Non-pharmacologic Management of Benign Ovarian Tumors and Ovarian Cancer

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What is a fibroadenoma?

A benign breast lesion consisting of fibrotic stroma and glandular tissue (correct)

A malignant breast lesion composed of fibrotic stroma and glandular tissue

A type of ovarian tumor with unknown etiology

An aggressive form of breast cancer

How are complex fibroadenomas different from simple ones?

They are associated with histologic characteristics like cysts greater than three millimeters in diameter, sclerosing adenosis, epithelium calcifications, or papillary changes (correct)

They tend to cause nipple discharge

They are usually smaller in size

They are more likely to be malignant

What is the likely etiology of benign breast disease like fibroadenomas?

Genetic mutations

An exaggerated response to normal cyclic hormonal stimuli (correct)

Exposure to environmental toxins

Immune system dysfunction

Why might a fine needle aspiration be necessary if a mass is found in the breast?

To obtain a sample for cytology and histology evaluation Signup and view all the answers

What is the recommended management approach for breast lesions less than three centimeters?

Yearly imaging and observation Signup and view all the answers

What is the risk of developing malignancy in benign breast disease without atypia if not excised?

1.5 to 3 times increased risk Signup and view all the answers

Which of the following is a possible cause of fibrocystic breast disease?

Sensitivity to methylxanthines Signup and view all the answers

What percentage of women in the United States have some degree of fibrocystic breast disease?

50% Signup and view all the answers

What is the age group where fibrocystic breast disease is more common?

30 to 50 years old Signup and view all the answers

Which of the following may help with non-pharmacologic management of fibrocystic breast disease?

Decrease in dietary fat Signup and view all the answers

What pharmacologic treatment has been shown to be effective for fibrocystic breast disease?

$2000 IUs of vitamin D per day Signup and view all the answers

What is the association between benign breast disease and malignancy?

$30% of all breast cancers develop in women with prior benign breast disease Signup and view all the answers

What is the characteristic feature of intraductal papilloma?

$45% proliferation of the ductal epithelium and myoepithelial cells Signup and view all the answers

What does ductal ectasia often associate with?

Intraductal papilloma Signup and view all the answers

What is the age group among which intraductal papilloma is most common?

35-50 years Signup and view all the answers

What is not known about the etiology of intraductal papilloma?

The age group it affects most Signup and view all the answers

What are the common symptoms associated with multiple papillomas in the breast?

Clusters of papillomas in smaller ducts away from the nipple Signup and view all the answers

What is the recommended diagnostic approach for patients with suspected papillomas in the breast?

Perform a mammogram, possibly an ultrasound or MRI Signup and view all the answers

What type of discharge is typically associated with papillomas in the breast?

Red, rusty, brown, greenish discharge Signup and view all the answers

What is the initial step to take when evaluating a patient with unilateral nipple discharge?

Check a TSH level to rule out hypothyroidism Signup and view all the answers

Which medications may cause bilateral nipple discharge in females?

Hormonal contraceptives and opioids Signup and view all the answers

What benign conditions of the breasts can be caused by trauma or infectious diseases?

Cellulitis and abscesses Signup and view all the answers

What are the screening recommendations for breast cancer according to the American Cancer Society?

Annual screening between 45 and 54, then every 2 years after 55 Signup and view all the answers

What is described as malignant neoplasm of the epithelial or stromal cells native to the breast?

Infiltrating ductal carcinoma Signup and view all the answers

Which genes function as tumor suppressor genes and are associated with breast cancer?

BRCA1 and BRCA2 Signup and view all the answers

What mutations can lead to cell cycle progression and limitations in DNA repair, contributing to breast cancer?

Mutations in cyclin D1 and c-Myc expression Signup and view all the answers

What percentage of tumors may crosstalk with estrogen receptors and epidermal growth factor receptors, leading to abnormal cellular replication?

Up to 33% Signup and view all the answers

What is described as the most commonly diagnosed cancer for United States women, according to the text?

Breast cancer Signup and view all the answers

What does the US Preventative Services Task Force recommend for women at increased risk for breast cancer?

Risk-reducing medications such as tamoxifen Signup and view all the answers

Why does the American Cancer Society no longer recommend monthly breast self-exams?

They lead to over-imaging and over-diagnosis Signup and view all the answers

What is the recommendation for clinical breast exams according to the US Preventative Services Task Force?

Insufficient evidence to assess clinical benefits and harms Signup and view all the answers

At what age does the US Preventative Services Task Force recommend bi-annual mammograms?

50 to 74 Signup and view all the answers

What might a patient with breast cancer describe during a history?

Painful lump in the breast or axilla Signup and view all the answers

What is recommended when visualizing the breast during a physical exam?

Visualize with the patient sitting in supine for skin dimpling Signup and view all the answers

What type of imaging may be necessary to differentiate fluid-filled cysts from solid masses in the breast?

Ultrasound Signup and view all the answers

Which medication requires calcium and vitamin D supplementation along with its use?

Tamoxifen Signup and view all the answers

What is the normal level of CA-125, a tumor marker used to rule out ovarian cancer?

Less than 35 micrograms per milliliter Signup and view all the answers

What is considered the best treatment for prevention of benign ovarian tumors?

Oral contraceptives Signup and view all the answers

At what age does the US Preventative Services Task Force recommend annual mammograms to start?

45 Signup and view all the answers

What is the primary role of a thorough history, physical, and physical exam in the diagnosis of benign ovarian tumors?

To rule out other causes of abdominal pain Signup and view all the answers

What is the recommended screening tool for ovarian cancer in the general population?

Mammogram Signup and view all the answers

Which condition can cause an elevated CA-125 level, leading to a false positive result?

All of the above Signup and view all the answers

What is one of the symptoms associated with an acute presentation of ovarian cancer?

Nausea, vomiting, and decreased oral intake Signup and view all the answers

Which diagnostic test is NOT recommended as a screening tool for ovarian cancer?

CA-125 level Signup and view all the answers

What should women with a family history placing them at high risk for ovarian cancer be referred to?

Genetic counselor Signup and view all the answers

What percentage of stage one ovarian cancers may have a falsely negative CA-125 level?

50% Signup and view all the answers

Which tumor markers are better indicators for mucinous tumors?

CA 19-9 and CEA Signup and view all the answers

What is NOT recommended for screening asymptomatic women at low to average risk for ovarian cancer?

(Mammogram) Signup and view all the answers

What are the recommended diagnostics for nonepithelial tumors?

(Inhibin A/B, HCG, AFP, LDH) Signup and view all the answers

What is one of the symptoms associated with a subacute presentation of ovarian cancer?

Bloating and sense of abdominal fullness Signup and view all the answers

What is one of the physical exam findings associated with confirmed or suspected ovarian cancer?

Cachectic appearance Signup and view all the answers

What is the indication for genetic testing if a patient has a triple negative ER or PR or HER2?

Age above 50 Signup and view all the answers

What is the relative risk associated with hormone replacement therapy during peri menopause?

2.1 to 4.0 Signup and view all the answers

What should be considered for annual MRI beginning at age 30 for patients with a 20 to 25% lifetime risk of breast cancer?

Family history of radiation exposure Signup and view all the answers

Under what condition would a male patient need to have annual mammograms?

History of male breast cancer Signup and view all the answers

What is the criteria for additional risk evaluation or gene testing related to the age of onset for breast cancer?

Breast cancer at any age and one or more family members with breast cancer at 50 or less years of age Signup and view all the answers

What is the indication for genetic testing if a patient has two breast cancer primaries?

$ ext{BRCA}$ mutation Signup and view all the answers

Which factor increases breast cancer risk for 10 years after discontinuation of medication?

$ ext{Hormone replacement therapy}$ during peri menopause Signup and view all the answers

What would indicate the need for genetic testing if present in a patient's family history?

$ ext{Dermatologic manifestations}$ in family members Signup and view all the answers

What is a risk factor that increases lifetime risk of breast cancer by 15 to 20%?

$ ext{Dense or unevenly dense breasts}$ Signup and view all the answers

What type of family history would indicate the need for annual MRI beginning at age 30?

$ ext{First degree relative with BRCA mutation history of radiation, age 10 to 30 years}$ Signup and view all the answers

What is a risk factor that increases lifetime risk of breast cancer by 1.1 to two?

$ ext{Diethylstilbestrol exposure}$ Signup and view all the answers

Who plays a huge role in the prevention of any type of cancer according to the text?

Primary care providers Signup and view all the answers

What is the most common type of ovarian cancer?

Epithelial ovarian cancer Signup and view all the answers

What is the leading cause of gynecologic related deaths in women?

Ovarian cancer Signup and view all the answers

What is the recommended non-pharmacologic management of benign ovarian tumors?

Laparoscopic surgery Signup and view all the answers

What is the age group in which half of all Epithelial Ovarian Cancer (EOC) cases are diagnosed?

Over 65 Signup and view all the answers

Which genetic syndrome increases the risk for colorectal, endometrial, stomach, small bowel, breast, pancreas, and ovarian cancers?

Lynch syndrome Signup and view all the answers

Which factor is NOT associated with an increased risk of ovarian cancer?

Infertility Signup and view all the answers

What can decrease the risk of ovarian cancer by 20% with five years of use and 50% with 15 years of use?

"Use of oral contraceptives" Signup and view all the answers

"Multiparity", "breastfeeding", and "tubal ligation or hysterectomy" are considered to:

"Reduce the risk of ovarian cancer" Signup and view all the answers

"Prophylactic oophorectomy" is advised for mutation carriers after childbearing is completed by the age of:

35 Signup and view all the answers

"CA-125 level measurement and transvaginal ultrasound every six to 12 months" is recommended for which group of patients?

"Women with family history of hereditary ovarian cancer syndrome" Signup and view all the answers

"Aspirin and NSAIDs" are believed to have a protective effect against ovarian cancer, but this is:

Controversial Signup and view all the answers

What should individuals and families with familial cancer syndromes undergo?

Genetic counseling Signup and view all the answers