Repro - breast things
6 risk factors in development of malignant breast cancer
1. Increased estrogen exposure 2. Increased menstrual cycles (no babies; early period or late menopause) 3. Older age at first delivery 4. Obesity 5. Gene mutations - BRCA or HNPCC 6. African American
Tamoxifen vs Raloxifene vs Anastrozole TX of ER+ breast cancer in post menopausal women
Anastrozole
Tamoxifen vs Raloxifene vs Anastrozole Used in ER+ breast cancer tx in postmenopausal women - Assc with increased risk of fracture and osteoporosis
Anastrozole
In evaluation of breast cancer, what is the single MOST IMPORTANT prognostic factor?
Axillary lymph node involvement****
Fibrosis vs cystic vs sclerosing adenosis vs epithelial hyperplasia Blue dome - found in evaluation of breast lump in 22 year old girl
Cystic
Management of pain, redness and tenderness of nipple during breast feeding?
Dicloxacillin - vs S. aureus Continued breastfeeding*** to wash out bacteria vs static growth
Breast cancer is assc with overexertion of what 3 receptors?
Estrogen or progesterone receptors or c-erbB2 ***If negative for all 3 = more aggressive - Assc with African- American population
Fibrosis vs cystic vs sclerosing adenosis vs epithelial hyperplasia Hyperplasia of breast stroma - found in evaluation of breast lump in 22 year old girl.
FIBROSIS
A 22 year old presents with concern for a mobile, firm mass on her left boob. It gets bigger and more painful before her period. Likely diagnosis?
Fibroadenoma
Blood nipple discharge with slight risk for breast cancer.
Intraductal papilloma
Woman presents with concern of growth* beneath the nipple* and BLOODY nipple discharge. Likely diagnosis?
Intraductal papilloma - Mass in lactiferous duct - Slight risk for breast cancer
Peau d'orange
Invasion of breast cancer to the lymphatics - blocks drainage! - ID retracted nipple
Upon biopsy, stellate cell infiltration is seen. Patient evaluation was a firm, fixed, rock-hard mass. What kind of breast cancer?
Invasive ductal - 70% - Most invasive - Worst prognosis
Most common breast cancer; most invasive and worst prognosis
Invasive ductal - ID stellate infiltration
Breast cancer assc with - Decreased E-cadherin expression; ID signet ring
Invasive lobular - ID order row of cells aka "Indian file"
At what stage is gynecomastia most prevalent, physiologically (not pathologically) - Birth, puberty, adulthood, old age
PUBERTY
Exzematous patches involving the nipple; risk of carcinoma?
Paget disease - underlying DCIS or invasive breast cancer
55 year old presents with mobile mass. ID *leaf-life projections* of cystic growth on imaging. Likely diagnosis?
Phyllodes tumor - "Leaf like"
Tamoxifen vs Raloxifene vs Anastrozole Estrogen AGONIST at bone Estrogen ANTAGONIST at breast - No assc risk of endometrial cancer - Used in tx of osteoperosis
Raloxifene - Tx osteoperosis
Pneumonic for drugs that can cause gynecomastia (usually d/t hyper estrogen)
STACKED - Spirinolactone - THC (marijuana) - Alcohol (cirrhosis) - Cimetidine - Ketoconazole - Estrogen supplement - Digoxin
Fibrosis vs cystic vs sclerosing adenosis vs epithelial hyperplasia Growth of ACINI and interlobular fibrosis; calcifications confuse with cancerous growth.
Sclerosing adenosis
Tamoxifen vs Raloxifene vs Anastrozole TX or ER/PR+ breast cancer
Tamoxifen - Risk endometrial cancer bc estrogen agonist at uterus!
Tamoxifen vs Raloxifene vs Anastrozole Estrogen AGONIST at uterus/ bone Estrogen ANTAGONIST at breast - Assc with increased risk of endometrial cancer
Tamoxifen - Used in treatment of ER/ PR+ breast cancer
Where is breast cancer most commonly located?
Upper outer quadrant of boob - Aka tail of Spence