Term
why have rates of breast CA not improved since the 1950s? |
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Definition
people are still not being screened to the level which would decrease incidence |
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Term
what is the prognosis for early breast CA? |
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Definition
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Term
what is the incidence of invasive breast CA in the US? |
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Definition
1 in 8 women in the US will develop invasive breast CA |
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Term
what benign findings can mimic breast CA? |
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Definition
cyst, fibroadenoma, mastitis, gynecomastia, and supernumerary breast |
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Term
how does mammography compare w/US in terms of diagnosing lesions? |
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Definition
mammography: good for diagnosing solid lesions. US: good for diagnosing fluid-filled lesions. |
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Term
what characterizes cysts a benign finding of the breast? |
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Definition
cysts are *most common in younger pts. they can be aspirated to dx/tx. US is also a good diagnostic modality for most cysts, which appear homogeneously dark (no septae, etc). however, there are complex cysts which may be a little harder to dx, as they appear more cloudy (contain some blood, septae, etc) and the index of suspicion goes up a little for these. |
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Term
how is a breast cyst aspirated? |
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Definition
the cyst needs to be palpated first, then a breast aspirator is used w/one hand (for even pressure) and the other hand holds the breast. |
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Term
why does mammography not work as well for younger pts? |
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Definition
mammography works b/c older breasts have more fatty tissue which shows up as black and any fibrous lesions show up as white. in younger breasts, which are more generally fibrous, atypical fibrous tissue just blends in on a mammogram. |
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Term
how will a cyst feel on palpation? |
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Definition
well-circumscribed and mobile (may come and go in association w/periods, diet, etc). fixed lesions are more concerning. |
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Term
what is the second most common breast lesion in younger pts? what characterizes it? |
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Definition
fibroadenomas - which are solid and do not come and go, but they are mobile. these lesions demand some kind of imaging to r/o malignancy and should appear well circumscribed on such. if there is doubt of benignity on imaging, a bx will then be required. on US, fibroadenomas will have acoustic shadowing due to their solid nature. |
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Term
what are giant fibroadenomas? |
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Definition
a subclass of adenoma which affects pts 12-16 y/o. 1% contain a malignancy, so they should be removed. the breast tissue is compressed by giant fibroadenomas and should return to normal shape once the lesion is removed (should allay cosmetic concerns). |
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Term
what can mastitis mimic? how is it differentiated? |
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Definition
inflammatory breast CA, both of which affect young women. mastitis should resolve with tx in a week or so, so if it doesn't - need to r/o malignancy. |
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Term
what is a supernumerary breast? |
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Definition
a relatively common lesion which can be misdiagnosed as a lipoma - but is actually composed of breast tissue and will therefore give symptoms w/periods or pregnancy. there is potential for supernumerary breasts to develop a malignancy just as w/any other breast tissue. these usually develop along the milk line. there may also be just a supernumerary nipple which would then mimic a mole. |
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Term
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Definition
enlargement of breast tissue in males, sometimes associated w/H2 antagonists or prostate problems. |
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Term
what are important elements of the hx to r/o breast CA? |
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Definition
gender, age, fam hx (both mother/father's side), genetics (BRCA1/2), hx of hyperplasia on bx, nulliparous (longer unopposed estrogen drive), OCPs (slight increase in breast CA risk), and obesity |
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Term
what is the first question before checking a woman for breast CA? |
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Definition
"do you do your own self-exams?" if they say no - impress upon them the importance of doing so. tell them just to worry about monitoring changes, not to focus on what exactly they are feeling. |
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Term
what is the anatomy of the breast? |
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Definition
septated lobules over a muscle tissue (which may mimic a lesion). |
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Term
what 2 planes is a breast palpated in? |
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Definition
standing up and lying down. |
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Term
what is hand placement in a breast exam? |
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Definition
the hand should be flat, pushing the breast against the chest wall or your other hand (need to have a background). |
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Term
where are common places to miss breast CA? |
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Definition
the nipple-areolar complex and inframammary fold |
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Term
what needs to be checked nodally w/a breast exam? |
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Definition
the axillary nodes, clavicular, and internal mammary chain of lymph nodes |
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Term
why should self-breast exams be performed in a mirror? |
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Definition
so that changes in skin contour/color/venous pattern may be seen |
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Term
is breast dyssymmetry indicative of malignancy? |
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Definition
no - this is more common than not |
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Term
what diagnostics are used to work up a suspicious breast lump? |
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Definition
mammogram, US, MRI (if mammogram is hard to read), and bx/aspiration |
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Term
how can you help prepare a pt for her first mammogram? |
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Definition
warn her that it will be uncomfortable (requires a large amount of compression) |
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Term
what is the BI-RADS classification? |
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Definition
a rating 1-5 for mammograms, which increases w/perceived likelihood of malignancy. however - a BI-RADS of "0" just means inconclusive, not benign (requires other images). BI-RADS 1: normal (uncommon), 2: finding benign (more common), 3: probably benign, 4: probably malignant, 5: malignant. BI-RADS 3-4 requires more diagnostics. |
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Term
what are macrocalcifications associated with? |
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Definition
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Term
what are microcalcifications associated with? what does this require (b/c palpation may not be sufficient)? |
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Definition
malignancy - esp in clusters/swirls, so it requires more of a workup such as: a compression mammogram, stereotactic bx, US-guided bx, and needle localization bx (needle hooks it on x-ray, then incision is made to cut out hooked lesion). |
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Term
what is an extended radical mastectomy? |
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Definition
removal of the breast, pectoralis major/minor, and all axillary/internal mammary nodes - not done any more b/c of morbidity/mortality associated w/just the procedure. |
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Term
what is a radical mastectomy? |
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Definition
removal of the breast, pectoralis major/minor, and all axillary mammary nodes |
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Term
what is a modified radical mastectomy? |
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Definition
removal of the breast, pectoralis minor, and all axillary mammary nodes |
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Term
what is a simple mastectomy? |
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Definition
removal of just the breast tissue |
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Term
what is a partial mastectomy? |
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Definition
removal of just the lesion (if this is an entire quadrant of the breast - quadrantectomy) |
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Term
what is a sentinel node bx? |
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Definition
sample the first node draining the breast, if it is positive for CA - then remove all the nodes. otherwise, the nodes are left in. |
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