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Breast Disease
Gynecology
| Question | Answer |
|---|---|
| Spontaneous bloody, serous, or cloudy nipple discharge | Intraductal papilloma |
| Breast mass, nipple retraction, bloody nipple discharge | Breast cancer (mass is most common presenting clinical manifestation) |
| Br Ca: estrogen receptors | All invasive lobular and 2/3 of ductal ca are est rec pos |
| Br Ca typical presentations | single nontender firm immobile mass; 45% in UOQ, 25% nipple |
| Br Ca increases risk of: | endometrial ca, and vice versa |
| Breast exam: lymph nodes | Axillary, supraclavicular, and infraclavicular lymph nodes |
| Polythelia = | supernumerary nipples |
| Duct ectasia = | widening of breast ducts; in pts near/past menopause; thick sticky discharge and/or itching around nipple |
| Fat necrosis | Firm round lump; often d/t MVA or trauma |
| Most common breast complaint = | mastalgia (benign breast pain); assoc w/hormonal changes; teens & 40s, usu ends w/menopause |
| Most common benign breast tumor: | Fibroadenoma: hormone influenced abnormal growth of fibrous & ductal tissue. AA women; teens/20s; rapid growth during PG |
| Fibroadenoma assessment | Discrete lump: firm, rubbery, round, mobile, non-tender, smooth, solitary. Usually in UOQ, 1-5 cm |
| Peau d'orange is associated with: | Inflammatory breast ca |
| Ductal BrCa types | In Situ; Invasive; Inflammatory |
| Lobular BrCa types | In situ; Invasive, predominantly in situ; Invasive |
| Nipple BrCa types | Paget disease with intraductal carcinoma. Paget disease with invasive ductal carcinoma |
| Mastalgia: firstline tx | Sports bra, NSAIDs, reduce caffeine & fat in diet, warm compress, avoid premenstrual Na |
| Fibroadenoma Tx | Excision of mass; monitor |
| mastodynia tx | reassurance, vit B6, bromocriptine, tamoxifen, or danazol |
| mastitis tx | cloxacillin, dicloxacillin, or nafcillin; or ceph. May continue breastfeeding |
| Breast cancer mgmt | lumpectomy = mastectomy (partial or radical) re: survival, if f/u w/xrt; poss adjuvant CT; tamoxifen if est-rec pos or postmenopausal |
| 30 – 50 yo female, painful, multiple, bilateral breast masses that increase in pain and size before menses = | Fibrocystic breast disease |
| Mammography: when (ACS) | 20-39 yo: q 3 yrs; annual at 40 (average risk); high risk: 5 yrs before age of 1st degree relative dx; individualize for older pt |
| Mammography: when (USPSTF) | 50-74: biennial; <50: individual |
| CBE: PE | Dimpling; Color changes; Retraction; Skin thickening; Pronounced/ recent asymmetry; Spontaneous nipple discharge |
| BSE recommendations | ACS: BSE is an option starting in pts' 20s; USPSTF: Grade D (no benefit) |
| Mastalgia: secondline tx | Suppress ovulation |
| Most common benign breast condition: | Fibrocystic changes; grainy, palpable, small lumps; 30-50 y.o.; mobile, well defined; bilateral, UOQ; tender last half of cycle; dx w/bx |
| If find mass on CBE: | Order a diagnostic mammogram (not screening), unless age <30, then order U/S |
| Fibroadenoma may grow rapidly during: | pregnancy |
| Fibroadenoma Dx | FNA; Cyto study of bloody fluid or solid tumor aspirate; U/S to differentiate solid from cystic mass; definitive dx by excisional bx and tissue exam |
| Paget dz of breast: progression | Begins in breast duct and spreads to nipple and areola; usually occurs w/ infiltrating ductal breast cancer |
| BrCa RF | Genetics (BRCA1&2). FH; PMH/SH, prior abnormal breast bx. Diet may reduce risk. Age (60 yo ave onset). Nulliparous, early menarche, late menopause, delayed childbearing. LT estrogen |
| BrCa Lifestyle factors | No kids/lactation; HRT; Mod to heavy alcohol; Obesity/ high fat diet; Sedentary lifestyle; OCP use? |
| Malpractice suits: due to failure to: | recommend screening; follow-up on or verify woman’s complaints; follow-up on an abnormal clinical breast exam |
| Age <30 yo, palpable lump, still there after menses, order: | unilateral breast U/S |
| Age > 30yo, palpable lump, order: | Unilateral dx mammogram & U/S. If c/w fibroadenoma, FNA or aspiration: excision if change in lesion |
| Palpable lump, age > 40 yo & due for screening mammo: | get mammogram on unaffected side at same time |
| BI-RADS category 0-4: | Needs additional imaging evaluation |
| BI-RADS category 4: | Suspicious abnormality |
| BI-RADS category 6: | biopsy-proven malignancy |
| Women at high risk (greater than 20% lifetime risk) should get: | an MRI and a mammogram every year |
| Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is: | less than 15% |
| Congestive breast disorder clinical features | bilateral breast pain / swelling (2/2 engorgement) 2-3 days postpartum, low fever, axillary LAD |
| Mastitis clinical features | Unilateral breast pain, fever, chills, tender, erythema, 1 week postpartum. |
| Clinical breast exam | At least Q3 years in pt 20-39 yo, annually after 40 yo |
| Mammogram guidelines | USPSTF: baseline at 50 yo, then QOYr until 74 yo. Begin at age 40 only in pt with RF. ACS: annual starting at 40 yo |
| BrCa Risk Factors | >50 yo. PMHx or FH BrCa. BRCA 1 or 2 gene. Postmenopausal obesity. EtOH. Early menarche / late menopause. Nulliparity >30 yo |
| Fibrocystic disease sx/sx | Bilateral breast involvement; multiple smooth lumps +/- discharge |
| Polypoid epithelial tumors arising in ducts = | Intraductal papilloma (usually solitary; diffuse lesions have increased risk of BrCa) |
| Stromal tissue with epithelium-lined ductlike structures and absence of elastic tissue = | Fibroadenoma |
| Br Ca stats | 11% of US women. AA>white if <40 yo, reversed >40 yo. Whites higher incidence but AA higher mortality. Most are invasive adenocarcinomas: 80% infiltrating intraductal, 10% infiltrating lobular |
| Types of infiltrating intraductal Br Ca | Papillary, intraductal, medullary |
| Br Ca mets | Spread by vascular and lymphatic routes. Adenocarcinomas to bones, lungs, liver, brain. Lobular to meninges, peritoneum, pleura, ovaries, mediastinal, retroperitoneal LNs |
| Br Ca workup | Mammogram. MRI for high-risk pt. FNA. Open bx is definitive. Resection of primary tumor & ipsilateral LN for staging. CXR, bone scan, CT for further dx |
| Br Ca mgmt | Lumpectomy vs mastectomy; +/- post-op XRT. Hormonal tx in mets dz or adjuvant (tamoxifen) in early dz in postmenopausal. Targeted therapy (trastuzumab, lapatinib) in HER2-positive dz. Bisphosphonates for bony mets pain |
Created by:
Abarnard
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