GYNECOLOGY

DISEASE

Fibrocystic
Change

Fibroadenoma

Intraductal
Papilloma

Ductal
Carcinoma In
Situ (DCIS)

CAUSE

1. Exaggerated
response to
hormones
(estrogen)
2. Green, straw
colored, or
brown nipple
discharge.
3. HISTO:
hypercellular
stroma that
encircles or
compresses
ducts
-Breast consisting
of collagen
arranged in swirl

BLOODY Discharge
Polypoid epithelial
tumors located in
lactiferous ducts of
breasts
Non-palpable

AGE /Pre- / Post

Meno

PRESENTATION

TREATMENT

Stop caffeine
Stop TAB
Vitamin E
Danzol
Tamoxifen
NSAIDs for pain
Bromocriptine

Prognosis,
Progression and
Complications
Risk factor for
future BREAST
CANCER

PREmenopausal

BILATERAL
breast
pain/tenderness

1.
2.
3.
4.
5.
6.
7.

PREmenopausal
<35

Palpable as a
small, mobile, well
circumscribed and
firm mass
-DO NOT change
with menstrual
cycle

Most reabsorb
therefore, small
tumors can be
observed with reevaluation in a
month

Risk factor for

future BREAST
CANCER

PREmenopausal
<50

NO Mass found
on Physical Exam

Surgical Excisional
biopsy of affected
ducts

NO Malignancy
risk

Irregular
calcifications on
mammograms

1. Surgical
resection with
clear margins
(lumpectomy)
2. Radiation
Therapy
3. Prevention:
Tamoxifen for 5

PREmalignant

DIAGNOSIS/
MANAGEMENT
1. Breast
Examination
2. Ultrasound or
Diagnostic
Mammography (if
>40)
3. FNA biopsy

1. Breast
Examination
2. INITIAL:
Ultrasound
(solid/cystic) or
Diagnostic
Mammography (if
>40)
3. FNA biopsy
4. EXCISION: any
Enlarging mass
1. Excisional biopsy
of affected ducts
RULE OUT
INTRADUCTAL
PAPILLARY
CARCINOMA
2. Mammography
Core/Excisional
Biopsy

GYNECOLOGY
years
Lobular
Carcinoma In
Situ (LCIS)

ER (+)
PR (+)

DISEASE

CAUSE

Invasive Ductal
Carcinoma

Most common type

Forms Solid Tumor
UNILATERAL

BILATERAL
usually in the
same quadrant

AGE /Pre- / Post

Meno
Mid 30s-Late
50s

PRESENTATION

HIGH RISK:
Excisional biopsy
1. Follow up
2. Tamoxifen
3. Bilateral
mastectom
y

Risk for BREAST

CANCER
If left alone will
become invasive
over 10-15
years

Mammography of the
contralateral breast
at regular intervals

TREATMENT

Prognosis,
Progression and
Complications
Tumor size is
most important
prognostic
factor.
Metastasizes to
Bone, Liver, and
Brain

DIAGNOSIS/
MANAGEMENT

1. Asymptomatic 1. Modified radical

2. Breast lump
mastectomy
3. Nipple
OR
Discharge
2. Lumpectomy
4. Upper/Outer
with post op
quad
radiation
PHYSICAL
3. Tamoxifen if ER
EXAM:
(+)
1. Firm immobile,
painless lump
2. Skin changes
3. Retraction of
Coppers
Ligament
4. Axillary
Lymphadenopa
thy

Invasive Lobular
Carcinoma
Inflammatory
Breast
Carcinoma
Peau d orange

Redness, swollen,
warm and pain of
breast.
Inflammation due
to the plugging of
the dermal
lymphatics

1. Radiation
2. Hormone
therapy
3. Chemotherapy

Metastasis occurs
early and poor
prognosis

1. Mammography:
will show mass
with an irregular
fibrotically
stranded
bounders
2. Core/Excisional
Biopsy
3. Stage with TNM
Staging System