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Y3 Reproductive > Benign / Malignant Breast > Flashcards

Benign / Malignant Breast Flashcards

1
Q

What is grading?

A

A measure of tumour differentiation

How similar it is to original tissue

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2
Q

What is the commonest cause of a breast lump in PTx aged under 30yrs?

A

Fibroadenoma

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3
Q

What is the commonest cause of a breast lump in PTx aged 30-50?

A

Cyst

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4
Q

What is the commonest cause of a breast lump in PTx aged over 50yrs?

A

Breast cancer

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5
Q

What imaging modality has the highest sensitivity at viewing the breast?

A

MRI

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6
Q

What age group does fibrocystic change occur in?

A

40 - 50 years

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7
Q

An early menopause is a RF for fibrocystic change T or F

A

False, a late menopause is

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8
Q

What symptom of the climacteric period is associated with fibrocystic change?

A

Abdominal menses e.g. menorrhagia, oligomenorrhea

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9
Q

How may fibrocystic change present?

A

Multiple smooth lumps

Cyclical breast pain

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10
Q

Are lumps in fibrocystic change solid or fluid full?

What type of epithelium are they lined by?

A

Fluid full

Lined by apocrine epithelium

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11
Q

What Ix should you do for suspected fibrocystic change?

A

US breast - fluid full not worrying

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12
Q

What is the Mx of fibrocystic change?

A

Nothing, most resolve post menopause

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13
Q

How does a fibroadenoma present?

  • Is it painful?
  • Firm or solid?
  • Mobile or fixed?
  • Rough or well circumscribed?
A

Painless
Well circumscribed
Firm
Mobile

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14
Q

What is the pathology of fibroadenomas?

A

Epithelial + stromal hyperplasia

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15
Q

Fibroadenomas are premalignant. T or F

A

False

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16
Q

What Ix should be done for fibroadenomas?

A

US +- core needle biopsy if suspicious

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17
Q

What is the definitive Dx for fibroadenomas?

A

Core needle biopsy

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18
Q

What is the Mx of a fibroadenoma?

A

Nothing, can excise if PTx requests

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19
Q

What is the name of the benign breast lump caused by normal breast components in abnormal proportion and distribution?

A

Hamartoma

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20
Q

What age range are breast papillomas most common in?

A

35 - 60 years

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21
Q

How do breast papillomas present?

A

Discharge +- bloody

+-Lump

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22
Q

Where in the breast are papillomas found?

A

Intraduct

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23
Q

Breast papilloma Ix

A

US / mammo
+
Core needle biopsy

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24
Q

Breast papilloma Mx

A

Excise

Very rarely malignant

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25
Q

Breast papillomas may calcify. T or F

A

True

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26
Q

What age range are breast cysts most common in?

A

40 - 50 years

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27
Q

Breast cysts are:

  • [Solid/fluid full]
  • [Soft/firm]
  • [Mobile/fixed]
  • [Distinct/indistinct] border
A

Breast cysts are:

  • Fluid full
  • Soft
  • Mobile
  • Distinct border
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28
Q

Breast cysts Ix

A

FNA

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29
Q

What is the aetiology of fat necrosis?

A

Trauma - seat belt injury
Warfarin
Idiopathic

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30
Q

Fat necrosis pathology

A

Foamy macrophages - fibrous scar

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31
Q

Fat necrosis Ix

A

Exclude malignancy

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32
Q

What cause of a breast lump is due to disordered proliferation, may calcify and presentation mimics carcinoma?

A

Sclerosing adenosis

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33
Q

What is the pathology of radial scars?

A

Fibrotic core

Stellate architecture

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34
Q

Radial scars are premalignant. T or F

A

False

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35
Q

Radial scars are often multiples. T or F

A

True

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36
Q

Radial scar Ix

A

US / mammo

Biopsy

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37
Q

What is carcinoma in situ?

A

Malignancy confined above the basement membrane

-not truly malignant since not invasive

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38
Q

What is the main ductal carcinoma precursor?

A

DCIS ductal carcinoma in situ

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39
Q

What are the grades of DCIS? Which one is commonest

A

Low
Intermediate
High - commonest

40
Q

What is the Mx of high grade DCIS

A

Wide local excision + radiotherapy

41
Q

What type of ductal carcinoma precursor is Paget’s disease of the nipple?

A

High grade DCIS

42
Q

How does Paget’s present?

A

Red

Dry or weeps

43
Q

What are the 2 types of lobular carcinoma precursors and what separates them?

A

Lobular CIS: >50% lobule effected

Atypical hyperplasia: <50%

44
Q

Is lobular or ductal carcinoma precursors associated with CDH1 mutations?

A

Lobular

45
Q

Are lobular or ductal carcinoma precursors more likely to be multifocal / bilateral?

A

Lobular

46
Q

What is the Ix for LCIS and DCIS?

A

If mammogram +ve do vacuum biopsy + US axilla

47
Q

Breast cancer effects 1 in how many women?

A

1 in 8

48
Q

The incidence of breast cancer is decreasing. T or F

A

False, increasing

49
Q

Who is eligible for breast screening and how often?

A

Age 50 - 70

Every 3 years

50
Q

If something potential malignant is found on a mammogram at screening, what is the next step?

A

Refer for vacuum biopsy

US axilla

51
Q

What colour is fat on a mammogram?

A

Dark

52
Q

Calcification on a mammogram is most likely caused by what?

A

DCIS

53
Q

Mammograms can differentiate solid and cystic lesions. T or F

A

True

54
Q

Does breast density increase or decrease with age?

A

Increase - hence screening harder or easier ???

55
Q

What age group is breast cancer most common in?

A

Over 50 years

56
Q

What features of a gynae history are risk factors for breast cancer?

A 
Early menarche
Late menopause
Not breastfeeding
Parity 0
1st pregnancy over 30yr
Current OCP use
Current or long term HRT
57
Q

What are the 2 main types of breast carcinomas and which is most common?

A

Ductal 80%
Lobular

(There are others but they’re less common)

58
Q

What type of cancer is breast cancer?

A

Adenocarcinoma

59
Q

What hormone receptors are sometimes expressed by breast carcinomas? List them in order of frequency

A

ER estrogen receptor
PR progesterone receptor
HER2

60
Q

Where do HER2+ cancers commonly metastasise?

A

Brain, lung, pleura, bone

61
Q

Where do lobular cancers commonly metastasise?

A

Lung, pleura, peritoneum, gut, bone

62
Q

What % of breast cancer is detected by screening?

A

50%

63
Q

How may breast cancer present?

A
  • Lump
  • Nipple inversion
  • Skin change e.g. puckering, peau d’orange, dimpling
  • Pain
  • Bloody discharge,
64
Q

If breast cancer is suspected from a presentation to primary care, what should a GP do?

A

Refer to 1 stop breast clinic

65
Q

What happens in the 1 stop breast clinic

A

Triple assessment

  • Exam + history
  • Mammo or US
  • If +ve; core needle biopsy and US axilla
66
Q

What is a sentinel node?What is the sentinel node in most breast carcinomas?

A

1st that drains a tumour

Axillary

67
Q

After analysing the biopsy specimen, if the breast carcinoma has invaded local structures, what additional Ix should be done and why?

A

CT chest abdo pelvis

Look for met

68
Q

How are hormone receptors checked for when investigating breast cancer?

A

Gene expression profiling immunostaining of the biopsy

69
Q

What staging system is used for breast cancer?

A

TNM

70
Q

What do TNM stand for?

A

T: 0-4 local
N: 0-3 nodes
M: 0-1 distant blood borne met

71
Q

What is the 1st line Mx in non-metastasized breast cancer?

A

Breast conserving surgery + radio

72
Q

What is neo-adjuvant and adjuvant Tx?

A

Neo-adjuvant pre surgery

Adjuvant post surgery

73
Q

What neo-adjuvant Tx is done for breast cancer?

A

Chemo to shrink tumour

Hormonal therapy if ER+

74
Q

What is the Layman’s term for breast conserving surgery?

A

Lumpectomy

75
Q

Breast conserving surgery should leave a ____ margin. It involves a ____ guided ____ local excision. Breast reconstruction is offered which is referred to as ____ surgery.

A

Breast conserving surgery should leave a 1CM margin. It involves a WIRE guided WIDE local excision. Breast reconstruction is offered which is referred to as ONCOPLASTIC surgery.

76
Q

What is the main SE of totally axillary clearance?

A

Lymphedema

77
Q

In breast cancer surgery, patients are offered immediate or delayed reconstructions. What are the 2 options for surgical reconstruction?

A

Implant or autologous flap

78
Q

What adjuvant therapy is given for breast cancer?

A

Radiotherapy
Chemotherapy
+-Hormonal therapy

79
Q

What is the purpose of adjuvant radiotherapy in breast cancer?

A

To decrease local recurrences

80
Q

What hormonal therapy options are there for ER +ve breast cancer?

A

Tamoxifen

Aromatase inhibitors

81
Q

When are aromatase inhibitors used over tamoxifen fro breast cancer?

A

Post-menopausal

82
Q

What are the side effects of tamoxifen?

A

Increases endometrial cancer

Vag bleeding

83
Q

What are the names of the aromatase inhibitors used for breast cancer?

A

Letrozole

Anastrozole

84
Q

What are the SEs of ER blockade?

A

Hot flushes

Vag dryness

85
Q

What hormonal therapy option is there for HER2 +ve breast cancer? What drug class does it belong to?

A

Herceptin trastuzamab

Monoclonal Ab

86
Q

What are the SEs of herceptin trastuzamab?

A

Allergy

Reversible HF

87
Q

Anthracycline FEC100 plus a taxane is the standard _____ option for breast cancer

A

Chemotherapy

88
Q

What are the main SEs of chemotherapy?

A

Anorexia, malaise, neutropenia, alopecia, myalgia

89
Q

Tumour markers are used in the Dx of breast cancer. T or F

A

False, used to monitor Tx

90
Q

What tumour markers are used to monitor Tx response in breast cancer?

A

CEA and CA15-3

91
Q

Post breast cancer Tx, how are PTxs monitored for recurrences?

A

Mammogram once a year for 3 years

Then back into national screening programme

92
Q

What are the 3 main progonostic factors that influence breast cancer outcome?

A

Tumour size
Grade
LN involvement

93
Q

What is the Mx of bone mets in breast cancer?

A

Radio

Bisphosphonate PO ibandronic acid

94
Q

What is the palliative Mx of breast cancer?

A

Chemo +- hormonal Tx

95
Q

What type of breast cancer occurs post radio Tx

A

Angiosarcoma

96
Q

What is the name of the breast tumour that can be benign or malignant, is composed of epithelium and stroma and is slow growing? IT is most common in 35 - 50 year olds

A

Phyllodes tumour

97
Q

What cancers most commonly metastasize to the breast?

A 
Lymphoma
Melanoma
Lung
Ovary
RCC
Others

Y3 Reproductive (28 decks)

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