-
type of cells of ducts
double layer columnar cells
-
artery to serratus anterior
lateral thoracic
-
nerve innervating both pec major and pec minor
medial pectoral nerve
-
arteries to breast
- internal mammary
- intercostal
- thoracromial
- lateral thoracic
-
batson's plexus
valveless vein plexus from pelvis to dura of brain allowing hematogenous spread of breast, prostate and rectal cancer to spine
-
infectious mastitis in non lactating women
- treat with abx
- mammogram and bx in two weeks if no improvement
-
pt has breast pain and creamy nipple discharge but no visible nipple retraction
- reassure
- need excisional biopsy if fails to resolve
- also if pt has nipple retraction
-
tx of galactocele
aspiration
-
galactorrhea can be seen with what meds
- ocps
- tcas
- phenothiazines
- reglan
- alpha-methyl dopa
- reserpine
-
gynecomastia in elderly
- can be normal if bilateral
- if unilateral need to r/o breast ca
-
mondor's disease
superficial thrombophlebitis
-
can have large coarse calcification on mammogram
fibroadenoma
-
w/u of fibroadenoma
- <30 u/s and fna
- >30 mammogram and u/s with exc bx
-
what is required if you are unable to locate duct causing discharge
complete subareolar rsxn
-
what nipple discharge does not need resection
cyclical that is yellow green
-
stereotactic needle for BIRAD 4 results in atypical ductal hyperplasia what is the next step
localization and excision
-
-
LCIS is most common in what group of women
premenopausal
-
linear or branching calcifications on mammogram
DCIS
-
variants of DCIS
- solid
- cribiform
- papillary
- comedo
-
comedo variant is at high risk of
- multicentricity
- recurrence
- microinvasion
-
recurrence of DCIS is increased in what situations
- comedo type
- lesion >2.5 cm
-
subcutaneous mastectomy only indicated for
-
best way to diagnose intraductal papilloma
ductogram
-
most common presentation of diffuse papillomatosis
breast mass
-
type of discharge with diffuse papillomatosis
serous
-
mammogram appearance of diffuse papillomatosis
swiss cheeze
-
tx of diffuse papillomatosis
resect area
-
risk factors assessed in Gail model
- age
- race
- age at menarche
- age at 1st live birth
- number of 1st degree relatives with breast ca
- number of previous breast bx
- any biopsies with atypical ductal hyperplasia
-
risk factors not assessed in Gail model
- age at menopause
- previous xrt
- HRT
- obesity
-
who should not use Gail model
those with lcis, dcis, or obviously breast ca
-
BRCA screening should be offered to
- fam hx of gene
- 10 relative with bilateral breast ca
- 10 relative with premenopausal breast ca
- 1 0 relative with bost breast and ovarian ca
- 1 0 relative with ovarian ca before 50
- 3 or mor primary relatives with breast ca
- aschkenazi jew with primary relative with breast ca
- gail risk >10%
-
higher incidence of ovarian cancer in what brca gene
I
-
brca II gene has a higher incidence of
pancreatic and male breast
-
screening for BRCA + pts
- yearly mammograms + MRI at age 25
- yearly pelvic exam and u/s
- yearly CA-125
-
size of mass detectable on mammogram
> or = 5mm
-
who gets breast mri
>20% risk (2 family members, brca, or previous xrt)
-
mgmt for birad 3
f/u 6 month
-
w/u for palpable mass in pt <30
- exam
- u/s
- core needle biopsy
-
pt with likely fibroadenoma comes back for 3 month f/u and mass has grown
excise
-
staging w/u for breast ca
cxr and lfts
-
what pts with newly diagnosed breast ca need a ct for staging
- elevated lfts
- advanced disease
-
what defines advanced disease
- inflammatory ca
- skin involvement
- chest wall involvement
- > 5cm
- N2 or N3
-
tis for
lcis, dcis, pagets without tumor
-
N1 is atleast what stage
IIa
-
T4 is atleast what stage
IIIb
-
N2 disease is atleast what stage
IIIa
-
T3 N1 is atleast what stage
IIIa
-
how is tumor size related to positive nodes
(size x 10) + 20%
-
other infrequent genetic syndromes associated with breast ca
-
Li Fraumeni is associated with what conditions
- soft tissue sarcomas
- brain tumors
- leukemia
- adrenocortical malignancies
- early onset breast ca
-
another name for herceptin
trastuzumab
-
most common site of breast ca mets
bone
-
axillary lymph node shows adenocarcinoma in a pt with a benign exam and mammogram
- test for ER and PR
- if positive then needs MRM
-
percent recurrence with BCT
2%
-
mets detected with local recurrence
chemo xrt only
-
absolute contraindications for BCT
- 2 or more primaries in different quadrants
- pos margins despite re resection
- 1st and 2nd trimester
- previous xrt
- multifocal or multicentric disease
- diffuse malignant appearing calcifications
-
indications for excisional biopys after core
- atypical ductal/lobular hyperplasia
- radial scar
- lack of concordance
- nondiagnostic i.e abscence of calcifications
-
what are the two different views of the mammogram
- craniocaudal
- mediolateral oblique
-
contraindications for slnbx
- pregnancy
- inflammatory or locally advanced
- prior axillary surgery
- neoadjuvant
-
anterior border of ALND
pec minor
-
nodes located between pec major and minor
Rotter's
-
early sudden post op swelling of arm following MRM
axillary vein thrombosis
-
adjuvant chemo is indicated for what tumors
-
what tnm characterizes IIIb
T4 N0-2 MO
-
what characterizes IIIC
N3
-
what distinguishes N3
- infraclavicular
- supraclavicular
- or both axillary and internal mammary
-
who gets herceptin
- Her2Neu pos and:
- 1cm tumor
- or pos LN
-
what can decrease complications from bony mets
bisphosphonates
-
tx for stage IIIb
- neoadjuvant
- surgery
- adjuvant chemo-xrt
-
tx for IIIc
- same as stage IV
- er pr pos needs hormonal +/- chemo
- Her pos needs Herceptin + chemo
- triple neg needs chemo
-
what pts with breast ca do not get chemo
- <1cm
- no nodes
- and + ER/PR
- ...basically Stage 1 thats ER or PR +
-
what kind of receptor is the HER2/neu receptor
tyrosine kinase
-
duration of treatment with herceptin
1 year
-
contraindications for Herceptin
previous cardiac disease
-
what are the different aromatase inh
- anastrozole
- letrozole
- exemestane
-
side effects of aromatase inh
fractures
-
duration of treatment with aromatase inh
5 years
-
indications for xrt following MRM
- T3 or T4
- - size>5cm or skin/chest wall
- positive margins
- inflammatory
-
who gets xrt to nodes
- advanced nodal disease
- > or = 4 nodes
- extracapsular invasion
- N2 or N3
-
relative contraindications to xrt
-
compared to tamoxifen raloxifene has decreased
- incidence of PE/DVT
- cataracts
- risk of fxs
-
types of ductal ca
- medullary
- tubular
- mucinous
- scirrhotic
-
margins needed for cystosarcoma phyllodes
1cm
-
tx of metastatic flare
xrt
-
recurrence at scar with neg w/u for mets
resection followed by chemo/xrt
-
tx for inflammatory breast ca
- chemo
- MRM if responds
- or xrt then mrm
- all followed by chemo xrt
-
important aspects for tx of Paget's
- simple mastectomy should include nipple areolar complex
- if Ca found then MRM
-
malignant lesions that look benign
- mucinous
- medullary
- cystosarcoma phyllodes
-
contraindications for TRAM
- smoking
- transverse laparotomy
- ipsilateral CABG
-
tx DCIS in pregnancy
lumpectomy and post partum xrt
-
bloody nipple discharge during pregnancy
- u/s and mammogram
- check cytology of discharge
- if all neg then follow
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