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breast
usmle breast cancer
| Term | Definition |
|---|---|
| fibroadenoma dif | most common benign breast tumor in women under 30 |
| fibroadenoma px | painless mass, well defined, rubbery, mobile, hormone dependent, firm |
| fibroadenoma dx | 1st sonography , FNA , biopsy |
| fibroadenoma tx | conservation, excision if 2-3 cm and rapidly growing on serial US |
| giant juvenile fibroadenoma dif | prepubretal or young girl |
| giant juvenile fibroadenoma px | breast mass getting bigger , well defined, rubbery, mobile, hormone dependent, firm . may destort devolpment of the breast |
| giant juvenile fibroadenoma dx | 1st sonography , FNA |
| giant juvenile fibroadenoma tx | always surgery excision |
| intraductal papiloma dif | most common of case bloody discharge from nipple |
| intraductal papiloma dx | mamography to rule out breast cancer |
| intraductal papiloma tx | surgical excision of involved duct |
| breast abscess dif | most common in woman post partum or breast feeding, pt may have been diagnosed with mastits |
| breast abscess px | unilateral localized pain, tenderness, eryhtema, subareolar mass, nipple discharge, nipple inversion, LAN, systemic symptoms of infection |
| breast abscess dx | sonography |
| breast abscess tx | surgical drinage, biopsy of the wall, culture the pus anti staph ABS ( nafcillin, oxicillin) |
| breast cysts dif | common breast masses can be from various causes, usally painless |
| breast cysts to confirm | songraphy |
| breast cysts dx/tx | 1st step - needle drainage if clear fluid or greenish SIMPLE CYST, benign no further steps. if fluid milky GALACTOCELE , benign no further steps. if fluid bloody MALIGNANT should be excision if the cyst continues recur even its benign excision |
| mammary duct ectasia dif | obstruction of a subareolar dusct leading to duct dilation, inflamation, and fibrosis |
| mammary duct ectasia px | breast pain, nipple retracion, subalveolar mass, sticky discharge, |
| mammary duct ectasia dx | mamography |
| mammary duct ectasia tx | surgery |
| breast cancer risk factor | femail, age >40, hx of BC, 1st degree relative w/ BC, nulliparty, 1st pregnancy >30, menrache <12, menopause >55, radiation, >5 years HRT |
| breast cancer genitic | BRCA 1/2, li-fraumeni syndrome p53 |
| breast cancer for whom we do gentic screening | pt diagnosed with breast and ovarian canver. strong Fx of breast/ovarian cancer. Fx of male breast cancer. young pt (<35years) |
| breast cancer when suspect ? | usually painless, breast mass, ill defined mass, FIXED mass, skin changes ( orange peeling, dimpling, erythema), nipple retraction,axilary LAN |
| ductal carcinoma in situ tx | * lumpectomy + radiation ( reccurence 5-10%) * modified radical mastectomy ( reccurence <1%) |
| lobular carcinoma in situ dif | most common to find incidentaly, marker for increase of invasive cancer in either breast |
| lobular carcinoma in situ tx | *1 qd observation, * lumpectomy + radiation ( reccurence 5-10%) * modified radical mastectomy ( reccurence <1%) *prophylactic bilateral mastectomy |
| infiltrating ductal carcinoma dif | most common breast cancer 80% |
| infiltrating ductal carcinoma tx | surgery : * lumpectomy and senetile node biopsy + radiation. * modified radical mastectomy . *radical mastectomy if inavion of pec major chemotherapy : *CAF,CMF hormone therapy( if tumor is ER/PR+) *estrogen inhibitor ( tamoxifien, raloxifien) |
| infiltrating lobular carcinoma dif | strong tendency toward bilaterlity |
| infiltrating lobular carcinoma tx | surgery : * lumpectomy and senetile node biopsy + radiation. * modified radical mastectomy . *radical mastectomy if inavion of pec major chemotherapy : *CAF,CMF hormone therapy( if tumor is ER/PR+) *estrogen inhibitor ( tamoxifien, raloxifien) |
| positive anti-her 2/neu | trastuzumab |
| postive ER or RR | tamoxifen, rolaxifen |
| lumbectomy contraindication | cancer is multifocal or radiation is contraindication |
| adjuvant chemotherapy is the answer when | lesions >1cm, postive axillary lymph nodes |
| when sentinel lymph node biopsy the answer? | routinely in all pts at the time of lumpectomy or mastectomy |
| when PET scan the answer ? | content of abnormal lymph nodes that are note easy accessible to biopsy |
| when ultrasound the answer ? | indetrminant mass lesion, cysts VS solid lesions ... painful , varies in size or pain with menstruation |
| FNA | best initial biopsy |
| open biopsy | most accurate diagnostic |
| core needle biopsy | larger sample, more deforming, can test ER, PR, HER 2/neu |
Created by:
Drsakhnini