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