Breast CA Flashcards by Seth Davis

what is functional part of breast

ducts and lobules

How well did you know this?

Not at all

Perfectly

3 locations of drainage -nodal

axillary - most
internal mammary
infra/supraclavicular

How well did you know this?

Not at all

Perfectly

what cells surround a lobule

double cell layer

inner duct-lubular- milk cells
myoepithelial cells- muscle

How well did you know this?

Not at all

Perfectly

what happens to breast as ages

fibrous CT is replaced with radiolucent adipose tissue

How well did you know this?

Not at all

Perfectly

what are borders of breast exam

clavicle, sternum, axilla, inframammary ridge

How well did you know this?

Not at all

Perfectly

what to look for on breast exam

breast
- size and shape
- change in contour
- color
- nipple
lymphatics
- mass
-

How well did you know this?

Not at all

Perfectly

**what are most breast lumps

majority are benign

fibroadenoma, fibrocystic changes
risk for CA increases with age

How well did you know this?

Not at all

Perfectly

** what is triple test for lump

clinical exam
biopsy
imaging

How well did you know this?

Not at all

Perfectly

non-modifiable risk factors for CA

age
positive family Hx
BRCA
previous breast CA
mantle radiation
reporductive issues
breast density
ashkenazi Jewish

How well did you know this?

Not at all

Perfectly

6 modificable risk factors

diet
vitamins
alcohol
obesity
sedentary lifestyles
HRT use

How well did you know this?

Not at all

Perfectly

3 risk reduction strategies

lifestyle mod
suregry
chemo

How well did you know this?

Not at all

Perfectly

what is effect of alcohol

5x for 3-5/day

- worse for HRT

How well did you know this?

Not at all

Perfectly

how can excercise help

some walking helps

How well did you know this?

Not at all

Perfectly

what is chemoprevention

tamoxifene daily for 5 years

How well did you know this?

Not at all

Perfectly

4 methods of breast screening

breast awareness
clinical breast exam
mammography
MRI

How well did you know this?

Not at all

Perfectly

what is breast awareness

women getting to know thair breasts so they can see what is abnormal

How well did you know this?

Not at all

Perfectly

when should breast exams be used

no longer reccomended - not good data

How well did you know this?

Not at all

Perfectly

when should mammogram be done

every 2-3 years starting at 50

How well did you know this?

Not at all

Perfectly

what are probs with mammography

false positives
hard to see in dense breasts
over diagnosis of DCIS

How well did you know this?

Not at all

Perfectly

when to use screening MRI

in high risk patients

BRCA
chest irradiation before 30

How well did you know this?

Not at all

Perfectly

should we give mammography in women under 40

lady thinks we should if PT wants

How well did you know this?

Not at all

Perfectly

when to stop mammography

when less than 10 years life expectancy

How well did you know this?

Not at all

Perfectly

what to do if BRCA carrier

annual mam and MRI starting at 30

How well did you know this?

Not at all

Perfectly

when do errors occur in diagnosis

self detected
young
negative mam
non-lump presenting form
preg or breast fedding

How well did you know this?

Not at all

Perfectly

3 imaging modalities

1. mamm 2. MRI 3. ultrasound

how many images on mam

2x 1. craniocaudal 2. mediolateral

what is BI-RADS system

rating system in which higher scores are worse

4 potential things to find on mammogram

1. assymetries 2. distortion 3. masses 4. calcificaitons

when to use ultrasound

when can't get mamm or MRI for some reason

when to use MRI (4)

1. staging 2. high risk screening 3. evaluation surgical margins 4. monitoring chemo

what are 3 genetic factors involved in breast

1. BRCA 2. li fraumeni 3. cowden

what is BRCA

tumor supressor genes | - when mutated get increased risk of carcinoma

what are 2 pathologic risk factors

1. proliferative breast disease | 2. preinvasive in situ

what are epithelial breast lesions

wide variety of alterations that may be benign

how are epithelial lesions defined

1. non-proliferative 2. proliferaitve without atypia 3. proliferative with atypia

what are fibrocystic changes

NON-proliferative and BENIGN alterations that are very common - often bilateral and focal - may be painful - maybe due to hormones

what is proliferative breast disease (2 types)

1. without atypia - florid ductal hyperplasia | 2. with atypia - beginning to resemble carcinoma in situ

**what is key to proliferative breast disease

myoepitelial layer is preserved

what is DCIS

preinvasive lesion in which the lesion proliferates within the duct and myoepithelial layer is intact - may involve the nipple

what is paget's disease

crrusted red nipple that may be associted with DCIS or carcinoma

4 features to presentation of carcinoma

1. plapable mass 2. nipple changes 3. skin changes 4. mammographic features

2 ways to diagnose breast carcinoma

1. cytology - fine needle biopsy - cannot diagnose invasion | 2. histology - preferred - core biopsy

2 general classifications of carcinoma

1. not special type (NST) - most common | 2. special type - better prognosis

3 general gene profiles of CA and prognosis

1. luminal - ER/PR+ - best prognosis 2. basal - ER/PR and Her2 -ve - poor prognosis 3. her2 - low ER/PR - poor prognosis

what can we give to Her2 +ve

trastuzumab - herceptin

when does CA not require staging

early breast CA - >5cm and no node

what are 2 types of surgeries

1. masectomy | 2. lumpectomy

what goes with lumpectomy and why

radiation - major risk reduciton

what to do with sample after lumpectomy

mammogram to see if there is still calcificaitons and margin

what is better surgery

equivalent with radiation

what are 5 absolute indications for masectomy

1. multicentric 2. some collagen vascular disease 3. pt choice 4. prior radiation 5. preg

when is axiallary surgery done

usually onyl for CA, except DCIS with masectomy

why do axillary surgery

many nodes not accurately examined | - nodal spread is prognostic

what is sentinal node biopsy

give blue dye and then pull out first node that should drain the area

who should get sentinal node biopsy (3)

1. T1,2 CA with clinically neg nodes 2. multicentric CA 3. DCIS with mastectomy

what to do with positive node

may not do complete dissection if: | - post meno, had lumpectomy, systemic therapy

when to do chemo

depends on a variety of PT factots

when to radiation

always after lumpectomy

when in breats CA inoperable

when can't remove it all with a surgery

why give neo-adjuvant chemo (3)

1. assess response to chemo 2. prognostication 3. shrink tumor before

3 types of systemic therapy

1. chemo 2. endocrine 3. herceptin

how does neo adjuvant compare to adjuvant

comparable

who is most likely to benefit from chemo

those with a worse prognosis - more reduction in risk

what is best prognosic group for breast

luminal A - ER/PR+ and her2 neg

what is treatment for luminal A

hormones and maybe chemo (pt preference)

what is 21 gene recurrence score (21-RS)

cancer and reference genes that give an idea about risk

what is most modern and used chemp

3rd gen

short term SE of chemo

- hair loss - nausea/vomiting - mucostitis - fatgure - febrile neutropenia

long term SE of chemo -

- infert - early menopause - cardiomyopathy - secondary leukemia - neurotoxicity

what are 2 hormone theapry types

1. tamoxifen - block receoptos | 2. aromatase inhibitors

what are adv. and dis of tomoxifen

adv: good for bones, CV risk | dis - bad for thrombolsis, stroke, CA

what are adv. dis of AI

more CV risk, more lipids, more osteo

how long to give for

may give for 10 years for higher risk PTs

what are potential survivorship issues

1. hot flashes 2. vaginal dryness 3. cognitive funciton 4. fatigue 5. psychosocial impact

Breast CA Flashcards

(74 cards)