1 / 11

Breast Mass

Breast Mass. Connie Lee, M.D. Michael Hong, M.D. UF Surgery. History for Breast Mass. HPI: Precise location of mass How was it identified How long has it been present Nipple discharge (unilateral or B/L, # ducts involved, color, spontaneity), nipple inversion

aristotle-russell
Download Presentation

Breast Mass

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Breast Mass Connie Lee, M.D. Michael Hong, M.D. UF Surgery

  2. History for Breast Mass • HPI: • Precise location of mass • How was it identified • How long has it been present • Nipple discharge (unilateral or B/L, # ducts involved, color, spontaneity), nipple inversion • New or persistent skin changes • Size & change in size • Does the size change during the menstrual cycle • PMHx, PSHx, SHx, FHx • ROS (note: malaise, bony pain, weight loss)

  3. 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, first pregnancy, menopause • 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

  4. PE for Breast Mass • Examine: neck, chest wall, breasts, and axillae – in upright and supine positions • Inspection: asymmetry, skin changes, nipples • Palpation: regional LN (cervical, supra/infraclavicular, axillary), breast exam (borders: clavicle, sternum, midaxillary line, rib cage) • Mass characteristics to note: size, shape, location, consistency, and mobility • Also, remember node levels: I (lateral to pec minor), II (deep to pec minor), III (medial to pec minor)

  5. Workup • Initial breast mass workup: • Diagnostic mammogram (CC, MLO, magnification views) • U/S • Core biopsies +/- image guidance, FNA, excisional biopsy • Further evaluation based on stage: • Stages 1 & 2: lab studies • Stage 3 (locally advanced or inflammatory) or symptomatic: CXR or chest CT, CT of abdomen/pelvis, +/- tumor markers • Stage 4: PET scan • MRI

  6. DDX • Non-tumor • Galactorrhea (increased prolactin) • Galactocele • Cyst • Fibroadenoma – MCC breast mass in young women, firm, rubbery • Fibrocystic disease – breast pain, nipple discharge, masses, cyclical size change • Mondor’s disease – superficial vein thrombophlebitis • Mastitis / Abscess • Intraductal papilloma – MCC bloody nipple discharge • Asymmetry – normal, Poland syndrome, fat necrosis • Benign Tumor • Cystosarcoma phyllodes • Fibromatosis

  7. Carcinoma Histology • In situ carcinoma • Ductal carcinoma in situ: comedo vs. noncomedo • Lobular carcinoma in situ: a biomarker of increased breast CA risk (note: no mass on PE) • Invasive carcinoma • Infiltrating ductal (75%) • Infiltrating lobular (10%) • Medullary (5%) • Mucinous (<5%) • Tubular (1-2%) • Papillary (1-2%) • Metaplastic breast cancer (<1%) • Mammary Paget disease (1-4%) • Locally advanced breast cancer • Inflammatory breast cancer

  8. 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)

  9. 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%

  10. Treatment of In Situ Carcinoma • DCIS: • Lumpectomy + XRT for most • Mastectomy if comedo pattern on biopsy • Usually axillary dissection/SLN biopsy not recommended • 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

  11. Treatment of Invasive Carcinoma • Tumor removal • Lumpectomy with radiation therapy (not for pregnant, 2+ primary tumors, prior XRT, large tumor in small breast, scleroderma) • Mastectomy • Modified radical mastectomy (includes level 1 LN) • Node dissection • Sentinel LN biopsy (for tumors >1cm), not for palpable LN • Axillary LN dissection (+sentinel node, palpable nodes) • 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)

More Related