usmle breast cancer
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| fibroadenoma dif | most common benign breast tumor in women under 30
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| fibroadenoma px | painless mass, well defined, rubbery, mobile, hormone dependent, firm
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| fibroadenoma dx | 1st sonography , FNA , biopsy
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| fibroadenoma tx | conservation, excision if 2-3 cm and rapidly growing on serial US
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| giant juvenile fibroadenoma dif | prepubretal or young girl
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| giant juvenile fibroadenoma px | breast mass getting bigger , well defined, rubbery, mobile, hormone dependent, firm .
may destort devolpment of the breast
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| giant juvenile fibroadenoma dx | 1st sonography , FNA
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| giant juvenile fibroadenoma tx | always surgery excision
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| intraductal papiloma dif | most common of case bloody discharge from nipple
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| intraductal papiloma dx | mamography to rule out breast cancer
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| intraductal papiloma tx | surgical excision of involved duct
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| breast abscess dif | most common in woman post partum or breast feeding, pt may have been diagnosed with mastits
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| breast abscess px | unilateral localized pain, tenderness, eryhtema, subareolar mass, nipple discharge, nipple inversion, LAN, systemic symptoms of infection
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| breast abscess dx | sonography
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| breast abscess tx | surgical drinage, biopsy of the wall, culture the pus
anti staph ABS ( nafcillin, oxicillin)
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| breast cysts dif | common breast masses can be from various causes, usally painless
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| breast cysts to confirm | songraphy
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| 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
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| mammary duct ectasia dif | obstruction of a subareolar dusct leading to duct dilation, inflamation, and fibrosis
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| mammary duct ectasia px | breast pain, nipple retracion, subalveolar mass, sticky discharge,
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| mammary duct ectasia dx | mamography
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| mammary duct ectasia tx | surgery
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| 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
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| breast cancer genitic | BRCA 1/2, li-fraumeni syndrome p53
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| 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)
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| breast cancer when suspect ? | usually painless, breast mass, ill defined mass, FIXED mass, skin changes ( orange peeling, dimpling, erythema), nipple retraction,axilary LAN
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| ductal carcinoma in situ tx | * lumpectomy + radiation ( reccurence 5-10%)
* modified radical mastectomy ( reccurence <1%)
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| lobular carcinoma in situ dif | most common to find incidentaly, marker for increase of invasive cancer in either breast
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| lobular carcinoma in situ tx | *1 qd observation,
* lumpectomy + radiation ( reccurence 5-10%)
* modified radical mastectomy ( reccurence <1%)
*prophylactic bilateral mastectomy
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| infiltrating ductal carcinoma dif | most common breast cancer 80%
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| 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)
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| infiltrating lobular carcinoma dif | strong tendency toward bilaterlity
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| 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)
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| positive anti-her 2/neu | trastuzumab
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| postive ER or RR | tamoxifen, rolaxifen
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| lumbectomy contraindication | cancer is multifocal or radiation is contraindication
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| adjuvant chemotherapy is the answer when | lesions >1cm,
postive axillary lymph nodes
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| when sentinel lymph node biopsy the answer? | routinely in all pts at the time of lumpectomy or mastectomy
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| when PET scan the answer ? | content of abnormal lymph nodes that are note easy accessible to biopsy
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| when ultrasound the answer ? | indetrminant mass lesion, cysts VS solid lesions ...
painful , varies in size or pain with menstruation
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| FNA | best initial biopsy
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| open biopsy | most accurate diagnostic
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| core needle biopsy | larger sample, more deforming, can test ER, PR, HER 2/neu
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