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Breast ca. Physical mf.asymmetrical vs symmetrical eczema in the breast In a NON lactating fem
Asymmetric. Symmetrical eczema
-Paget 's ds of breast - Allergic eczema
Breast ca If you see Mastitis in non lactating vs lactating fem what is the next step
Non lactating Lactating mastitis
Do w/u for infl BR Ca. Likely cellulitiis
BR CA screening. 3 guidelines. For screening -MMG
ACP ACP. USPSTF
-At 40. Q1yr ?50-74 40-49 q 2y optional
(til women good 50-74 q2yrs
-CBE > 40 q1yr. ? Insuf data
( 20-39 q3yr)
BR CA. Screening. What are indication for MRI of the breast in screening (5)
-BRCA1, or 2 / 1 DR w BRCA in untested pt
-TP53 or PTEN mut. /. or 1DR w....
-LTR >20%. X
-radiation chest 10-30yo. X
BREASt CA. W/u. 4 steps
1. MMG 1st, +/- u/s, +/- MRI
3. Determine receptors E/P, and HER2/neu
BREAst ca w/u. Suspicious findings on MMG (3)
A rchitecture distortion
B order irregular w densities
C luster of irregular calcifications
BR CA. W/u what is the next step when simple cyst and solid tm ID by u/s.
Simple cyst. Solid tm
-Do fluid aspiration. - Refer for bx
Breast. Carcinoma in situ (non-invasive). Cl CRT of 2 types.
-Is a marker of -evolve in invasive CA
Invasive CA. at 1% /yr
-freq B/L. -has distict microcalc
-mult lobular on MMG, and 1 lobule
X. -low, med, hi grade type
Breast CA. Tx of LCIS vs. DCIS
LCIS. DCIS tx
Observation. Surgical excision
(some pt opt for. (BCT w RTX +/- Tamo
B/l MMectomy due to Or mastectomy alone)
Being multifocal, b/l). X
-tamoxifen in ER + dec. -tamoxifen above
Inv CA 56%. X
BR CA. What are the progn factor in
Localized invasive breast cancer( 4)
1. Presence of LN mtt (most important)
2. Size of tm
3. HER2/neu (bad)
4. E/P (good)
BREAST Ca. Tx of invasive BR CA is in two parts
Local control. Systemic
-BCT + RT. -Adjutant tx ( dec recurrence
Or mastectomy. At distance sites)
INVASIVE BC. Local control in tx options expanded BB2.
1. Breast conserving tx (lumpectomy)= excision of 1ry tm ( < 5 cm) + ipsilat Rtx --> 5 yrs of endocrine tx if ER/EP +
( premeno- use tamoxifen, postmeno use AI)
2. Mastectomy. Usu no Rtx, (except in large tm > 5 cm, w/ 4 or more positive axillary LN, close surgical margins, or dermal invasion)
* svv is iqual
* most cases invasive BC use adjuvant chemotx
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