AbGyn Flashcards on Breast and Ovarian CA
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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</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</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</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</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</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</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</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</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</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</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</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</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</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</p> Signup and view all the answers

    Which of these is positive for E-Cadherin?

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

    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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    Description

    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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