Mammography Module 5: Pathology

A

Hormone therapy can affect breast tissue density because hormones can cause the breast tissue to become ___________. a. more prominent b. less prominent c. mostly fatty d. dotted with fluid-filled sacs

Abscess

-Is a local accumulation of pus caused by an infection in the breast -Usually is tender and frequently feels mobile beneath the skin -The edge of the mass is typically regular and well defined

Ductal Carcinoma In Situ (DCIS)

-Is a more common breast cancer in part because of advances in imaging techniques and equipment -Diagnosis often is based on pathological evaluation of very small specimens collected using image-guided biopsy equipment -Tumors are staged as Tis, which indicates that the tumor has not yet spread, and a treatment stage of 0 -Treatments include: localized surgical removal or lumpectomy, radiation therapy and hormonal treatment where indicated -If it is estrogen receptor-positive, postsurgical treatment with tamoxifen can reduce the risk of developing another carcinoma or an invasive cancer

Wegener Granulomatosis

-Is a rare disease characterized by necrotizing tissue that is chronically inflamed -It is a type of vasculitis, or inflammation of the small- to medium-sized blood vessels -Inflammation can affect organs such as the lungs, kidneys, eyes, skin, muscles, as well as the nervous system and heart -May mimic a malignancy because of its irregularly shaped, high-density masses

Modified Radical Mastectomy

-Is a simple mastectomy plus removal of the axillary lymph nodes -In this procedure, the pectoral muscles are left intact

Amyloidosis

-Is a systemic disease associated with extracellular deposits of various insoluble proteins: the deposits accumulate locally but cause few reported symptoms -There are 3 main systemic forms -Primary, or idiopathic, is the most common type in the US -Some patients develop this secondary to other diseases or conditions, such as various malginancies, rheumatoid arthritis and tuberculosis -Frequently appears as an irregular or spiculated mass with irregular or amorphous microcalcifications

Sarcoidosis

-Is a systemic disorder of unknown cause -Involves the lungs, eyes and musculoskeletal system -Most notably appears in the form of a granuloma, or microscopic clump of inflammatory cells -Is visualized as an irregular, ill-defined or spiculated mass that is suspicious for malignancy

Cyst

-A benign fluid-filled sac that has a distinct membrane and may develop abnormally in a body cavity or structure such as the breast -Liquid usually cannot be detected on mammography, so sonography often is used to verify the presence of fluid to help distinguish it from a solid lump

Lipoma

-A benign tumor or mass composed of fatty tissue -Are the most common noncancerous soft tissue growth and can occur in many different locations of the body, including the breast -Are slow growing, rarely cause pain, feel soft and somewhat rubbery and are mobile on palpation -Typically appear as a radiolucent mass surrounded by a thin capsule

Breast Cancer Staging

-A classification system that describes the distinct periods in the course of a disease -The system helps describe the extent of disease and identify whether the malignancy has spread locally, regionally, or distantly -Ranges from 0 to stage IV -The lowered number stages indicate earlier phases of cancer and the higher numbers reflect later stages of the disease

Asymmetries

-A unilateral area of more pronounced or thickened fibroglandular breast tissue that is seen on only one mammographic view -Many factors can cause this including: both malignant and benign conditions

Genetic Mutations

-About 5-10% of BRCAs result from inherited genetic mutations -Certain genes such as: BRCA1 and BRCA2 have been identified as tumor suppressor genes -Patients with BRCA1 and BRCA2 are more susceptible to BRCA over their lifetime -Having close paternal or maternal blood relatives with the disease can increase factors

Invasive Ductal Carcinoma (IDC)

-Also called infiltrating ductal carcinoma or IDC, is the most common form of breast cancer, accounting for about 80% of all breast cancers -Originates in the milk ducts and then spreads to other areas of the breast -Can present as a palpable hard lump that is anchored to the surrounding tissues -The skin over the affected area or the nipple may be retracted, which is another sign of possible breast cancer

Invasive Lobular Carcinoma (ILC)

-Also called infiltrating lobular carcinoma, originates in the lobular unit before spreading to surrounding breast tissue -Is the second most common type of breast cancer, accounting for 10% to 15% of breast cancers -Can appear in the breast as a general thickening of tissue, usually in the area above the nipple -Can also spread to other areas of the body including the ovaries and uterus -Can usually be treated with chemotherapy, hormonal therapy, surgery and radiation therapy, and the combination of these treatments depends on the stage and pathology of the cancer

Lymphoma

-Also rare -Usually is associated with non-Hodgkin's -Secondary is more common than primary -Tumors originate in lymph tissue, and patients may present with enlarged axillary lymph nodes or a palpable, painless mass in the outer portion of the breast -A biopsy is usually performed to confirm diagnosis

Changes in Breast Composition

-As women continue to age, the glandular tissue eventually is replaced by fatty tissue in a process called lobular involution -Hormone therapy affect density and cause the breast tissue to become more prominent -Increased density can be a sign of developing asymmetry

Clinical Signs

-Based on or characterized by observable symptoms of disease, and certain clinical signs may indicate breast cancer -Specific signs include any palpable lump that is fixed to the skin or chest wall or a lump that is stony, hard and irregular on palpation -Skin dimpling -Nipple retraction -Any type of unusual discharge from the nipple

Aromatase Inhibitors

-Block the production of estrogen, primarily are prescribed for postmenopausal women -Tamoxifen, which blocks the effects of estrogen produced by the ovaries, is approved for use by women before or after menopause and by men

Stage IV

-Breast cancer indicates that a distant metastasis has been detected -Usually, the distant spread is to organs such as the lungs, liver or brain or to the bones -Breast cancer carries the highest mortality rate of all stages because spread to vital organs has already occurred -Treatments options include radiation, surgery, and chemotherapy

Stage III

-Breast cancer is complex, and there are 3 subcategories, labeled A, B, and C, which are based largely on spread to local sites -A tumor has spread to multiple axillary lymph nodes or multiple internal mammary lymph nodes, and the nodes are fixed to one another or to other structures -B is assigned to a tumor of any size that involves the tissues near the skin and chest muscles; it may have spread to lymph nodes within the breast or axilla; inflammatory breast cancer is usually included in this -C includes breast tumors of any size; includes cancers that have spread to the clavicular lymph nodes and may also have spread to the internal mammary lymph nodes

Breast Cancer Risk Factors

-Can be environmental, chemical, psychological, physiological or genetic elements that predispose a person to developing a disease -Can be broken down into 2 categories: modified and those that cannot

Stage II

-Cancers are larger in size than stage I cancers and typically show signs of spread to the nearby lymph nodes -Lymph node involvement and the location of the lymph nodes can provide clues as to the extent of disease -Also includes breast cancers that are larger than 5 cm but have not spread to axillary lymph nodes

Adjuvant Drug Therapy

-Chemo is usually recommended for women with invasive breast cancers regardless of whether their tumors are hormone receptor-positive or negative -If the tumor is smaller than 1 cm at its largest point, therapy generally is not part of the treatment plan -However, some physicians suggest using if a small tumor has high-risk features, such as benign high grade, hormone receptor-negative or ERBB2-positive, or has a high score on one of the gene panels

Screening Mammography

-Crucial tool in the fight against BRCA because a large percentage of cancer is treatable if it is found in its earliest stages -Is performed on patients with no symptoms of BRCA

Imaging Dense Breasts

-Density can appear white on the image, especially in thick areas of breast tissue -Often difficult to image -Sonography and Magnetic Resonance (MR) imaging are useful tools to further evaluate breasts -Heterogeneous breasts can present an imaging challenge because the mammographer must ensure that the x-ray beam penetrates dense areas adequately but does not overexpose the areas of fatty tissue

Architectural Distortion

-Describes changes in the normal appearance of the breast's structures -In a normal breast, ductal structures are arranged as a pattern of radial lines that join at the nipple -When lines appear outside of this normal pattern, but no definitive mass is present -Can be associated with benign or malignant abnormalities, and a biopsy or additional imaging may be recommended depending on patient's personal history, recent surgeries, and the location and size

Stage 0

-Describes noninvasive, or in situ, breast cancer -It can occur in the ducts, where it is called ductal carcinoma in situ or DCIS, or it can occur in the lobules, called lobular carcinoma in situ or LCIS

Other Systemic Diseases

-Diabetic fibrous mastopathy: is associated with insulin-dependent type 1 diabetes and can produce breast lesions -Dermatomyositis: is a muscular disease with an inflammatory component that produces a rash and diffuse subcutaneous calcifications in the skin -Mammary tuberculosis: can appear as slow-growing, painless mass that can be either poorly defined or well circumscribed depending on the pattern of the disease

Paget Disease

-Disease of the breast is rare; disease starts in the breast ducts and spreads to the skin of the nipple; the patient might first notice a burning or itching sensation; skin often appears crusted, scaly and red, with areas of bleeding or oozing

Triple-Negative Breast Cancer

-Do not have receptors for estrogen, progesterone or ERBB2, and they do not respond to hormonal or ERBB2-targeted therapies -These breast tumors are aggressive, usually are associated with a poorer prognosis and most often occur in younger women -Treatment usually involves chemotherapy, surgery, and radiation therapy

BI-RADS (Breast Imaging Reporting and Data System)

-Established by the ACR -Provides guidance for the radiologist and referring physicians in organizing image interpretation and reporting -Assessment categories are: *Category 0: incomplete, needs additional imaging evaluation and/or prior mammograms for comparison *Category 1: negative *Category 2: benign *Category 3: probably benign *Category 4: suspicious *Category 4A: indicates low suspicion for malignancy *Category 4B: indicates moderate suspicion for malignancy *Category 4C: indicates high suspicion for malignancy *Category 5: highly suggestive of malignancy *Category 6: known biopsy, proven malignancy

Unmodifiable Risks

-Factors that a patient cannot control -Biggest is gender: women are 100 times more likely to develop BRCA than men -Genes and family history of BRCA can increase risk -Race and ethnicity -Women with dense breasts -Number of menstrual cycles a woman has over a lifetime -Early menarche, or onset of menses before age 12, and late menopause after age 55 slightly increase risk

IBC Treatment

-Frequently is diagnosed at stage III or IV and is an aggressive type of breast cancer, so treatment usually involves a multimodality plan -Patients often receive chemotherapy first, to shrink the tumor, followed by surgery to remove the tumor and radiation therapy to the chest wall -A modified radial mastectomy is the standard surgical treatment; the surgeon removes the entire breast and the axillary lymph nodes -Can spread and grow more quickly and is associated with poorer prognosis

Neoadjuvant Therapy

-If adjuvant therapy is given before the primary therapy -Goal is to make the primary therapy more effective -May be recommended based on the tumor's characteristics, lymph node involvement and other prognostic considerations

Typically Benign Calcifications

-Include uniformity round, or punctate, calcifications less than 0.5 mm in diameter -Can contain fluid known as "milk of calcium," which can solidify -May demonstrate a "tea cup" sign, referring to a crescent shape or cup-like appearance seen on a lateral projection -Others include vascular calcifications, coarse or popcorn-like calcifications, large rod-like calcifications, and rim calcifications, which can form along the margins of a benign mass -Dystrophic calcifications, which can form in degenerated tissue following trauma or irradiation -Suture calcifications, which can form on suture material following surgery

Invasive Cancers

-Indicates that the disease has spread beyond the structure in which it started -There are 3 different types: inflammatory breast cancer or IBC, invasive lobular carcinoma and invasive ductal carcinoma -IBC has the lowest incidence of the 3 cancers -Most breast cancers begin in the ductal structures, although cancer can develop in the lobules or in other breast tissues -Ductal cancers typically form into a mass, making them somewhat easier to identify -Lobular cancers tend to develop in several areas of the breast in a sheet-like pattern that sometimes makes them more difficult to locate

Stage 1

-Indicates that there is no evidence of cancer cells spreading beyond the local area, or the invasion is early and microscopic -Tumors are generally a very small mass, up to 2 cm

Proliferative Lesions with Atypia

-Involve extensive cellular growth in the ducts or lobules of the breast tissue, and the growth does not appear normal -These types of lesions include atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ, depending on the location of cell growth

Proliferative Lesions without Atypia

-Involve new cell growth by a rapid succession of cell divisions -Without atypia show growth of new cells in the lobules or ducts of breast tissue -The complex fibroadenoma, sclerosing adenosis, multiple papillomas and radial scars are examples

Fat Necrosis

-Is a benign inflammatory process associated with the death of fatty tissue -Typically is caused by irradiation, ductal ectasia from chronic mastitis, or by external breast trauma such as a breast biopsy or breast reduction surgery -Can appear as a cluster of microcalcifications, a lipid cyst or as a focal mass, and might bot be distinguishable from malignancy until a biopsy is peformed -Usually has a rounded density with central fat and is surrounded by a capsule resembling an eggshell -Can cause formation of benign oil cysts

Papilloma

-Is a benign tumor resulting from an overgrowth of epithelial or connective tissue -May be painful at times and may cause a bloody discharge from the nipple -The bloody discharge is likely the most alarming symptom for patients because it can also be a sign of malignanacy -Appear most often in women between the ages of 35-55, and there are no known causes or risk factors -Are involved with atypical cellular growth characteristic of ductal carcinoma in situ or atypical ductal hyperplasia

Galactocele

-Is a benign, cyst-like mass within the breast that contains milk or milky fluid -Is caused by a blocked duct that prevents the milk from exiting the breast properly

Hamartoma

-Is a benign, tumor-like growth consisting of a disorganized mixture of cells and tissues -This growth is a mass of normal tissue that builds up in areas of the body, including the breast -May present as a soft, painless lump or nonpalpable mass, usually in women older than age 35

Hematoma

-Is a buildup of blood in an injured area of the breast -An example is a bruise -Can appear on a mammogram as a well-defined, ovoid mass with relatively sharp margins

Masses

-Is a three dimensional lesion seen in two projections -An oval shape has rounded edges but elongated height compared with the width -An irregular shape is suspicious because some forms of breast cancer have irregular borders -Circumscribed margins have clear, distinct borders and are confined to a specific area -Well circumscribed margins are usually benign -Indistinct margins are not well distinguished from surrounding tissues -Spiculated margins appear as star-burst in shape and exhibits sharp, finger like projections; often is a hallmark sign of breast cancer -Star-burst pattern can indicate malignancy

Radial Scar

-Is a type of benign proliferative breast lesion -It has a central core consisting of fibrous tissue surrounded by tubular ducts or lobules -It is usually visible on a mammogram as a spiculated, rosette-like lesion with a radiolucent center -Often is surrounded by areas of adenosis, or enlarged breast lobules, hyperplasia, and numerous papillomas -Is considered a high risk lesion that significantly increases the risk of future breast cancer

Ductal Ectasia

-Is a widening of the milk ducts -Usually is found around the subareolar region and can cause clinical signs such as nipple retraction, nipple discharge or a palpable mass that is accompanied by pain or tenderness -Is a benign condition most likely caused by an anti-inflammatory reaction and fibrosis -Patients in the chronic stage show signs of calcification that may appear as needle-like, tubular and cyst-like shapes -Both acute and subacute stages may cause the nipple to retract and possible cause a subareolar density to develop -On a galactogram, it may be represented by a dilated duct, obstruction, extravastion, epithelial irregularity, or architectural distortion

Systemic Lupus Erythematosus

-Is an autoimmune disease that rarely involves the breast, but when it does, its called lupus mastitis -It can affect multiple organs and the musculoskeletal system in the form of arthritis -Resembles masitis on mammography, with macrocalcifications appearing as curvilinear of diffuse coarse calcifications either bilaterally or unilaterally

Breast Sarcoma

-Is another very rare type of breast cancer -Do not originate in the breast ducts or lobules -Instead, they originate in the connective tissue of the breast -Can be primary or secondary tumors and are sometimes associated with previous radiation therapy to the chest wall

Inflammatory Breast Cancer (IBC)

-Is caused by cancer cells blocking lymph vessels in the skin -Usually is clinically visible -Clinical signs include: a warm, red and swollen area of the breast that might look pitted or thick like an orange peel, called peau d'orange -Breast may become firmer and larger -Patient might report symptoms such as tenderness or itching -Sonography, MR and positron emission tomography combined with computed tomography, or PET-CT, may provide additional assistance in diagnosis

Lobular Carcinoma In Situ (LCIS)

-Is considered the earliest possible and most treatable diagnosis of breast cancer -A yearly mammogram is recommended because a woman with unilateral LCIS is at higher risk of developing invasive breast cancer

Mastitis

-Is inflammation of breast tissue that usually occurs in women of childbearing age who are breastfeeding

Adjuvant Hormone Therapy

-Is not appropriate for every patient and only is recommended for cancer that is hormone receptor-positive -Can be used no matter how small the tumor is, but patients with tumors larger than 0.5 cm usually experience most benefit -Tamoxifen and aromatase inhibitors are prescribed

Diagnostic Mammography

-Is ordered by the physician to evaluate specific clinical indications, such as palpable lumps, or mammographic indications, such as asymmetry

Lymph Nodes

-Its altered appearance can signal a possible metastatic disease from other sites -The size and consistency become important clues in determining diagnosis -Is a rounded mass surrounded by a capsule of connective tissue -Contain a numerous lymphocytes, which filter the clear fluid, or lymph, that drains through the node to remove impurities from the bloodstream -MLO projections must include the axilla to ensure the breast tissue have not been missed; axillary nodes might appear on these images -Can carry cancer cells from the breast to distant sites

Macrocalcifications

-Larger than 0.5 mm -Described as larger and coarse in appearance -Most often indicate changes caused by the aging of the breast arteries, old injuries or sometimes inflammation

Gynecomastia

-Men also can develop breast conditions -Usually appears as swelling of the breast or as a button or disk-like growth within the breast near the nipple or areola -Hormonal changes in teenage boys and older men make it more common in these age groups -Men may also develop as a side effect of antidepressants, calcium channel blockers, anabolic steroids or drugs such as marijuana

6 Different Types of Breast Tissue

-Milk producing glands called lobules -Ducts that carry milk from the glands to the nipple -Adipose or fatty tissue -Connective tissue -Blood vessels and Lymph vessels

Treatment Options

-Most is based on the staging and pathology of a particular breast cancer, and the therapy proven to be most effective for that particular type -Surgical options include different types of mastectomies, lumpectomies, and lymph node evaluation

Modifiable Risk Factors

-Not having children, called nulliparity, having her first child at a later age, or not breastfeeding can contribute to a women's breast cancer risk because of increased hormones -Use of oral contraceptives and hormone replacement therapy -Overweight and obesity, a sedentary lifestyle and frequent alcohol consumption can contribute to breast cancer development

Fibroadenoma

-One of the more common types -A benign tumor or mass usually composed of stroma and epithelial tissues -Some contain coarse calcifications -Often occur in premenopausal women: after menopause it will atrophy, leaving calcifications behind -Typically appears as a circumscribed oval or round shape on a mammogram -Additional imaging may be used including sonography or MR

Adjuvant Therapy

-Used after a patient undergoes primary cancer treatment such as radiation therapy or surgery -May be used to reduce the chance of cancer recurrence and increase the patient's chance of long-term survival -Types include: chemo, hormonal therapy, targeted drug therapy, radiation therapy, or a combination of treatments -May be recommended based on the tumor's characteristics, lymph node involvement and other prognostic considerations

Sentinel Lymph Node Biopsy

-Or an axillary lymph node dissection checks the regional lymph nodes for cancer -Is the first lymph node into which a tumor drains and is most likely to contain cancer cells if they have spread -Mapping can be used to identify the node of biopsy -Procedure: a raditracer is injected near the site of tumor, a blue dye often is used in conjunction with the radiotracer to improve visualization of the nodes, the radiotracer and dye are absorbed by the lymphatic system, and a gamma detector is used to locate the node

Distant Recurrence

-Or metastasis, describes the spread of breast cancer to organs such as the lungs and brain or to the bones

Simple Mastectomy

-Or total mastectomy -Involves removal of the entire breast, but does not include the axillary lymph nodes

Other Types of Breast Cancer

-Paget disease of the breast -Breast Sarcoma -Lymphoma

Lumpectomy

-Removes only the breast mass and a margin of normal tissue surrounding the tumor -Is performed for patients with a confirmed cancer diagnosis -Patients usually undergo a course of radiation therapy following procedure -If the patient is also scheduled to receive chemo, radiation treatment usually is delayed until chemo is completed

Reporting Terminology

-Reports describe areas of concern as masses, calcifications, architectural distortion, and asymmetries -Characteristics of these findings such as size, location, morphology and appearance help provide diagnostic clues

Lobular Involution

-Results in a breast composed almost entirely of fatty tissue -This type of breast is usually the easiest to image because the glandular tissue is no longer present

Male Breast Cancer Risk Factors

-Specific risk factors including aging, family history, genetic mutations, Klinefelter syndrome, radiation exposure, alcohol abuse, liver disease, estrogen exposure, obesity and testicular problems -Inherited genes such as BRCA1 and BRCA2 are thought to contribute, particularly if they occur in family members younger than age 60 -Have similar prognosis as women with the same stage of breast cancer -Is treated similarly to female breast cancer, using local or systemic therapies such as surgery, chemo regimens or hormone therapy

Nonproliferative Lesions

-Such as breast cysts, are not caused by new cell growth and generally are not associated with an increased risk of cancer -Are the most common finding in breast cancer screening biopsies

Breast Cancer Risk

-The ACS reports that more than 246,000 new cases of invasive breast cancer are diagnosed in the US each year -The lifetime risk of developing breast cancer for women who reach age 95 is 1 in 8, and statistical data shows that 1 in 36 women, about 3%, die from the disease

TNM Mestastasis Classification

-The M stands for distant metastasis -The M is followed by numbers to indicate whether the cancer has spread to distant organs such as the lungs or bones -M0 indicates that there is no evidence of distant metastasis to other organs -cM0(i+) is used to indicate microscopically detected tumor cells in areas of the body such as the blood, bone marrow or distant nodal tissue, in the absence of clinical or radiographic evidence -M1 is used when distant metastasis to other organs has been detected clincially, radiographically or histologically

TNM Lymph Node Classification

-The N indicates the regional lymph nodes -The N is followed by a number from 0 to 3 that indicates whether the cancer is found in the lymph nodes near the breast -NX indicates that the lymph nodes cannot be assessed -N0 indicates that the cancer has not spread to local-regional lymph nodes -N1 is used to describe cancer that has spread to moveable ispilateral, or same-side, axillary lymph nodes -N2 indicates that cancer has spread to fixed ipsilateral axillary lymph nodes or to ipsilateral internal mammary nodes -N3 cancer has spread to certain levels or combinations of the ipsilateral internal mammary lymph nodes, ipsilateral supraclavicular lymph nodes or ipsilateral infraclavicular lymph nodes

TNM Breast Cancer Staging

-The T indicates the breast tumor size -The T is followed by a number from 0 to 4, which describes the size of the tumor and whether it has spread to the skin or chest wall under the breast -TX indicates that the primary tumor cannot be assessed -T0 indicates that there is no evidence of a tumor -Tis means an in situ cancer such as DCIS or noninvasive Paget disease -T1 is used when the tumor is 2 cm or smaller at its greatest dimension -T2 is for a tumor that measures 2 to 5 cm -T3 indicates a tumor larger than 5 cm -T4 describes a tumor of any size that extends into the chest wall or the skin

Pathology

-The study of the nature and cause of disease -Can also be defined as a condition produced by disease

Noninvasive Cancers

-There are 2 types: lobular carcinoma in situ, or LCIS, and ductal carcinoma in situ, or DCIS -In situ means the cancer remains in its original location -Of the two, DCIS is more common, making up about 20% of all breast cancers

Breast Composition

-There are 4 types labeled a through d, which are categorized based on the amount of fibroglandular tissue and the possibility that a mass could be obscured by breast tissue -A has the least amount of fibroglandular tissue and is described as almost entirely fatty -B demonstrates slightly more areas of x-ray attenuation and is described as having scattered areas of fibroglandular density -A heterogeneously dense breast, C, has a large enough proportion of fibgroglandular tissue that small masses may be obscurred -D is described as extremely dense and has a significant amount of fibroglandular tissue

Suspicious Morphology

-Types include amorphous, meaning the calcifications lack apparent shape or organization, or have no real or apparent crystalline form -Coarse heterogeneous calcifications are irregular, conspicuous calcifications that are generally larger than 0.5 mm in diameter and tend to coalesce -Fine pleomorphic calcifications are more conspicuous than amorphous, have a discrete shape, and are typically less than 0.5 mm in diameter -Fine linear or fine-linear branching calcifications are thin, irregular linear calcifications, usually less than 0.5 mm in diameter, that may have branching forms

Calcifications

-Usually are small deposits of calcium or other materials, are another type of abnormality that may or may not be associated with malignancy -Might appear diffusely spread throughout the breast, regionally located in a large portion of the breast, grouped in small clusters, or in linear or segmental patterns, both of which suggest ductal deposits

Radiation Therapy

-Usually is performed following breast-conserving surgery to eradicate cancer cells that remain in the breast, chest wall or axilla area -Sometimes used following mastectomy if the tumor is larger than 5 cm or if the cancer has spread to the lymph nodes -External beam treatment uses a focused beam to penetrate the body and treat the area affected by the cancer -Brachytherapy delivers radiation directly to the tumor through the use of radioactive seeds or pellets; the seeds are placed directly into the breast tissue adjacent to the tumor

Radical Mastectomy

-Very common through the 1980s -Is an extensive operation in which the surgeon removes the entire breast, axillary lymph nodes and the pectoral muscles

Recurrent Cancer

-When the cancer returns to the same anatomic area as the primary tumor -Local usually is treated with a mastectomy

C

A(n) _______ type of microcalcification contains a fluid known as "milk of calcium." a. amorphous b. pleomorphic c. tea cup d. dermal

D

According to the National Cancer Society, how many new cases of breast cancer are diagnosed in the US each year? a. 50,000 b. 100,000 c. 150,000 d. 200,000

C

All of the following are controllable risk factors for breast cancer EXCEPT: a. use of birth control pills b. use of alcohol c. a family history of breast cancer d. being overweight

Coarse Heterogeneous Calcifications

Are irregular, conspicuous calcifications that are generally larger than 0.5 mm in diameter and tend to coalesce

Fine Pleomorphic Calcifications

Are more conspicuous than amorphous, have a discrete shape, and are typically less than 0.5 mm in diameter

B

BI-RADS provide guidance for radiologists in which aspect of breast imaging? a. biopsy results b. image interpretation c. cancer staging d. needle localization

Fine Linear Calcifications (Fine-Linear Branching Calcifications)

Fine linear or fine-linear branching calcifications are thin, irregular linear calcifications, usually less than 0.5 mm in diameter, that may have branching forms

A

For a calcification to be classified as macrocalcification, it must be larger than _________. a. 0.5 mm b. 1.0 mm c. 0.5 cm d. 1.0 cm

Lining of the Ducts

Most common location for breast cancer

C

The benign condition known as ________ is the result of wart-like growth in the breast ducts that can lead to bloody discharge from the nipple. a. fibroadenoma b. galactocele c. papilloma d. lipoma

Amorphous Calcifications

The calcifications lack apparent shape or organization, or have no real or apparent crystalline form

B

The most common form of invasive breast cancer is ___________. a. inflammatory breast cancer b. infiltrating ductal carcinoma c. lobular carcinoma in situ d. ductal carcinoma in situ

C

The staging system for cancer ranges from 0 to: a. II b. III c. IV d. V

D

Which types of unusual discharge from the nipple should be a cause for concern? 1.) clear 2.) cloudy 3.) bloody a.1 and 2 b. 1 and 3 c. 2 and 3 d. 1, 2, and 3