breast

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Author:
nsmallwood
ID:
124944
Filename:
breast
Updated:
2011-12-23 13:58:08
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breast
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  1. type of cells of ducts
    double layer columnar cells
  2. artery to serratus anterior
    lateral thoracic
  3. nerve innervating both pec major and pec minor
    medial pectoral nerve
  4. arteries to breast
    • internal mammary
    • intercostal
    • thoracromial
    • lateral thoracic
  5. batson's plexus
    valveless vein plexus from pelvis to dura of brain allowing hematogenous spread of breast, prostate and rectal cancer to spine
  6. infectious mastitis in non lactating women
    • treat with abx
    • mammogram and bx in two weeks if no improvement
  7. 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
  8. tx of galactocele
    aspiration
  9. galactorrhea can be seen with what meds
    • ocps
    • tcas
    • phenothiazines
    • reglan
    • alpha-methyl dopa
    • reserpine
  10. gynecomastia in elderly
    • can be normal if bilateral
    • if unilateral need to r/o breast ca
  11. mondor's disease
    superficial thrombophlebitis
  12. can have large coarse calcification on mammogram
    fibroadenoma
  13. w/u of fibroadenoma
    • <30 u/s and fna
    • >30 mammogram and u/s with exc bx
  14. what is required if you are unable to locate duct causing discharge
    complete subareolar rsxn
  15. what nipple discharge does not need resection
    cyclical that is yellow green
  16. stereotactic needle for BIRAD 4 results in atypical ductal hyperplasia what is the next step
    localization and excision
  17. %risk/year for LCIS
    1
  18. LCIS is most common in what group of women
    premenopausal
  19. linear or branching calcifications on mammogram
    DCIS
  20. variants of DCIS
    • solid
    • cribiform
    • papillary
    • comedo
  21. comedo variant is at high risk of
    • multicentricity
    • recurrence
    • microinvasion
  22. recurrence of DCIS is increased in what situations
    • comedo type
    • lesion >2.5 cm
  23. subcutaneous mastectomy only indicated for
    • prophylactic
    • DCIS or LCIS
  24. best way to diagnose intraductal papilloma
    ductogram
  25. most common presentation of diffuse papillomatosis
    breast mass
  26. type of discharge with diffuse papillomatosis
    serous
  27. mammogram appearance of diffuse papillomatosis
    swiss cheeze
  28. tx of diffuse papillomatosis
    resect area
  29. 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
  30. risk factors not assessed in Gail model
    • age at menopause
    • previous xrt
    • HRT
    • obesity
  31. who should not use Gail model
    those with lcis, dcis, or obviously breast ca
  32. 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%
  33. higher incidence of ovarian cancer in what brca gene
    I
  34. brca II gene has a higher incidence of
    pancreatic and male breast
  35. screening for BRCA + pts
    • yearly mammograms + MRI at age 25
    • yearly pelvic exam and u/s
    • yearly CA-125
  36. size of mass detectable on mammogram
    > or = 5mm
  37. who gets breast mri
    >20% risk (2 family members, brca, or previous xrt)
  38. mgmt for birad 3
    f/u 6 month
  39. w/u for palpable mass in pt <30
    • exam
    • u/s
    • core needle biopsy
  40. pt with likely fibroadenoma comes back for 3 month f/u and mass has grown
    excise
  41. staging w/u for breast ca
    cxr and lfts
  42. what pts with newly diagnosed breast ca need a ct for staging
    • elevated lfts
    • advanced disease
  43. what defines advanced disease
    • inflammatory ca
    • skin involvement
    • chest wall involvement
    • > 5cm
    • N2 or N3
  44. tis for
    lcis, dcis, pagets without tumor
  45. N1 is atleast what stage
    IIa
  46. T4 is atleast what stage
    IIIb
  47. N2 disease is atleast what stage
    IIIa
  48. T3 N1 is atleast what stage
    IIIa
  49. how is tumor size related to positive nodes
    (size x 10) + 20%
  50. other infrequent genetic syndromes associated with breast ca
    • li fraumeni
    • cowdens
    • lych
  51. Li Fraumeni is associated with what conditions
    • soft tissue sarcomas
    • brain tumors
    • leukemia
    • adrenocortical malignancies
    • early onset breast ca
  52. another name for herceptin
    trastuzumab
  53. most common site of breast ca mets
    bone
  54. axillary lymph node shows adenocarcinoma in a pt with a benign exam and mammogram
    • test for ER and PR
    • if positive then needs MRM
  55. percent recurrence with BCT
    2%
  56. mets detected with local recurrence
    chemo xrt only
  57. 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
  58. indications for excisional biopys after core
    • atypical ductal/lobular hyperplasia
    • radial scar
    • lack of concordance
    • nondiagnostic i.e abscence of calcifications
  59. what are the two different views of the mammogram
    • craniocaudal
    • mediolateral oblique
  60. contraindications for slnbx
    • pregnancy
    • inflammatory or locally advanced
    • prior axillary surgery
    • neoadjuvant
  61. anterior border of ALND
    pec minor
  62. nodes located between pec major and minor
    Rotter's
  63. early sudden post op swelling of arm following MRM
    axillary vein thrombosis
  64. adjuvant chemo is indicated for what tumors
    • > 1cm
    • + nodes
    • ER/PR neg
  65. what tnm characterizes IIIb
    T4 N0-2 MO
  66. what characterizes IIIC
    N3
  67. what distinguishes N3
    • infraclavicular
    • supraclavicular
    • or both axillary and internal mammary
  68. who gets herceptin
    • Her2Neu pos and:
    • 1cm tumor
    • or pos LN
  69. what can decrease complications from bony mets
    bisphosphonates
  70. tx for stage IIIb
    • neoadjuvant
    • surgery
    • adjuvant chemo-xrt
  71. tx for IIIc
    • same as stage IV
    • er pr pos needs hormonal +/- chemo
    • Her pos needs Herceptin + chemo
    • triple neg needs chemo
  72. what pts with breast ca do not get chemo
    • <1cm
    • no nodes
    • and + ER/PR
    • ...basically Stage 1 thats ER or PR +
  73. what kind of receptor is the HER2/neu receptor
    tyrosine kinase
  74. duration of treatment with herceptin
    1 year
  75. contraindications for Herceptin
    previous cardiac disease
  76. what are the different aromatase inh
    • anastrozole
    • letrozole
    • exemestane
  77. side effects of aromatase inh
    fractures
  78. duration of treatment with aromatase inh
    5 years
  79. indications for xrt following MRM
    • T3 or T4
    • - size>5cm or skin/chest wall
    • positive margins
    • inflammatory
  80. who gets xrt to nodes
    • advanced nodal disease
    • > or = 4 nodes
    • extracapsular invasion
    • N2 or N3
  81. relative contraindications to xrt
    • sle
    • active RA
  82. compared to tamoxifen raloxifene has decreased
    • incidence of PE/DVT
    • cataracts
    • risk of fxs
  83. types of ductal ca
    • medullary
    • tubular
    • mucinous
    • scirrhotic
  84. margins needed for cystosarcoma phyllodes
    1cm
  85. tx of metastatic flare
    xrt
  86. recurrence at scar with neg w/u for mets
    resection followed by chemo/xrt
  87. tx for inflammatory breast ca
    • chemo
    • MRM if responds
    • or xrt then mrm
    • all followed by chemo xrt
  88. important aspects for tx of Paget's
    • simple mastectomy should include nipple areolar complex
    • if Ca found then MRM
  89. malignant lesions that look benign
    • mucinous
    • medullary
    • cystosarcoma phyllodes
  90. contraindications for TRAM
    • smoking
    • transverse laparotomy
    • ipsilateral CABG
  91. tx DCIS in pregnancy
    lumpectomy and post partum xrt
  92. bloody nipple discharge during pregnancy
    • u/s and mammogram
    • check cytology of discharge
    • if all neg then follow

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