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Year 3 > Block 32 Week 2 > Flashcards

Block 32 Week 2 Flashcards

1
Q

appendicular skeleton?

A
  • upper limbs
  • pectoral girdle
  • lower limbs
  • pelvic girdle
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2
Q

axial skeleton?

A
  • skull
  • VC
  • thoracic cage
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3
Q

the skeleton is the ? most common to be affected by mets

A
  • 3rd most common to be affecetd by mets after lung and liver
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4
Q

primary tumours that mets to bone?

A
  • prostate
  • breast
  • lung
  • kidney
  • myeloma - bone is the primary
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5
Q

presentation of bone mets?

A
  • asymptomatic
  • pain
  • pathological fracture espec if bone cortex affected
  • spinal cord compresssion
  • hypercalcemia (but the primary cause of this is tumour related PTH secretion)
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6
Q

acrometastases?

A
  • acrometastases = distal to elbow and knee (rare)
  • usually from kidneys and lungs
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7
Q

what is a lytic mets?

A
  • if osteoclast activity predominates, there will be lytic metastases
  • lytic mets: higher fracture rate but occurs w both.
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8
Q

osteoclerotic mets?

A

if osteoblast activity predominates, there will be disorganised ossification

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9
Q

which cancers cause lytic type mets?

A
  • mutiple myeloma
  • thyroid cancer
  • renal cell cancer
  • melanoma
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10
Q

which cancers cause sclerotic type mets?

A
  • prostate
  • breast
  • mucinous cancer of the bowel
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11
Q

Which cancers cause mixed-sclerotic and lytic type mets?

A
  • lung cancer
  • bladder cancer
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12
Q

management - investigation?

A
  • FBC
  • bone related ALP
  • kidney function and liver enzymes
  • PSA - ruling out PC
  • paraproteins - suggests multiple myeloma
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13
Q

urine testing for bone mets?

A
  • proteins - Bence Jones - MM
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14
Q

bence jones proteins in urine?

A
  • sign of MM (plasma cell cancer) or malignant lymphomas
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15
Q

DDs of bone mets?

A
  • primary bone tumour - benign/ malignant
  • bone islands
  • osteomyelitis
  • paget’s disease
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16
Q

inc uptake in bone scans suggests?

A
  • inc uptake in scans (Widespread) suggests metastasis - more useful in sclerotic type of mets
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17
Q

pain ladder - step 1

A
  • 1 - paracetamol and anti-inflammatories
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18
Q

pain ladder step 2?

A
  • 2 - weak opiods: codeine and tramadol
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19
Q

pain ladder step 3?

A
  • 3 - stronger opiods: morphine and oxycodone, fentanyl
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20
Q

managing bone pain?

A
  • bisphosphonates: zolindronic acid (IV)
  • radiotherapy
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21
Q

side effects of paracetamol?

A

hepatotoxic

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22
Q

anti-inflammatories like diclofenac side effects?

A

renal function, gastritis

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23
Q

opiods side effects?

A

constipation, nausea, drowsiness, confusion

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24
Q

bisphosphonates side effects?

A

nephortoxic and jaw necrosis - ulcers in the mandible and maxilla

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25
Q

percentage of cancer patients that develop met CE?

A

3-5%

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26
Q

When does CE become irreversible?

A

if neurological deficit (paraplegia) sets in

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27
Q

3 components of cauda equina?

A
  • mets to the vertebra pressing the cord
  • pain and tenderness
  • neurological symptoms depending on the level of compression
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28
Q

mechanism of cauda equina?

A
  • direct compression results in venous congestion
  • which leads to oedema
  • which then causes demyelination
  • arterial ischemia
  • direct damage to tracts -> permanent deficits
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29
Q

management of CE?

A
  • dexamethasone - risk if diabetic or active peptic ulcer
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30
Q

Symptoms of CE?

A
  • pain (occurs in 90% of ptients)
  • worse on lying down
  • tenderness - local pressure
  • muscle weakness
  • jelly legs and cannot climb stairs
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31
Q

Sensory deficits with cauda equina?

A
  • autonomic dysfunction related to bladder dysfunction
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32
Q

pain w CE?

A
  • if the bone collapses, pain is worse on movement
  • increases with the Valsave manouevre
  • if the nerve root is involved - radicular pain
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33
Q

SC =

A

from medulla to conus medullaris at L1-L2 junction

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34
Q

Conus medullaris?

A
  • conus medullaris: tapered structure at the spinal cord end
  • at the IVD between L1 and L2
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35
Q

cauda equina =

A
  • Cauda equina: interdural nerve rooots at the end of the SC
  • in the subarachnoid space distal to conus medullaris
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36
Q

filum terminale?

A
  • filum terminale: fibrous extension of the cord
  • non-neural element that extends down to the coccyx
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37
Q

history of cauda equina compression?

A
  • patient presents a known cancer presented w a new onset of back pain?
  • pain - duration, nature, severity, radiation
  • numbness
  • bowel and bladder difficulty
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38
Q

C5 nerve root?

A

elbow flexors - biceps, brachialis

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39
Q

C6?

A

Wrist extensors - extensor carpi radialis longus and brevis

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40
Q

C7?

A

elbow extensors (triceps)

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41
Q

C8?

A

Finger flexors (FDP) to the middle finger

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42
Q

T1?

A

Small finger abductors (abductor digiti minimi)

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43
Q

L2?

A

Hip flexors (iliopsoas)

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44
Q

L3?

A

knee extensors (quads)

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45
Q

L4?

A

ankle dorsiflexors - tibialis anterior

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46
Q

L5?

A

long toe extensors - EHL

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47
Q

S1?

A

ankle plantar flexors - gastrocnemius, soleus

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48
Q

examination for CEC?

A
  • mobility and gait
  • elicit tenderness
  • power, tone and rigidity
  • tendon reflexes including planter - state of spinal shock can cause hyporeflexia or flaccid paralysis
  • sensation
  • anal tone and perianal sensation
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49
Q

spinal cord compression signs?

A
  • UMN signs - uniform
  • pain: localised or radicular
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50
Q

SC compression motor signs?

A
  • motor: low power and rigidity
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51
Q

bladder signs from SCC?

A
  • bladder: urge incontinence
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52
Q

Reflexes in SCC?

A

hyperreflexia, planter response is up-going

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53
Q

Cauda equina signs?

A
  • localised or radicular
  • motor: flaccid paralysis
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54
Q

bladder signs in CEC?

A
  • bladder: overflow incontienence
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55
Q

Reflexes in CEC?

A

areflexia

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56
Q

common primary cancer sItes for metastatic CE?

A
  • lung
  • prostate
  • breast
  • kidney
  • multiple M
  • lymphoma and melanoma
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57
Q

Medical management of CEC?

A
  • steroids - dexamethasone w PPI
  • MRI of whole spine & radiotherapy
  • pain management
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58
Q

What is the treatment for cord compression from leukemia and lymphoma?

A
  • if cord compression is from leukaemia and lymphoma, surgery is not carried out and the treatment is steroids and chemo
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59
Q

what needs to be tapered off?

A
  • taper off dexamethasone (risk of hyperglyacemia and gastric ulcer)
  • physio - gradual mobilization
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60
Q

other speciality input - CE?

A
  • macmillan nurse
  • palliative care team
  • physiotherapy
  • OT
  • GP
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61
Q

Prognosis of CEC?

A
  • responsive to steroids
  • early surgical and radiotherapy <24hrs of developing neuro signs is key
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62
Q

Radiation sensitive cancers?

A

MM and small cell lung cancer

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63
Q

moderately sensitive cancers to radiation?

A

prostate and breast cancer

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64
Q

poor prognosis CEC?

A
  • extra spinal mets
  • paraplegic >48 hrs
  • radioresistant tumours: renal cell cancer and melanoma (unless surgery is done within 24 hrs)
  • cord compression w vertebral fracture
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65
Q

Early signs of CEC?

A
  • local tenderness and plantars upgoing are early signs
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66
Q

cauda equina common causes?

A
  • lumbar stenosis
  • spinal trauma
  • disc disease - herniation
  • malignanct
  • spinal infections - abscess, TB
  • neural tube defects
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67
Q

spinal cord lesion?

A
  • uMN lesion
  • high tone,
  • weakness,
  • hyperreflexia, upgoing plantars
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68
Q

Cauda equina?

A
  • cauda equina - contains nerves that exit from the SC and form part of the peripheral NS
  • LMN weakness - low tone, weakness, hyporeflexia, downgoing plantars
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69
Q

what is CES characterised by?

A
  • cauda equina syndrome is characterised by low back pain, leg weakness, saddle anaesthesia, bladder/bowel dysfunction
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70
Q

classical presentation of CES?

A
  • unilateral (or bilateral) sciatica like pain (shooting pain due to irritation of lumbosacral nerve roots) with new neurological deficits in the lower limb and bladder/ bowel dysfunction is classic
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71
Q

Symptoms of CES?

A
  • Low back pain
  • Asymmetrical sciatica pain
  • Saddle anaesthesia: reduced or absent sensation around the perineal skin
  • Bladder dysfunction: urinary retention, difficulty passing urine, overflow incontinence
  • Bowel dysfunction: constipation, incontinence, loss of anal tone
  • Lower limb weakness: often asymmetrical
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72
Q

Signs of CES?

A
  • hypotonia
  • leg weakness
  • hyporeflexia
  • leg sensory changes - may have abnormal sensation along a single dermatome
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73
Q

Bladder and bowel signs of CES?

A
  • Reduced sensation around perianal area
  • Loss of anal tone(on PR examination)
  • Palpable bladder
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74
Q

DDs of cauda equina?

A

conus medullaris and cord compression

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75
Q

conus medullaris?

A
  • compression of the last part of the spinal cord at L1/L2.
  • Compression at the conus causes a clinical picture similar to cauda equina but with mixed neurological signs (upper and lower motor neuron features) as it also affects part of the cord.
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76
Q

cord compression?

A
  • Cord compression: compression of the spinal cord at any level within the cervical, thoracic or lumbar region.
  • Following the acute insult, this causes a classical upper motor neuron pattern of weakness.
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77
Q

triple assessment?

A
  • history and exam
  • imaging
  • pathology (biopsies)
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78
Q

breast history?

A
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79
Q

examination of the breast?

A
  • look for asymmetry, skin tethering, nipple retraction, discoloration
  • ask patient to put hands above her head, ask patient to put arms on her hips and push in
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80
Q

P scoring for breast examination?

A
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81
Q

supraclavicular fossa nodes in BC?

A

once the cancer has spread to the supraclavicular nodes, classed as metastatic as no longer surgically curable

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82
Q

imaging for BC?

A
  • mammography
  • high res US
  • mri - useful for assessment of implants, high risk screening
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83
Q

Fine needle aspiration cytology (FNA)

A
  • wide core needle biopsy
  • discriminates pre-cancerous DCIS and invasive cancers
  • oestrogen sensitivity can be assessed
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84
Q

Mammotome biopsy (vaccum)?

A
  • Large needle with facility to apply suction.
  • Capable of large volume biopsy in cases of diagnostic doubt.
  • May remove small benign lesions without surgery.
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85
Q

Mammotome biopsy -?

A
  • Time consuming process
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86
Q

congenital breast diseases?

A
  • usually develop along the milk line
  • most common site for an accessory nipple is below the breast
  • Most common site for accessory breast is in the axilla
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87
Q

Benign masses - cysts?

A
  • Common cause of dominant breast mass
  • May occur at any age, but uncommon in post menopausal women
  • Fluctuates with menstrual cycle
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88
Q

characteristics of a breast cyst?

A
  • Well demarcated from the surrounding tissue
  • Characteristically firm and mobile
  • May be tender
  • Difficult to differentiate from solid mass
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89
Q

treatment of breast cysts?

A

aspiration

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90
Q

fibroadenomas?

A
  • second most common benign breast lesion
  • Benign solid tumors containing glandular as well as fibrous tissue.
  • Usually present as well defined, mobile mass (BREAST MOUSE)
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91
Q

who do fibroadenomas commonly affect?

A
  • Commonly found in women between the ages of 15 and 35 years
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92
Q

fibroadenomas can increase in size with?

A
  • Cause is unknown, thought to be due to hormonal influence
  • May increase in size during pregnancy or with estrogen therapy
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93
Q

phylloides tumour?

A
  • Rapidly growing
  • One in four malignant
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94
Q

how do phylloides tumours appear?

A
  • Create bulky tumors that distort the breast
  • May ulcerate through the skin due to pressure necrosis
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95
Q

Tx of phylloides tumours?

A

wide excision

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96
Q

fat necrosis?

A
  • rare
  • secondary to trauma
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97
Q

appearance of fat necrosis lumps?

A
  • tender, ill defined mass
  • occassionally there is skin retraction
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98
Q

galactocele?

A
  • milk filled cyst from over distension of a lactiferous duct
  • presents as a firm, non tender mass in the breast
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99
Q

where are galactoceles common?

A

upper quadrants behind the aerola

100
Q

duct ectasia?

A
  • generally in older women
  • dilatation of the subareolar ducts can occur
101
Q

what can occur w duct ectasia?

A
  • a palpable retro-areolar mass, nipple discharge or retraction can be present
102
Q

gynaecomastia?

A
  • growth of the glandular tissue of the male breast.
  • Due to an imbalance in the estrogen to androgen activity.
  • May be unilateral or bilateral
103
Q

when is gynaecomastia common?

A
  • Common in infancy, adolescence and adult life (Physiological)
  • Pseudogynecomastia may be seen in obese individuals
104
Q

causes of gynaceomastia?

A
  • Causes include; drugs (e.g. digoxin?, chronic diseases, Testicular Tumours.
105
Q

management of normal cyclic breast pain and fibrocystic change?

A
  • exam & breast pain leaflet
  • star flower oil
  • ibf gel
  • bra fitting service
  • analgesia
106
Q

management of mastitis?

A

pus aspiration/ surgical incision and drainage

107
Q

nipple discharge?

A
  • majority of cases benign
  • most common cause is lactational
  • other: overstim, prolactin secreting tumours, hypothyroidism, drugs
108
Q

suspicious nipple discharge?

A
  • unilateral, spontaneous, bloody discharge is suspicious (Intraduct Papilloma/DCIS/Invasive cancer)
109
Q

breast infection - mastitis?

A
  • Most common in lactating female
  • Dry, cracked fissured areola/nipple complex provides portal for infection
  • Usually caused by Staph/Strep organisms
110
Q

Tx of mastitis?

A
  • Treat with heat, continued breast feeding,
  • Antibiotics for 10-14 days to cover staph and strept infections
111
Q

breast abcesses?

A
  • May present with breast swelling, tenderness and fever
  • O/E breast is tender , warm and fluctuant, may also have purulent discharge ,may have systemic symptoms.
112
Q

Tx of breast abcesses?

A
  • Treated by USS guided aspiration and Antibiotics
  • Surgical drainage only if skin necrosis (ie: Abcess about to rupture through the skin)
113
Q

most common cancer in women in the UK?

A

breast

114
Q

RF of breast cancer?

A
  • Age.
  • Family history
  • Duration of oestrogen exposure(Exogenous/Endogenous).
  • Early Menarche/Late Menopause/Late first pregnancy/Breast Feeding
  • HRT-may double relative risk after 10 years use
  • Obesity
  • Alcohol
115
Q

Breast Cancer Screening Programme(NHSBSP)?

A
  • All women aged 50-70 years (
  • On demand after 70
  • Mammography every 3 years (2 Views)
116
Q
  • of breast cancer screening?
A
  • X ray dose may contibribute <1:100000 extra cancers
117
Q

grade 1 vs 3 cancers?

A
  • grade 1 cancers are more similar to normal breast
  • grade 3 cancers are more aggressive
118
Q

Nottingham prognostic index?

A
  • prognosis if no treatment other than surgery occurs
  • Grade (1-3) + Nodes (1-3) + 0.2x size (cm)
119
Q

TNM staging?

A
120
Q

breast conservation surgery?

A
  • small tumour
  • no prev radiotherapy to the breast
  • pre-op chemo may allow breast convservation
121
Q

masectomy indications?

A
  • large tumour
  • multifocal cancer
122
Q

lymphatic drainage of the breast?

A

97% to axillary nodes and 3% to internal mammary nodes

123
Q

axilla anatomy?

A
  • Superior – axillary vein
  • Lateral – Latissimus dorsi
  • Medial – Serratus anterior
  • Anterior – Pectoralis major
124
Q

Posterior and inferior borders of the axilla?

A
  • Posterior – Subscapularis and lat dorsi
  • Inferior – clavipectoral fascia and skin
125
Q

key structures to preserve in surgery for BC?

A
  • Long thoracic nerve of bell
  • Thoracodorsal pedicle
126
Q

Types of axillary node staging?

A

axillary node clearance, axillay node sampling

127
Q

axillay node clearance?

A
  • removal of AN in staging and management of BC
  • high complication rates: shoulder stiffness, seroma, pain and numbness
  • lymphoedema
128
Q

axillary node sampling?

A
  • SLNB - sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present
129
Q

adjuvant therapies?

A
  • endocrine therapies
  • chemotherapy
  • radiotherapy
  • herceptin
130
Q

aromatase inhibitors?

A
  • Aromatase inhibitors-Anastrozole, Letrozole, Exemestane
  • prevent conversion of androgen -> oestrogen
131
Q

GNRH agonists?

A

Zoladex - reduced oestrogen production

132
Q

Tamoxifen?

A

SERM

133
Q

tamoxifen complications?

A
  • hot flushes
  • nausea
  • vaginal bleeding
  • rarely: thrombosis and endometrial cancer
134
Q

selective aromatase inhibitors?

A
  • cuts off oestrogen supply
  • Only used in Post Menopausal women, (can’t block oestrogen production by the ovaries).
  • may cont to osteoporosis
135
Q

adjuvant chemo and neoadjvant chemo?

A
  • Adriamycin and Cyclophosphamide, (AC), cycles 3 weeks apart.
  • Taxanes.
  • 6 cycles of Chemotherapy
136
Q

Adjuvant radiotherapy?

A
  • ALWAYS after wide local excision (local recurrence rate 35% w/o)
  • use of post mastectomy radiotherapy for high risk cancers
137
Q

herceptin?

A
  • monoclonal ab
  • interferes w HER2 receptors
  • injection/ 3 weeks for a year
138
Q

herceptin -?

A

cardiomyopathy

139
Q

immediate breast recons +

A

better cosmesis

140
Q

immediate breast recons -?

A
  • May delay chemotherapy or radiotherapy if complications
  • Radiotherapy may spoil result
141
Q

breast implants complications?

A
  • capsular formation
  • infection
  • rupture
  • shape changes w age and gravity
142
Q

implants after a masectomy?

A
  • after a mastectomy subcutaneous placement carries a high risk of implant loss, wrinkling and infection
  • so a partial or fully submuascular is preffered
143
Q

types of breast flaps?

A
  • lats dorsi flap
  • TRAM Flap(Transverse Rectus Abdominis Flap)
  • DIEP Flap (Deep Inferior Epigastric Artery Flap) Free Flap
144
Q

grade vs stage?

A
  • high grade = rapid growth and spread
  • stage: how far has it spread - TNM classification
145
Q

benign disease?

A
  • cells retain features similar to normal tissue
  • normal mitosis
  • cells retain cohension
  • expanding pattern of growth
146
Q

malignant features?

A
  • Continuous growth- cells lose features of normal tissue
  • Abnormal rapid mitosis- DNA loss pleomorphism,
  • Loss of cohesion and spread via lymphatics or blood vessels
  • Invasive growth
  • Neoangiogenesis
147
Q

most common type of breast cancer?

A

invasive ductal - 90%

148
Q

Invasive ductal breast cancer?

A
  • Hard lump, skin tethering.
  • Easily seen on mammogram.
149
Q

invasive lobular breast cancer affects ?%

A

8

150
Q

invasive lobular BC?

A
  • May be thickening or skin tethering, but may have minimal symptoms.
  • Often difficult to see on mammogram, and often multiple tumours in same or both breasts.
  • Histology grade 1 or 2.
151
Q

rare breast cancers?

A
  • mucinous, tubular
  • secondary tumours presenting as breast lumps - MM, renal, lymphoma
152
Q

ductal carcinoma in situ?

A
  • Do not usually present with clinical findings.
  • Principally detected on screening. mammogram [calcification] or incidental finding on a biopsy.
153
Q

LCIS?

A
  • Rate of progression uncertain, usually slow.
154
Q

Which age groups are cysts common in?

A
  • very common 40-50 yrs
  • rare over 60s
155
Q

what makes breast cysts more common?

A

HRT

156
Q

how can cysts present?

A
  • may be flat, smooth and fluctant or tense and painful
  • freq multiple and bilateral
157
Q

who do fibroadenomas commonly affect?

A
  • Mobile discrete nodule most frequent in 15-30 yrs.
158
Q

Phylloides tumours?

A
  • closely resemble fibroadenoma
  • locally aggressive/borderline malignant
159
Q

breast screening programme?

A
  • over 50s
  • recalled if abnormalities
  • assessment clinic - history, clinical exam, biopsy and ultrasound
160
Q

triple assessment?

A
  • examination
  • imaging - mammography and/or US
  • sampling - core biopsy or fine needle aspiration cytology
161
Q

presentation of breast cancer?

A
  • lump
  • inverted nipple or dimpling
  • inflammation
  • discharge - usually blood stained
162
Q

others risks of BC?

A
  • Age at menopause and menarche
  • alcohol intake
  • older mothers
  • BRCA 1/2
  • higher oestrogen levels
163
Q

What does screening do?

A
  • 3-yearly
  • 2 view mammography
  • detection of pre symptomatic disease in the well
164
Q

types of surgery for BC?

A
  • mastectomy -removal of all of the breast.
  • Oncoplastic breast reduction-removal of a quarter or more of the breast tissue, with rearrangement of residual tissue to a normal cosmetic shape.
  • Wide local excision -the lump plus a boarder of normal tissue
165
Q

how are lymph nodes staged?

A
  • Lymph node staging by removing the sentinel node, axillary sampling or clearance for all invasive tumours.
166
Q

which breast cancer patients will have radiotherapy?

A
  • Women with invasive cancer who have had a local excision will have radiotherapy to the breast.
  • Women with involved lymph nodes may have further surgery or radiotherapy to the axilla.
167
Q

endocrine therapy for breast tumours?

A
  • Oestrogen receptor positive tumours need endocrine therapy
  • HER2 positive tumours need trastuzumab for 12 months
168
Q

if it’s difficult to decide whether the cancer will benefit from chemo?

A

gene array test - oncotype Dx

169
Q

To justify screening we need to satisfy the following conditions:

A

*A common or severe disease
*A recognisable early stage that responds better to treatment
*A non harmful test which is acceptable to the screened population and has an acceptable false positive and false negative rate
*Cost effectiveness

170
Q

benefits of breast screening ?

A
  • less deaths from BC
  • more conservative surgery
  • improved breast awareness
  • reassurance
171
Q

disadvantages of breast screening?

A
  • Increased anxiety
  • Time off work, transport costs
  • Unnecessary recalls and benign biopsies
  • Treatment of cancers and precancerous states in women who die prematurely from other causes.
  • False reassurance
172
Q

aims of BC screening?

A
  • to detect invasive cancers
  • to persuade 70% of invited women to attend
  • to reduce mortality from BC by 25% in the screened population
173
Q
A
  • microcalcifications due to ductal carcinoma in situ
174
Q

Features of a BC lump?

A
  • painless, hard, irregular, fixed
  • may distort the breast and alter the shape/ contour
175
Q

benign lumps?

A
  • most lumps under 50 are benign - smooth mobile and often tender
176
Q

nipple pain, redness, swelling w discharge?

A
  • nipple pain redness and swelling w discharge is caused by periductal masitis
  • related to smoking
177
Q

imaging for women under 35?

A

ultrasound

178
Q

imaging for women over 40?

A

mammography

179
Q

imaging for where the breast is dense?

A
  • MRI where the breast is dense or an oncogene is suspected
180
Q

breast screening detects many cases of?

A

DCIS

181
Q

Advantages and disadvantages of breast screening?

A
182
Q

Latissimus Dorsi Myocutaneous Flap Reconstruction ?

A
  • Uses LD muscle and overlying fat and skin ellipse
  • Can be used for whole breast / partial breast reconstruction
  • With underlying implant or without (autologous)
  • Can be irradiated if autologous
183
Q

TRAM/DIEP Flaps ?

A
  • Uses anterior abdominal wall tissue
  • Transverse Rectus Abdominis Myocutaneous Flap (taking rectus muscle)
  • Deep Inferior Epigastric Perforator Flap (no muscle taken)
184
Q
  • of TRAM/ DIEP flaps?
A
  • higher risk of flap loss and wound morbidity
  • variable reaction to radiotherapy
  • patient gets a ‘tummy tuck’
185
Q

lipomodelling?

A
  • autologus fat transfer
  • fat from areas of excess removed by liposuction
  • fat centrigued to remove blood and dead cells and then re-injected into breast to augment reconstruction or correct deformaty
  • can be used in addition to other types of reconstruction
186
Q

breast conserving surgery: indications ?

A
  • small tumour: breast ratio
  • tumour site - tumours in the inner half of breast are harder to remove w/o defect
  • solitary lesions - multifocal tumours need mastectomy
187
Q

cancer is the ? most common cause of death

A

2nd

188
Q

oncogenes vs TSGs?

A
  • oncogenes normally act in a cell to promote cell /
  • TSG normally act to downregulate cell growth and promote differentiation or programmed cell death
189
Q

hyperplasia?

A

too much reproduction of cells - can be a normal reaction e.g. to hormonal stimuli or tissue damage

190
Q

dysplasia?

A

excessive proliferation of cells which appear abn in size, shape and organisation

191
Q

cancer in situ?

A

cells carry features of malignancy w/o penetrating basement membrane. Will usually develop into invasive cancer w time.

192
Q

invasive cancer?

A

penetrates the BM

193
Q

types of cancer?

A
  • carcinomas
  • sarcomas
  • leukemias/ lymphomas
194
Q

carcinomas?

A
  • 85%
  • from epithelium which lines or covers organs.
195
Q

sarcomas?

A
  • 6%
  • arise from connective tissues eg muscle, bone and fatty tissue.
196
Q

leukemias/ lymphomas?

A
  • 5%
  • occur in the bone marrow / lymphatic system.
197
Q

causes of cancer - environment/ lifestyle?

A
198
Q

causes of cancer - infection?

A
199
Q

causes of cancer - inherited?

A
200
Q

cancer presentation

A
201
Q

tumours that rarely metastasise?

A
  • brain tumours
  • BCC, mesothelioma
  • larynx
202
Q

tumours that commonly metastasise?

A
  • lung, breast
  • prostate, colon
203
Q

lung cancer commonly spreads to?

A

adrenals, and skin

204
Q
A
205
Q

radiological Ix of cancer?

A
  • Plain X-ray
  • Contrast studies
  • CT scan – cross sectional info
  • MRI – anatomical / pathological info
  • PET – functional info
  • Bone scan – useful for bone mets
206
Q

haematological investigations of cancer?

A
  • FBC
  • bone marrow
  • myeloma proteins
  • changes often non spec in common solid tumours
207
Q

biochemical Ix of cancer?

A
  • liver enzymes
  • serum calcium
  • proteins, electrolytes
  • tumour markers - PSA, CEA, CA125, HCG
208
Q

2 types of breast pain?

A
  • cyclical - related to MC
  • non-cyclical
209
Q

cysts features?

A
  • Flat, smooth & fluctuant OR tense, painful and appear quickly.
  • Frequently multiple and bilateral.
  • Common in patients on HRT
  • Contain green or brown fluid, but re assess if blood is aspirated.
210
Q

cysts are rare over?

A

60

211
Q
A
212
Q

features of a malignant lump?

A
  • firm/ hard
  • irregular surface
  • drawing in of the skin near the lump frequently
  • indentation more obvs when arms are raised above the head
  • irregular edges
213
Q

how to examine the axilla?

A

with the arm down, fingers would point up the armpit

214
Q

benefits of BC mammography in BC screening?

A
  • promotes early identification of treatable cancers
  • reduces mortality rate
  • increases choice of Tx options
215
Q

risks of mammography?

A
  • some cancers r missed
  • some identified cancers are not curable
  • false positives
  • overdiagnosis may lead to unecessary treatment
216
Q

operable primary BC tX?

A
  • surgery will usually be the first treatment
  • neoadjuvant endocrine surgery in post menopaisal women w ER positive breast cancers
217
Q

locally advanced primary breast cancer?

A
  • core biopsy and staging investigations
218
Q

metastatic BC tx?

A
  • Following symptomatic presentation of distant mets, aim of treatment is to palliate symptoms and maintain QOL
219
Q

US in breast screening?

A
  • helpful in women w dense breast tissue which can make it hard to see abn on mammograms
  • can tell the difference between cysts and solid masses
220
Q

what can cause lymphoedema?

A
  • From surgery to LN, radiotherapy or tumour obstruction of LN areas
221
Q

Mx of lymphedema?

A
  • management is decongestive lymphatic therapy - compression bandaging, skin care and decongestive lymphatic therapy
  • MLD - manual lymph drainage - light massages
222
Q

surgery for lymphoedema?

A
  • surgery - complex decongestive therapy - liposuction, debulking operations and bypass procedure
223
Q

FHx in breast cancer risk?

A
  • having a first degree relative doubles the risk of developing breast cancer
  • risk increases w the number of relatives affected and the age at diagnosis - younger = greater risk
224
Q

prevention of BC in high risk women?

A
  • mastectomy
  • meds
225
Q

Medications used for BC prevention?

A
  • tamoxifen - can be used for pre and post menopausal women
  • anastrazole - aromatase inhibitor - post-menopausal women
  • raloxifene - post menopausal women
226
Q

BRCA-1?

A

mutation on chromosome 17 - breast and ovarian cancer

227
Q

BRCA-2?

A

chromosome 13 mutation. More of a risk factor in BC in men

228
Q

BRCA-2 mutation is also associated with which types of cancer?

A

pertioneal, endometrial, fallopian, pancreatic and prostate cancer

229
Q

Features of BC reflecting metastatic spread?

A

The bone (bone pain), liver (malaise, jaundice), lungs (shortness of breath, cough) and brain (confusion, seizures)

230
Q

ductal carcinomas in situ?

A
  • non-invasive malignancies that may progress to invasive malignancy
  • comedi DCIS is a high grade type that has an increased risk of malignancy
231
Q

invasive ductal carcinoma?

A
  • comprises 70-80% of invasive breast cancer
232
Q

LCIS?

A
  • a.k.a as lobular neoplasia
  • tends to be incidentally found on biopsy
233
Q

ILC - invasive lobular carcinoma?

A
  • 2nd most common invasive breast caNcer
  • relationship w post-meno hormone therapy
234
Q

changes to the breast skin associated w malignancy?

A
  • Change to normal appearance
  • Skin tethering
  • Oedema
  • Peau d’orange
235
Q

nipple changes associated w malignancy

A
  • Inversion
  • Discharge, especially if bloody
  • Dilated veins
236
Q

fiberoadenomas affect?

A

Common in women under the age of 30 years

237
Q

Fiberoadenomas features?

A

Often described as ‘breast mice’ due as they are discrete, non-tender, highly mobile lumps

238
Q

Fibroadenosis (fibrocystic disease, benign mammary dysplasia) affects

A

Most common in middle-aged women

239
Q

Who does fibroadenosis affect?

A
  • Lumpy’ breasts which may be painful.
  • Symptoms may worsen prior to menstruation
240
Q

breast cancer features?

A

Characteristically a hard, irregular lump. There may be associated nipple inversion or skin tethering

241
Q

Paget’s disease of the breast?

A

intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the nipple/areola

242
Q

Mammary duct ectasia?

A
  • Dilatation of the large breast ducts
  • Most common around the menopause
243
Q

How does mamary duct ectasia present?

A
  • May present with a tender lump around the areola +/- a green nipple discharge
  • If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’
244
Q

Duct papilloma presentation?

A
  • Local areas of epithelial proliferation in large mammary ducts
  • Hyperplastic lesions rather than malignant or premalignant
  • May present with blood stained discharge
245
Q

Fat necrosis is most common in?

A
  • More common in obese women with large breasts
  • May follow trivial or unnoticed trauma
    Initial inflammatory response, the lesion is
246
Q

How does fat
necorosis present?

A
  • Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
  • Rare and may mimic breast cancer so further investigation is always warranted
247
Q

Breast abcess?

A
  • More common in lactating women
  • Red, hot tender swelling

Year 3 (45 decks)

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