incomplete; obtain additional studies
# 1- negative; continue routine screening
# 2- benign finding; continue routine screening
# 3- probably benign; repeat mammo in 6 mo
# 4- suspicious abnormality; perform needle bx
# 5- highly suspicious of malignancy; bx and tx
# 6- know biopsy-proven malignancy; continue tx plan |
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Term
| Palpable mass with a BI-RADS 2 mammogram |
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Definition
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Term
| Most important risk factor for local recurrance |
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Definition
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Term
| Management options for DCIS, option with the lowest local recurrence rate, option with the longest survival |
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Definition
# wide local excision alone
# wide local excision with radiation
# mastectomy (lowest recurrence rate)
# all have equal long-term survival |
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Term
| Histological subtypes of DCIS |
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Definition
# nuclear grade
# presence of necrosis (comedo)
# DCIS grade |
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Term
| Appropriate margin for DCIS |
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Definition
| optimal is 1 cm, but should be great than 1 mm |
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Term
| Non-genetic risk factors for male breast ca |
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Definition
| # anything that causes increased estrogen exposure (+/- androgen deficiency); i.e, any disease that affects testicular function- cryptorchidism, orchiectomy, orchitis, testicular injury, chronic alcohol abuse with cirrhosis and obesity |
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Term
| Genetic risk factors for male breast cancer |
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Definition
# Klinefelter syndrome
# Ashkenazie
# BRCA2 |
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Term
| Epidemiology of male breast cancer (as compared to female breast ca) |
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Definition
# presents older (avg ~68 yrs) than women
# Mostly invasive (because develops at later stage than women)
# majority are hormone receptor positive |
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Term
| Ethnic groups at increased risk for male breast cancer |
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Definition
| Ashkenizic and Black dudes |
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Term
| Histologic appearance of Paget cells |
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Definition
| large, pale vacuolated cells in the rete pegs of the epithelium and immunostaining for CEA |
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Term
| Management of an eczematoid rash of the nipple area |
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Definition
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Term
| Management of Paget dz of the breast |
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Definition
# MC tx is mastectomy and SLNBx (esp if a/w a mass)
# if clinically and radiographically confined to the nipple areolar- excision of nipple areolar comples with at least 2 cm cone of retro-areolar tissue encompassing all radiograhic abnormalities, SLNBx and radiation |
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Term
| Order of invasive breast cancer by prognosis from best to worst |
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Definition
# tubular
# medulary = papillary
# lobular
# ductal |
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Term
| Definition of neighborhood calcification |
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Definition
| # histologic calcifications that occur in the tissue adjacent to the areas of microcalcifications on mammography |
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Term
| Significance of LCIS and management |
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Definition
# up to 1/3 eventually develop invasive cancer in either breast
# Close follow-up, tamoxifen, or B/L prophylactic mastectomies in high-risk pts |
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Term
| Indications for tamoxifen |
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Definition
1) metastatic breast ca in men and pre-menopausal women
2) adjuvant tx in pts undergoing breast-conservation tx
3) DCIS
4) Cancer prevention in high risk women |
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Term
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Definition
# increases relapse free and overall survival in ER+ ca
# reduces the risk of invasive ca in either breast in pts with DCIS or LCIS
# reduces risk of breast ca in high risk women (>35 yo; >1.67# 5-yr predicted risk of ca by Gail model) |
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Term
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Definition
| cataracts, VTE >> uterine adenocarcinoma >> uterine sarcoma |
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Term
| Risks a/w Herceptin (trastuzumab) and management |
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Definition
# cardiac toxicity (CHF or decreased LVEF)
# assess LVEF prior to instituting tx and avoid concurrent use of other cardiotoxic drugs (anthracyclines) |
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Term
| Mechanism of action of Herceptin (trastuzumab) |
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Definition
| # humanized IgG1 kappa monoclonal Ab that selectively binds to EGFrecept 2 |
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Term
| MC type of breast lymphoma |
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Definition
| B-cell: diffuse large B-cell lymphoma |
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Term
| MC site of distant spread of breast lympoma |
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Definition
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Term
| Management of breast lymphoma |
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Definition
# localized, low-grade: primary excision
# diffuse or intermediate or high grad lymphoma: CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine, prednisone) and radiation |
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Term
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Definition
# first line: warm compresses and continuing to breast feed
# second line: if persists abx
# I&D if area of fluctuance |
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Term
| Nerve injury that causes winged scapula |
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Definition
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Term
# Nerve injury that causes weakness of arm adduction and medial rotation
# muscle innervated
# location of said nerve |
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Definition
# Thoracodorsal nerve
# innervates the latissimus dorsi
# lateral to the long thoracic nerve on the latissimus dorsi |
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Term
| A mass that undergoes rapid enlargement and causes a "tear-drop deformity" |
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Definition
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Term
| Management of Phylloides tumors |
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Definition
| wide local xcision with at least 1 cm margin (may require mastectomy if large) DO NOT NEED SLNBx or ALNBx since they do not spread via lymphatics |
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Term
| Reason why Phylloides tumors don't need lymph node exploration |
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Definition
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Term
| Presentation of an angiosarcoma |
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Definition
| bluish nodules and red and edematous skin, pleomorphic nuclei and evidence of necrosis in a breast after surgery, after radiation or in a lymphedematous extremity after ALNBx |
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Term
| Strongest risk factor for developing angiosarcoma |
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Definition
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Term
| management of angiosarcoma |
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Definition
| wide local excision to a negative margin |
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Term
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Definition
| venules that encircle the vertebrae and course along the spinal colum from the sacrum to the cervical vertebrae; has connections to thoracic, abdominal and pelvic viscera and is thought to be the route for boney spinal mets from breast and prostate |
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Term
| Initial stage of inflammatory breast cancer |
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Definition
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Term
| Management of inflammatory breast ca |
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Definition
# first: chemo tx with taxanes and anthracyclines
# if good response, then surgery for locoregional control followed by radiation and hormone tx
# if not good response to neoadjuvant chemo, then radiation to breast and nodes followed by surgery |
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Term
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Definition
| Tumor less than 2 cm and negative nodes |
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Term
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Definition
| No more than 3 positive nodes and only in axilla |
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Term
| Factors that immediately make breast ca stage III |
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Definition
| Involvement of nodes other than axilla (infra/supraclavicular, internal mammary), involvement of the chest wall or inflammatory breast ca |
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Term
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Definition
| Involvement of the chest wall or skin (inflammatory) |
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Term
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Definition
| Involvement of the chest wall or skin (inflammatory) |
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Term
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Definition
| ten or more pasitive axillary nodes or positive infra/supraclavicular nodes |
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Term
| Histologic hallmark of comedo subtype DCIS |
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Definition
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Term
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Definition
# Less aggressive: Cribiform, papillary, micropapillary
# solid and comedo |
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Term
| 5 year survival rates by stage of breast ca |
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Definition
I: 100%
II: 86%
III: 57%
IV: 20% |
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Term
| Single most important predictor of 10- and 20- year survival rates in breast can |
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Definition
| Number of axillary lymph nodes |
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Term
| Risk of breast cancer with benign dz |
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Definition
# proliferative lesions w/o atypia have 1.88 RR of breast cancer
# proliferative lesions w/ atypia have 4.24 RR of breast cancer |
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Term
| Types of proliferative benign breast lesions without atypia |
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Definition
| ductal hyperplasia, papillomatosis, radial scar, sclerosing adenosis |
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Term
| Types of proliferative benign breast leasions with atypia |
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Definition
| Lobular or ductal hyperplasia |
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Term
| Definition of sclerosing andenosis |
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Definition
| fibrosing dz of glandular tissues of the breast a/w enlarged distorten lobular units |
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Term
| Definition of pappillomatosis |
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Definition
| condition of multiple benign epithelial tumors |
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Term
| Histologic appearance of fat necrosis |
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Definition
| Scarring and associated lipid-containing cystic structures |
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Term
| Definition of Stewart-Treves syndrome |
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Definition
| Lympangiosarcoma/angiosarcomat hat develops in a limb with chronic lymphedema |
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Term
| Method of diagnosis and treatment of lymphangio/angiosarcoma |
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Definition
# Dx open bx b/c FNA is not sufficient
# Tx is early wide surgical debreidement which may require amputation |
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Term
| Prognosis of angiosarcoma |
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Definition
| less than 2 years after diagnosis |
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Term
| Management of breast cancer in preganacy |
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Definition
# If in 1st trimester or early 2nd trimester, MRM (can't irradiate) and start chemotherapy in 2nd trimester
# if in late 2nd trimester or 3rd trimester, can do breast conserving therapy and delay radiation until after delivery |
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Term
| Conditions considered relative contraindications to breast conserving tx specifically b/c of the necessary radiation and why |
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Definition
# pregnancy, unless in late 2nd trimester, or 3rd trimester
# h/o breast irradiation- b/c will likely be unable to give full dose radiation
# SLE or scleroderma b/c radiation thought to exacerbate |
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Term
| Connective tissue d/o not a contraindication to breast conserving tx |
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Definition
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Term
| Contraindications to breast conserving tx |
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Definition
# two or more primary tumors in separate quadrants
# multicentric dz
# invasive ca accompanied by diffuse suspicious mammographic abnormalities
# persistaently positive surgical margins after reasonable attempts at local excision |
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Term
| Nerve injuryies from a MRM commonly tested |
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Definition
# long thoracic: winged scapula from denervation of serratus anteria
# intercostal brachial: anesthesia to axilla and medial arm
# thoracodorsal: inability to adduct and medially rotate arm from denervation of lats
# supraclavicular: sensation to upper part of breast
# medial pectoral: motor innervation to pac major and minor |
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Term
| Prognosis of breast cancer during pregnancy |
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Definition
| Same as nonpregnant stage for stage |
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Term
| Method of dx of breast cancer in pregnancy |
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Definition
| Ultrasound and core needle bx |
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Term
| Surgical tx of choice for breast cancer in pregnancy |
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Definition
| MRM because it avoids fetal exposure to radation from radiation tx and from sentinal node mapping |
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Term
| Use of chemotherapy for breast cancer in pregnancy |
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Definition
| Ok during 2nd or 3rd trimester |
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Term
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Definition
| It is found incidentally when a bx is done for other mammographic abnormalities b/c it does not produce a mammographically visible pattern of calcifications |
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Term
| Type of invasive cancer more frequently a/w LCIS |
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Definition
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Term
| Difference in tx for fibroadenoma and Phyllodes tumors |
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Definition
| Fibroadenoma requires simple enucleation and Phyllodes tumors require a 1 cm margin |
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Term
| Difference b/w breast ca in men and women in terms of LCIS:DCIS |
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Definition
| # Men 95% are invasive ductal and DCIS much less likely than women |
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Term
| Difference b/w breast ca in men and women in terms of HER2/neu over-expression |
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Definition
| # much more common in women (33%) than men (5%) |
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Term
| Difference b/w breast ca in men and women in terms of ER positivity |
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Definition
| # more common in men (95%) than women (75) |
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Term
| Difference b/w breast ca in men and women in terms of prognosis by stage |
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Definition
| prognosis is the same stage for stage |
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Term
| Difference b/w breast ca in men and women in terms of stage at presentation |
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Definition
| # men present at a much later stage ( 40% at II or IV) than women (74% at I or II) |
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Term
| Use of MRI in breast cancer SCREENING |
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Definition
# annually in pts with BRCA mutations and in pts with a 1st degree relative with BRCA who have not been tested
# adjunct to mammo in pts with greater than a 20-25% lifetime risk of breast cancer
# adjunct in pts who received chest radiation b/w 10 and 30 yo
# adjunct in pts with first degree relatives with genetic syndromes a/w high risk of breast cancer |
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Term
| Genetic syndromes a/w high risk of breast cancer |
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Definition
# Li-Fraumeni syndrome
# Cowden dz
# Bannaya-Riley-Ruvalcaba syndrome
# Peutz-Jeghers syndrome |
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Term
| Contraindications to SLNBx |
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Definition
# locally advanced tumors (T4) or inflammatory breast cancer
# previous mastectomy or major breast or axillary surgery
# DCIS when mastectomy is not being performed if FNA confirms positive nodes
** above should go straight to ALNDx**
# pregnancy |
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Term
| Role of SLNBx in clinically suspcious nodes |
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Definition
| # first do FNA, if negative, do SLNBx |
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Term
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Definition
# breast cancer
# multiple hamartomatous lesions
# thyroid tumors |
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Term
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Definition
# breast cancer
# mlanocytic macules on lips
# bowel hamartomas
# GI cancers |
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Term
| Ataxia-telangiectasia syndrome |
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Definition
# breast cancer
# lymphoma and leukemia |
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