breast mass n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Breast Mass PowerPoint Presentation
Download Presentation
Breast Mass

Loading in 2 Seconds...

play fullscreen
1 / 13

Breast Mass - PowerPoint PPT Presentation


  • 109 Views
  • Uploaded on

Breast Mass. Lori F Gentile, MD UF Surgery. History for Breast Mass. HPI: Location of mass How was it identified How long has it been present Nipple changes - discharge (unilateral or B/L, # ducts involved, color, spontaneity), nipple inversion New or persistent skin changes

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Breast Mass' - hayes-bauer


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
breast mass

Breast Mass

Lori F Gentile, MD

UF Surgery

history for breast mass
History for Breast Mass
  • HPI:
    • Location of mass
    • How was it identified
    • How long has it been present
    • Nipple changes - discharge (unilateral or B/L, # ducts involved, color, spontaneity), nipple inversion
    • New or persistent skin changes
    • Change in size or tenderness
    • Do symptoms vary with menstrual cycle
    • History of other breast complaints
  • PMHx (including reproductive hx), PSHx, SHx, FHx
  • ROS (note: malaise, bony pain, weight loss)
breast cancer risk factors
Breast Cancer Risk Factors
  • Risk factors to note during history:
    • Gender
    • Age
    • Prior breast cancer or breast biopsy (h/o ADH, ALH, LCIS increases risk)
    • FHx of cancer (relationship, age of onset, type of CA)
    • FHx of genetic mutations (BRCA1, BRCA2)
    • Age of menarche/menopause, first full term pregnancy, parity
    • ETOH use, hormonal replacement therapy, DES exposure in utero
  • Risk calculated using the Gail model based on:
    • Age
    • Menarche
    • Reproductive history
    • FHx in 1st degree relatives
    • Prior biopsies
abnormal mammogram
Abnormal Mammogram
  • Abnormal screening mammogram is the most common initial presentation for women with breast cancer
  • 5% to 10% of all screening mammograms are abnormal
  • BIRADS
    • 0 Additional imaging evaluation required
    • 1 Negative finding; routine screening
    • 2 Benign finding Negative mammogram, routine screening
    • 3 Probably benign finding, short-interval follow-up
    • 4 Suspicious abnormality; conisder bx
    • 5 Abnormality highly suggestive of malignancy High probability of cancer; appropriate action should be taken
pe for breast mass
PE for Breast Mass
  • Inspection: asymmetry, skin changes (dimpling, rashes), nipples (discharge, retraction, inversion). Perform sitting upright.
  • Palpation: regional LN (cervical, supra/infraclavicular, axillary), breast exam (borders: clavicle->infra-mammary fold, sternum,->posterior axillary line), nipple exam for discharge
    • Supine one arm raised
  • Mass characteristics to note: size, shape, location, consistency, and mobility
    • Hard, immobile, fixed, irregular borders are more likely malignant
  • Also, remember node levels: I (lateral to pec minor), II (deep to pec minor), III (medial to pec minor)
workup
Workup
  • Imaging
    • Bilateral diagnostic mammogram
    • U/S – solid vs cystic
    • MRI-can detect implant leaks, S&S still being assessed
  • Biopsy
    • Palpable – FNA or CNB
    • Non-palpable - stereotactic or ultrasound-guided percutaneous core biopsy

Remember to correlate imaging findings with pathology results

management algorithm
Management Algorithm

http://www.aafp.org/afp/2005/0501/p1731.html

slide8
DDX
  • Benign Breast Disease
    • Fibroadenoma – MCC breast mass in young women, firm, rubbery, smooth, mobile (hypoechoic mass on US)
    • Cyst – aspirate, if does not completely disappear then bx
    • Galactorrhea - increased prolactin, OCPs, TCAs, etc
    • Galactocele – breast cyst filled with milk
    • Fibrocystic disease – breast pain, nipple discharge, masses, cyclical size change
    • Mondor’s disease – superficial vein thrombophlebitis
    • Mastitis / Abscess-usually associated with breast feeding, s.aureus most common
    • Intraductal papilloma – MCC bloody nipple discharge
    • Asymmetry – normal, Poland syndrome, fat necrosis
  • Benign Tumor
    • Phyllodes tumor- mimics fibroadenoma, <5% metastisize, tend to recur locally, resect with 1 cm margins
carcinoma histology
Carcinoma Histology
  • In situ carcinoma
    • Ductal carcinoma in situ: comedo vs. noncomedo
    • Lobular carcinoma in situ: increased risk of invasive ductal CA in bilateral breasts
  • Invasive carcinoma
    • Infiltrating ductal (75%)
    • Infiltrating lobular (10%)
    • Medullary (5%) - favorable
    • Mucinous (<5%) - favorable
    • Tubular (3%)-better prognosis
    • Papillary (1-2%)
    • Metaplastic breast cancer (<1%)
    • Mammary Paget disease (1-4%)
  • Locally advanced breast cancer – neoadjuvent chemo
  • Inflammatory breast cancer
prognostic predictive factors
Prognostic & Predictive Factors
  • Factors:
    • Axillary LN status
    • Tumor size
    • Lymphatic/vascular invasion
    • Age
    • Histologic grade
    • Histologic subtypes
    • Response to neoadjuvant therapy
    • ER/PR status (hormone-positive tumors have more indolent course & are responsive to hormonal therapy)
    • HER2/neu gene amplification and/or overexpression (HER2 overexpression a/w more aggressive tumor phenotype & worse prognosis)
staging
Staging
  • Patients grouped into 4 stages based on:
    • Tumor size (T)
    • Lymph node status (N)
    • Metastasis (M)
  • Five-year survival rates a/w stage:
    • Stage 1: 99%
    • Stage 2: 86%
    • Stage 3: 57%
    • Stage 4: 20%
  • Further evaluation based on stage:
    • Stages 1 & 2: lab studies- cbc, Lfts
    • Stage 3 (locally advanced or inflammatory) or symptomatic: CXR or chest CT, CT of abdomen/pelvis, +/- tumor markers, bone scan
    • Stage 4: PET scan
treatment of in situ carcinoma
Treatment of In Situ Carcinoma
  • DCIS:
    • Lumpectomy + XRT for most
    • Mastectomy if comedo pattern on biopsy or >5 cm
    • SLN bx in pts with palpable lesions, high grade DCIS, mastectomy
    • Tamoxifen (SERM) is approved for adjuvant therapy in pts treated with breast-conserving therapy & radiation
  • LCIS:
    • Not premalignant itself, consider marker of future risk
    • Close observation
    • Chemoprevention w/SERM
    • B/L mastectomy +/- reconstruction
treatment of invasive carcinoma
Treatment of Invasive Carcinoma
  • Tumor removal
    • Lumpectomy with radiation therapy (not for pregnant, prior XRT, large tumor in small breast, scleroderma, tumor greater than 5 cm)
    • Mastectomy
  • Node dissection
    • Sentinel LN biopsy (for tumors >1cm), not for palpable LN
    • Axillary LN dissection (+sentinel node, palpable nodes), cx-lymphedema, nerve injury
  • Adjuvant Treatments
    • Postmastectomy radiation therapy
    • Adjuvant chemotherapy
    • Adjuvant therapy for HER2+ breast cancer with trastuzumab (Herceptin), a mAb targeting the extracellular domain of the receptor
    • Adjuvant hormonal therapy decrease estrogen’s ability to stimulate micro-metastases or dormant cancer cells
    • Aromatase inhibitors (aromatase converts other steroid hormones into estrogen)
    • Tamoxifen, raloxifen in ER+ cancers
  • Preventative Treatment

Tamoxifen/raloxifen decrease risk of breast cancer if high risk pts