AbGyn Flashcards on Breast and Ovarian CA
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Questions and Answers

What's the treatment for Peau-D'Orange (inflammatory) breast CA?

Neoadjuvant chemotherapy + surgery + radio

What's the surgery for Peau-D'Orange breast CA?

Modified radical mastectomy

What's the best tumor marker for each subtype of ovarian CA? (Select all that apply)

  • Alfa-feto for yolk sac (correct)
  • CA-125 for epithelial (correct)
  • B-hCG for embryonal cells (correct)
  • CA-15-3 for all subtypes

Other than radial scar, what can have architectural distortion and spiculated mass?

<p>Carcinoma (B), Fat necrosis (D)</p> Signup and view all the answers

Match the pathology report with the lesion:

<p>Abundant stromal and epithelial content = Fibroadenoma Spiculated mass with central necrosis surrounded by entrapped ducts and lobules = Radial Scar Lipid-laden macrophages = Fat necrosis</p> Signup and view all the answers

What are the contraindications for stereotactic breast biopsy?

<p>Extremely large or thin breast; lesions abutting the chest wall; subareolar lesions</p> Signup and view all the answers

What are the 1st and 2nd most common gynecological surgeries in the US?

<ol> <li>Cesarean, 2. Hysterectomy (fibroids)</li> </ol> Signup and view all the answers

What are the best antibiotics for mastitis? (Select all that apply)

<p>Cephalexin (B), Dicloxacillin (D)</p> Signup and view all the answers

In a patient with family history of breast CA who presents with unilateral bloody breast discharge, what's the most likely diagnosis?

<p>Intraductal papilloma</p> Signup and view all the answers

When is the sentinel lymph node biopsy indicated for breast CA?

<p>Invasive CA without axillary node exam; DCIS &gt; 4cm; DCIS comedo subtype; mastectomy required</p> Signup and view all the answers

What is the treatment for male breast CA?

<p>Simple mastectomy + sentinel (D)</p> Signup and view all the answers

In patients who will undergo radiation for breast CA, is it better to have autologous reconstructive surgery or implants?

<p>True (A)</p> Signup and view all the answers

Are most of the breast fat necrosis cases after trauma or idiopathic?

<p>Most idiopathic</p> Signup and view all the answers

In terms of medical treatment, what should you link to breast CA ER/PR+?

<p>Hormone therapy (B)</p> Signup and view all the answers

What type of breast CA benefits from neoadjuvant chemo?

<p>Triple negative &gt;0.5cm and inflammatory CA</p> Signup and view all the answers

Cite 3 genes associated with skin melanoma.

<p>BRAF, NRAS, KIT</p> Signup and view all the answers

How many positive sentinel lymph nodes are necessary to make an axillary dissection happen for T1-2 breast CA?

<p>3 or more</p> Signup and view all the answers

If a patient undergoes breast reconstruction before a 6-month gap from radiation, what's the best option?

<p>Tissue expander</p> Signup and view all the answers

What's the most common non-obstetric surgery in pregnant women?

<p>Appendectomy</p> Signup and view all the answers

What's the resection margin for phyllodes tumor, DCIS, and invasive ductal CA?

<p>2 mm (A), No ink on tumor (B), 1 cm (C)</p> Signup and view all the answers

What adjuvant therapy should triple negative breast CA have?

<p>Olaparib</p> Signup and view all the answers

What's the treatment for gynecomastia?

<p>Liposuction and direct tissue excision (D)</p> Signup and view all the answers

If NSAIDs fail in the treatment of mastodynia, what's the next step?

<p>Selective estrogen modulator</p> Signup and view all the answers

How much is radial scar associated with cancer?

<p>25%</p> Signup and view all the answers

What's the next step if core needle biopsy is positive for radial scar?

<p>Excisional biopsy</p> Signup and view all the answers

What's the treatment for pelvic inflammatory disease?

<p>Ceftriax (once), Doxy (14d), Metro (14d)</p> Signup and view all the answers

In which trimester is appendicitis more frequent in pregnancy?

<p>2nd</p> Signup and view all the answers

How high is the risk of fetal loss in uncomplicated appendicitis?

<p>2% fetal loss</p> Signup and view all the answers

What about preterm labor in the same situation?

<p>6% labor</p> Signup and view all the answers

Is the result of atypical cells in cytology from serous fluid from cyst aspiration concerning for cancer?

<p>False (B)</p> Signup and view all the answers

Will premenopausal patients with BRCA2 gene mutation have risk reduction after bilateral salpingo-oophorectomy?

<p>Both ovarian and breast</p> Signup and view all the answers

If you're concerned about recurrent spontaneous bloody nipple discharge, what should be ordered first?

<p>Mammogram</p> Signup and view all the answers

In axillary dissection, match the boundaries:

<p>Superior = Axillary vein Medial = Serratus anterior Lateral = Latissimus dorsi Inferior = Tail of breast Posterior = Subscapularis</p> Signup and view all the answers

When should screening mammography start?

<p>40</p> Signup and view all the answers

If 6 months after mastectomy with breast reconstruction the patient doesn't like the cosmetic results in a focal area, what's the best option?

<p>Lipo grafting</p> Signup and view all the answers

In a patient suspected of having endometriosis with negative ultrasound, what's the next step?

<p>Oral contraceptives</p> Signup and view all the answers

Which of these lesions are pre-malignant and which have higher risk of associated cancer?

<p>Atypical lobular hyperplasia (B), Ductal CA in situ (C)</p> Signup and view all the answers

Is DCIS or LCIS more associated with bilateral lesions?

<p>LCIS more related to bilateral lesions</p> Signup and view all the answers

If you find LCIS in one breast, do you have to biopsy the other one?

<p>False (B)</p> Signup and view all the answers

In vulvar SCC, what's the size cutoff to determine wide local excision versus radical vulvectomy?

<p>Depth &gt;1mm = radical vulvectomy</p> Signup and view all the answers

High levels of which marker are a bad prognosis for breast CA?

<p>Her2</p> Signup and view all the answers

What's the most common primary malignancy to metastasize to the lungs?

<p>Colon (D)</p> Signup and view all the answers

In patients who need sentinel node biopsy but had reduction mammoplasty in the past, should you still do the node biopsy?

<p>True (A)</p> Signup and view all the answers

What's the incidence of breast CA in females and males?

<p>Female 12%, Male 0.1%</p> Signup and view all the answers

Injury to which nerve causes winged scapula?

<p>Long thoracic</p> Signup and view all the answers

What kind of breast mass has biopsy with a single-file pattern?

<p>Invasive lobular CA</p> Signup and view all the answers

What's the best treatment for Stewart-Treves syndrome?

<p>Wide local excision/amputation</p> Signup and view all the answers

If left untreated what's the most likely outcome of breastfeeding mastitis with abscess?

<p>Duct fistula</p> Signup and view all the answers

Beyond which score should patients be offered adjuvant chemotherapy in breast CA?

<blockquote> <p>= 26</p> </blockquote> Signup and view all the answers

What's the etiology of Mondor's disease?

<p>Idiopathic</p> Signup and view all the answers

What's the most likely cause of mastitis in the breastfeeding patient?

<p>S.aureus</p> Signup and view all the answers

What determines a DCIS to be high, intermediate, or low grade?

<p>Mitotic index</p> Signup and view all the answers

If you're operating on invasive ductal CA and find DCIS in the specimen, what should be the clear margin?

<p>No ink on specimen</p> Signup and view all the answers

What are the factors on the Gail model?

<p>Breast biopsy in the past, age of menses onset, race, family history, age, first pregnancy age</p> Signup and view all the answers

What is the pathology report of breast Paget's disease?

<p>Large pale staining epithelial cells intermixed with normal keratinocytes</p> Signup and view all the answers

Which substance is safe to use in pregnancy?

<p>Radiolabeled sulfur colloid (C)</p> Signup and view all the answers

What's the origin of Stewart-Treves tumor?

<p>Endothelium</p> Signup and view all the answers

Is BRCA more associated with ALH, ADH, or LCIS?

<p>ADH (C)</p> Signup and view all the answers

Which of these is positive for E-Cadherin?

<p>ADH (C)</p> Signup and view all the answers

Flashcards

What is Peau-D'Orange breast cancer?

A type of breast cancer characterized by a thick, pitted appearance similar to orange peel.

What is a modified radical mastectomy?

A surgical procedure that removes the entire breast, the underlying pectoral muscle, and some axillary lymph nodes.

What is a sentinel lymph node biopsy?

A biopsy to evaluate the sentinel lymph node, the first node in the lymphatic system that receives lymph from the tumor.

What is CA-125?

A protein found in the blood that can be elevated in certain cancers, particularly epithelial ovarian cancer.

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What is B-hCG?

A tumor marker associated with embryonal cell tumors, including certain testicular and ovarian cancers.

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What is alpha-fetoprotein?

A tumor marker elevated in yolk sac tumors, a rare type of cancer that can occur in the ovaries.

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What is a radial scar?

A benign breast lesion characterized by a central radiolucent area on mammogram.

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What is fat necrosis?

A benign breast lesion that can mimic cancer on mammogram due to its dense appearance.

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What is a fibroadenoma?

A benign breast tumor composed of both epithelial and stromal tissue.

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What is a duct fistula?

A complication that can occur in untreated breastfeeding mastitis, resulting in a connection between the breast duct and the skin.

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What is liposuction?

A surgical procedure to remove excess fat and tissue from the chest area, often used to treat gynecomastia.

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What is gynecomastia?

A condition characterized by enlargement of breast tissue in males.

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What is invasive lobular carcinoma?

A type of breast cancer that spreads in a single-file pattern on biopsy.

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What is high-grade DCIS?

An elevated mitotic index in DCIS, indicating a higher risk of progression to invasive cancer.

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What is atypical lobular hyperplasia?

A benign breast lesion that does not classify as pre-cancerous but carries a risk of developing cancer.

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What are selective estrogen modulators?

A group of medications that can be used to treat mastodynia, or breast pain.

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What is the most common type of cancer that metastasizes to the lungs?

The most common primary malignancy that spreads to the lungs.

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What is the effect of bilateral salpingo-oophorectomy on cancer risk in BRCA2 mutation carriers?

The risk of developing both breast and ovarian cancer is reduced after a bilateral salpingo-oophorectomy in premenopausal women with BRCA2 mutations.

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When should screening mammography start?

The age at which screening mammography should begin.

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What is winged scapula?

A condition that can affect the serratus anterior muscle, causing a wing-like appearance of the scapula.

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What antibiotics are commonly used for mastitis?

The best antibiotics for mastitis in most cases.

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What is lobular carcinoma in situ?

A type of breast cancer that can occur in multiple areas of the breast tissue.

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What is the axilla?

An area in the axilla containing lymph nodes, blood vessels, and nerves.

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What is the risk of cancer associated with a radial scar?

The risk of developing cancer associated with a radial scar.

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What is a safe substance during pregnancy?

A substance considered safe during pregnancy.

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What is the main reason for hysterectomy in the US?

The main reason for hysterectomy in the US.

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What are the boundaries of the axilla?

The boundaries of the axilla during an axillary dissection.

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What is Paget's disease of the breast?

A form of breast cancer that affects the skin.

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Study Notes

Breast Cancer Treatment and Diagnosis

  • Peau-D'Orange breast cancer treated with neoadjuvant chemotherapy, surgery, and radiation.
  • Modified radical mastectomy indicated for Peau-D'Orange breast cancer.
  • Sentinel lymph node biopsy indicated in invasive breast cancer without axillary evaluation and certain DCIS conditions.

Tumor Markers in Ovarian Cancer

  • Key tumor markers include CA-125 for epithelial, B-hCG for embryonal cells, and alpha-fetoprotein for yolk sac tumors.

Imaging and Lesion Characteristics

  • Architectural distortion and spiculated masses can also be due to fat necrosis or carcinoma.
  • Radial scar noticeable by central radiolucent appearance on mammogram.

Pathology and Lesions

  • Pathology associated with specific lesions: abundant stroma and epithelial content indicate fibroadenoma; necrotic mass with ducts suggest radial scar; lipid-laden macrophages signify fat necrosis.
  • Radial scar associated with approximately 25% risk of cancer.

Surgical Procedures and Recommendations

  • Most common gynecological surgeries in the U.S. are cesarean section followed by hysterectomy, primarily due to fibroids.
  • Optimal treatment for gynecomastia involves liposuction along with tissue resection.

Antibiotic Treatment

  • Best antibiotics for mastitis are dicloxacillin or cephalexin; alternatives for resistant S.aureus include clindamycin or Bactrim.

Genetic Considerations in Cancer Risk

  • Pre-menopausal patients with BRCA2 mutations have a reduced risk for both breast and ovarian cancer post-bilateral salpingo-oophorectomy.

Additional Surgical Details

  • In axillary dissection, boundaries include structures like the axillary vein (superior), serratus anterior (medial), latissimus dorsi (lateral), the tail of the breast (inferior), and subscapularis (posterior).

Screening and Follow-Up

  • Screening mammography should begin at age 40.
  • High-grade DCIS assessed by mitotic index, while pure DCIS requires clear margins with no ink on tumor.

Incidence and Demographics

  • Breast cancer incidence is 12% in females and 0.1% in males.
  • Colon cancer is the most common primary malignancy that metastasizes to the lungs.

Other Conditions and Treatment Considerations

  • Selective estrogen modulators are next after NSAIDs for mastodynia treatment failure.
  • Atypical lobular hyperplasia does not classify as pre-malignant, but carries a high risk for associated cancer.
  • DCIS linked to a higher risk of bilateral lesions compared to lobular carcinoma in situ (LCIS).

Specific Tumor Types and Histology

  • Long thoracic nerve injury causes winged scapula affecting serratus anterior muscle.
  • Invasive lobular carcinoma characterized by a single-file pattern on biopsy.

Other Relevant Points

  • Slower resolution of untreated breastfeeding mastitis may lead to duct fistula formation.
  • Safe pregnancy substance includes radiolabeled sulfur colloid.
  • Pathological report of Paget's disease shows large pale-staining epithelial cells mixed with normal keratinocytes.

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Test your knowledge with these flashcards on the treatment and surgical procedures for breast cancer, particularly Peau-D'Orange. Additionally, evaluate your understanding of tumor markers for different subtypes of ovarian cancer. Perfect for medical students and professionals in the field of obstetrics and gynecology.

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