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44 Cards in this Set
- Front
- Back
Blood supply to breast
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Internal thoracic
Thoracoacromial Long thoracic Intercostal |
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Treatment of Mondor's Disease
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NSAIDs
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Management of fibrocystic diesease with atypical hyperplasia
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resect no need for neg margins
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Fibroadenoma work up
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<30 U/S or mammo then FNA or core needly biopsy
>30 excisional biopsy |
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Management of green vs bloody vs serous vs spontaneous discharge
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Green (fibrocystic usually) reassure if cyclical and nonspontaneous
Bloody --> galactogram and excision Serous (cancer) excisional bx |
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Diffuse papillomatosis
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swiss cheese mammo
40% get breast CA |
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DCIS
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50-60% ipsi cancer
5-10% contra breast premalignant Need 2- mm margin |
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most aggressive DCIS
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comedo
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Treatment of DCIS
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mastectomy for high grade (comedo, multicentric, multifocal) + SLNB?
lumpectomy/xrt + tamoxifen if ER +? No ALND Need negative margins |
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LCIS
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40% breast CA in either breast (70% ductal)
5% synchronous breast CA @ time of dx not premalignant |
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Treatment of LCIS
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observe or tamoxifen or b/l mastectomy
NO ALND! |
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Symptomatic breast mass work up
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<30 y.o
1.) U/S 2.) FNA if solid 3.) exc bx if FNA is nondx |
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Management of bloody cyst fluid
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excisional biopsy (also indicated if clear and recurs)
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Management of suspicious vs indeterminate calcifications on mammo
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stereotactic needle excisional bx in former and core needle bx in latter
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BIRADS
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1 Neg
2 Benign 3 Probably benign (6 month f/u) 4 Suspicious 5 Highly malignant |
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Which level of nodes need to be sampled in SLND
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level 1 (lateral to pec minor)
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Most important prognostic staging factor?
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# of positive nodes
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Most common site of metastasis
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bone
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Greatly increased risk for breast CA
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BRCA gene in fam hx of breast CA
>= 2 primary relatives with b/l breast CA or premeno breast CA DCIS LCIS fibrocystic dz with ADH |
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moderate risk for breast CA
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Fam hx of breast other than b4
early menarche late meno nulliparity first birth after age 30 radiation previous breast CA high fat diet proliferative benign disease HRT |
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Treatment of male breast cancer
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MRM
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Inflammatory cancer has what type of invasion?
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dermal lymphatic
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Absolute contraindications to breast conserving therapy in invasive CA
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1) 2 or more primary tumors in separate quads
2) Pregnancy (unless in 3rd trimester) 3) Diffuse malignant appearing microCa 4) History of XRT 5) Persistent positive margins |
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When is SLNB indicated?
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<1cm tumors and no clinically positive nodes
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When do you have to do formal ALND during SLND
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when you can find radiotracer or dye
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Contraindications to SLND
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Pregnancy
multicentric disease neoadjuvant clinically positive nodes prior axillary surgery inflammatory or locally advanced |
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complications of ALND
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axillary vein thrombosis (early) or lymphatic fibrosis (over 18 months)
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Indications for XRT after mastectomy
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<4 nodes
<5cm (T3) inflammatory CA + margins T4 |
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Chemo for breast CA
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5FU +cyclophosphamide + methotrexate
OR Adriamycin + cyclophosphamide for 3-6 months |
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Paget's disease
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DCIS or ductal CA in breast
MRM if cancer is present otherwise mastectomy |
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Cystosarcoma phyllodes
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10% mal
no nodal mets (hematogenous rare) stromal/epithelial (giant fibroadenomas) WLE with NEG MARGINS no ALND |
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Do you need negative margins or ALND in cystosarcoma?
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yes neg margins no ALND
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Stewart Treves syndrome
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lymphangiosarcoma
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Pregnancy w/ mass
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U/S no mammo
core needle bx or FNA MRM unless 3rd trimester (lumpectomy + ALND + XRT after birth) |
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What should you avoid in children with breast masses?
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excisional biopsies
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Best management of pathological nipple discharge?
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ductogram and direct duct excision
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Paget's disease
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>97% have underlying CA
~50% with underlying mass |
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Treatment of Paget's disease
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mastectomy + axillary staging
OR wide excision of nipple/areola, axilary staging and XRT |
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SLND
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High false neg rate
1-3% risk of lymphedema Frozen section has a 10-15% FN rate and 1% FP low axillary recurrence if negative |
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Chance of breast CA in LCIS and management
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Marker not premalignant
Not palpable, no calcifications incidental finding in premeno 1% chance of breast CA/year (40% bilateral lifetime) 5% synchronous breast CA Tamoxifen provides 50% risk reduction |
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Surgical procedure of choice for LCIS
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Bilateral total mastectomy would be procedure of choice because incidence of cancer is equal for both breasts
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Gail model factors
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Age
Age @ menarche (not menses) # of 1st degree relatives (not 2nd) # of breast biopsies atypical ductal hyperplasia |
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Effect of tamoxifen on survival and recurrence in invasive CA vs in situ
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improved survival (25%) and decreased recurrence (16%) in invasive, NOT IN SITU (reduces risk of developing CA by 50%)
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Main difference in surgical management of DCIS vs LCIS
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DCIS needs negative margins
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