BREAST- Doc Weceslao

Pt: 30 y. F premenopausal Nulligravid

History
- nO family hx of malignancy.
- Right breast mass of 6 ,months duration

PE: characterized the mass (3x4 cm mass UQ, 6cm from nipple)

Why family hx is important in relation to breast management?

-Surveillance among siblings.

- BRACA mutations
- BRACA 1- assoc. with breast and ovarian CA, and colon CA. (Poorly differentiated)
- You can do sampling, bilateral mastectomy, surveillance of siblings, (MRI have more advantage
than mammogram. Young patient don’t request mammogram because their breast are dense.
MRI 20-25% risk of breast CA.). The accuracy of mammogram decreases in young pt.
- Tamoxifen; hormonal therapy
- Postmenopausal hormonal therapy: aromatase inhibitors- more effective than tamoxifen.
- Risk reduction surgery (reduce risk >90%)
- Bilateral salphingo-oophorectomy 35-40yr old; child bearing
- Increase bilaterally and motility of mass (if BRCA)

Management:

1.) ULTRASOUND- give picture if its benign or malignant, cystic or solid.

Malignant:
-Hypoechoic,Irregular border,solid, 10’oclock positiom, measuring approx 3.5x1.4x2.5
Advantage; looking into axillary nodes.
BI-RADS- whether ur dealing with benign or malignancy.

2.) Then do an FNAB.

Ultrasound guided CORE NEEDLE biopsy:
- Invasive mammary CA
- - Nottingham grade 3 NOS- how differentiated the lesion is. (Why it is important to know if its
poorly differentiated? Malayo basya sa breast tissue? Would the management be different? YES!
(If its poorly differentiated: knowing aggressiveness, indication in doing chemotherapy))
- No definite lymphovascular invasion identified

RECEPTOR ASSAY
ER ++ in 95% of tumor cells
PR++ in 80% of tumor cells
Her2 neu- receptor
Ki- 67 + (>10%): dictates what chemotherapeutic agent is concerned.
Genomic subtypes of Breast CA:
Luminal A- responsive in hormonal therapy
Luminal B- responsive in chemotherapy

STAGING:
- (Pt. stage T2, NO,MO) are you going to do breast work up? Stage 2A- early Breast CA)

Tx for early breast CA:

-breast conservation surgery (lumpectomy)
-radiotherapy
- SLNB.

Before surgery what work up should be done first?

Should you do metastatic work up (chest radiograph) if early breast CA?- No as long as its normal.
Mammogram should be requested even if you know its already a breast CA: to identify if its multi-
centric (you cant do breast conservation surgery if multicentric), bilaterally mammograms ;45% chance if
theres family hx. of breast ca.

What other tx?

-Give chemotherapy (depends size of lesion) (0.6-1cm)
- give hormonal tx.( tamoxifen: because 30yo plng ang pt. Inhibitor aromatase if menopausal.)
-Doxorubicin + cyclophosphamide x 4

#just2letters💕