21 Questions
Benign Conditions of the Breast Match the findings with the condition!
Late teen to early twenties, Fine needle aspiration or core biopsy to confirm the diagnosis = Fibroadenoma Most common breast mass in women 40-50 years old = Breast Cyst 1-3 cm in size; fibrous stromal tissue and tissue clefts = Fibroadenoma Aspiration is usually only treatment required, may be seen on mammogram = Breast Cyst
Breast Cancer Histologic types!
Firm, irregular mass on physical exam that can also be seen on mammogram; 80% of invasive breast cancer = Invasive ductal carcinoma Indistinct borders making it hard to diagnosis via mammograph and hard to palpate on PE; 10% of breast cancers; Multicentricity = Invasive lobular carcinoma No distinct mass and not detected on mammogram; 3% of breast cancers; could look like Peau d’ orange (1:3 will be metastatic/not curable at diagnosis!) = Inflammatory carcinoma Cutaneous nipple abnormality needing a nipple biopsy to determine if there is a underlying malignancy = Paget’s disease of the nipple
Peau d’ orange is another way to say "dimpling" or "thickening" of the breast skin
True
How do you detail where you found a breast mass/lump?
clock and cm from nipple
What imaging modality is good for evaluating dense breast tissue, scar, and implants and used to evaluate extent of breast cancer in women who have known diagnosis?
MRI
When is a Partial Mastectomy (aka Lumpectomy) NOT appropriate?
T3 or less for staging
Tissue expanders can be used after mastectomy to create tissue for surgeons to work with to place permanent implants after a mastectomy. It usually takes place ___ months after the initial mastectomy to get permanent implants.
6
TNM staging of cancer - higher the number, the worse the staging.....
T = size of tumor N = # lymph nodes involved M = metastates / spread a = a
Mastectomy Types!
Removal of entire breast including skin, nipple/areola, fascia of pectoralis major = Simple or Total Mastectomy Majority of skin is left intact. Can be done if no skin involvement = Skin Sparing Mastectomy Nipple/areolar complex left intact; cannot be done if tumor is invading or close to the nipple = Nipple Sparing Mastectomy Combines simple mastectomy with Axillary Lymph Node Dissection (removes the pectoralis muscle, breast, and lymph nodes) = Modified Radical Mastectomy
What can be used to determine the first lymph node that filters fluid draining from the breast? This can help guide CONSERVATIVE lymph node removal to prevent lymphadema.
Sentinel Lymph Node Biopsy
You should AVOID BP checks, blood draws and excessive use of arm that had a Axillary Lymph Node Dissection due to risks of lymphedema and risk of brachial plexus injury.
True
A triple negative breast cancer does not have ANY breast cancer receptors (no estrogen, Progesterone, or HER2 receptors).
True
What is the difference between the therapies?
downsize the tumor size and/or axillary lymph node involvement to provide better surgical options = Neoadjuvant Therapy given before surgery = Neoadjuvant Therapy patients with tumors that are poorly delineated or difficult to assess clinically = Adjuvant Therapy Given after therapy to reduce risk of recurrence/metastasis = Adjuvant Therapy
Prophylactic contralateral mastectomy can be considered for patients with BRCA or ATM mutations, strong family history, or for cosmetic symmetry
True
HER 2 Positive results in rapid growth and spread of breast cancer; 10-20% of breast cancers
True
What is a common complication of breast surgery, such as lymphedema, and what typically causes it?
Cellulitis caused by skin infection
How does Her2+ status impact breast cancer?
Results in rapid duplication and growth of tumor
What imaging is typically recommended for a patient post-lumpectomy (BCT)?
Bilateral breast imaging every 6-12 months
What follow-up schedule is advised for patients with breast cancer, especially for the first 5 years?
Every 3-6 months for the first 5 years
For patients who are ER/PR+, what adjunctive therapy can be offered?
Hormone therapy (e.g., tamoxifen, anastrozole)
how many positive lymph nodes on SLNB warrant more axillary surgery?
2
Study Notes
Breast Surgery Study Notes
Fibroadenoma
- Thickened tissue that can fluctuate with menstrual cycles, commonly occurring in late teens/early 20s, with a typical size of 1-3 cm.
- Confirm diagnosis with FNA or core needle biopsy.
Breast Mass Diagnosis
- Most common breast mass in women aged 40-50: fibroadenoma.
- Spontaneous nipple discharge from one nipple only: intraductal papilloma (benign growth in milk duct).
- Firm, irregular mass on breast exam: suspect invasive ductal carcinoma (IDC).
Breast Cancer
- Invasive ductal carcinoma (IDC): 80% of invasive breast cancer cases, with indistinct borders, difficult to palpate, and may not show up on mammogram.
- Inflammatory carcinoma: starts as a rash, involves skin, no associated mass, often metastatic.
- Invasive lobular carcinoma (ILC): cancer with indistinct borders, difficult to palpate, may not show up on mammogram.
Breast Imaging
- Diagnostic mammography: ordered for patients >30 years old who find a breast mass.
- Bilateral breast imaging: required for patients post-breast-conserving therapy (lumpectomy), every 6-12 months.
Complications of Breast Surgery
- Lymphedema: a common complication caused by radiation and/or lymph node removal.
HER2+ Breast Cancer
- Causes rapid duplication and growth of tumor cells.
Follow-up Care
- Post-breast-conserving therapy (lumpectomy): bilateral breast imaging every 6-12 months.
- Post-mastectomy: annual imaging of contralateral breast.
- Follow-up for breast cancer treatment: every 3-6 months for the first 5 years, then annually thereafter.
Hormone Therapy
- ER/PR+ patients can be offered hormone therapy (tamoxifen, anastrozole, letrozole, exemestane).
Test your knowledge by matching findings with common benign conditions of the breast in this quiz. Differentiate between various non-cancerous breast conditions and their associated symptoms.
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