Block 32 Week 2 Flashcards
1
Q
appendicular skeleton?
A
- upper limbs
- pectoral girdle
- lower limbs
- pelvic girdle
2
Q
axial skeleton?
A
- skull
- VC
- thoracic cage
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
4
Q
primary tumours that mets to bone?
A
- prostate
- breast
- lung
- kidney
- myeloma - bone is the primary
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)
6
Q
acrometastases?
A
- acrometastases = distal to elbow and knee (rare)
- usually from kidneys and lungs
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.
8
Q
osteoclerotic mets?
A
if osteoblast activity predominates, there will be disorganised ossification
9
Q
which cancers cause lytic type mets?
A
- mutiple myeloma
- thyroid cancer
- renal cell cancer
- melanoma
10
Q
which cancers cause sclerotic type mets?
A
- prostate
- breast
- mucinous cancer of the bowel
11
Q
Which cancers cause mixed-sclerotic and lytic type mets?
A
- lung cancer
- bladder cancer
12
Q
management - investigation?
A
- FBC
- bone related ALP
- kidney function and liver enzymes
- PSA - ruling out PC
- paraproteins - suggests multiple myeloma
13
Q
urine testing for bone mets?
A
- proteins - Bence Jones - MM
14
Q
bence jones proteins in urine?
A
- sign of MM (plasma cell cancer) or malignant lymphomas
15
Q
DDs of bone mets?
A
- primary bone tumour - benign/ malignant
- bone islands
- osteomyelitis
- paget’s disease
16
Q
inc uptake in bone scans suggests?
A
- inc uptake in scans (Widespread) suggests metastasis - more useful in sclerotic type of mets
17
Q
pain ladder - step 1
A
- 1 - paracetamol and anti-inflammatories
18
Q
pain ladder step 2?
A
- 2 - weak opiods: codeine and tramadol
19
Q
pain ladder step 3?
A
- 3 - stronger opiods: morphine and oxycodone, fentanyl
20
Q
managing bone pain?
A
- bisphosphonates: zolindronic acid (IV)
- radiotherapy
21
Q
side effects of paracetamol?
A
hepatotoxic
22
Q
anti-inflammatories like diclofenac side effects?
A
renal function, gastritis
23
Q
opiods side effects?
A
constipation, nausea, drowsiness, confusion
24
Q
bisphosphonates side effects?
A
nephortoxic and jaw necrosis - ulcers in the mandible and maxilla
25
percentage of cancer patients that develop met CE?
3-5%
26
When does CE become irreversible?
if neurological deficit (paraplegia) sets in
27
3 components of cauda equina?
* mets to the vertebra pressing the cord
* pain and tenderness
* neurological symptoms depending on the level of compression
28
mechanism of cauda equina?
* direct compression results in venous congestion
* which leads to oedema
* which then causes demyelination
* arterial ischemia
* direct damage to tracts -> permanent deficits
29
management of CE?
* dexamethasone - risk if diabetic or active peptic ulcer
30
Symptoms of CE?
* pain (occurs in 90% of ptients)
* worse on lying down
* tenderness - local pressure
* muscle weakness
* jelly legs and cannot climb stairs
31
Sensory deficits with cauda equina?
* autonomic dysfunction related to bladder dysfunction
32
pain w CE?
* if the bone collapses, pain is worse on movement
* increases with the Valsave manouevre
* if the nerve root is involved - radicular pain
33
SC =
from medulla to conus medullaris at L1-L2 junction
34
Conus medullaris?
* conus medullaris: tapered structure at the spinal cord end
* at the IVD between L1 and L2
35
cauda equina =
* Cauda equina: interdural nerve rooots at the end of the SC
* in the subarachnoid space distal to conus medullaris
36
filum terminale?
* filum terminale: fibrous extension of the cord
* non-neural element that extends down to the coccyx
37
history of cauda equina compression?
* patient presents a known cancer presented w a new onset of back pain?
* pain - duration, nature, severity, radiation
* numbness
* bowel and bladder difficulty
38
C5 nerve root?
elbow flexors - biceps, brachialis
39
C6?
Wrist extensors - extensor carpi radialis longus and brevis
40
C7?
elbow extensors (triceps)
41
C8?
Finger flexors (FDP) to the middle finger
42
T1?
Small finger abductors (abductor digiti minimi)
43
L2?
Hip flexors (iliopsoas)
44
L3?
knee extensors (quads)
45
L4?
ankle dorsiflexors - tibialis anterior
46
L5?
long toe extensors - EHL
47
S1?
ankle plantar flexors - gastrocnemius, soleus
48
examination for CEC?
* 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
49
spinal cord compression signs?
* UMN signs - uniform
* pain: localised or radicular
50
SC compression motor signs?
* motor: low power and rigidity
51
bladder signs from SCC?
* bladder: urge incontinence
52
Reflexes in SCC?
hyperreflexia, planter response is up-going
53
Cauda equina signs?
* localised or radicular
* motor: flaccid paralysis
54
bladder signs in CEC?
* bladder: overflow incontienence
55
Reflexes in CEC?
areflexia
56
common primary cancer sItes for metastatic CE?
* lung
* prostate
* breast
* kidney
* multiple M
* lymphoma and melanoma
57
Medical management of CEC?
* steroids - dexamethasone w PPI
* MRI of whole spine & radiotherapy
* pain management
58
What is the treatment for cord compression from leukemia and lymphoma?
* if cord compression is from leukaemia and lymphoma, surgery is not carried out and the treatment is steroids and chemo
59
what needs to be tapered off?
* taper off dexamethasone (risk of hyperglyacemia and gastric ulcer)
* physio - gradual mobilization
60
other speciality input - CE?
* macmillan nurse
* palliative care team
* physiotherapy
* OT
* GP
61
Prognosis of CEC?
* responsive to steroids
* early surgical and radiotherapy <24hrs of developing neuro signs is key
62
Radiation sensitive cancers?
MM and small cell lung cancer
63
moderately sensitive cancers to radiation?
prostate and breast cancer
64
poor prognosis CEC?
* 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
65
Early signs of CEC?
* local tenderness and plantars upgoing are early signs
66
cauda equina common causes?
* lumbar stenosis
* spinal trauma
* disc disease - herniation
* malignanct
* spinal infections - abscess, TB
* neural tube defects
67
spinal cord lesion?
- uMN lesion
- high tone,
- weakness,
- hyperreflexia, upgoing plantars
68
Cauda equina?
* cauda equina - contains nerves that exit from the SC and form part of the peripheral NS
* LMN weakness - low tone, weakness, hyporeflexia, downgoing plantars
69
what is CES characterised by?
* cauda equina syndrome is characterised by low back pain, leg weakness, saddle anaesthesia, bladder/bowel dysfunction
70
classical presentation of CES?
* 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
71
Symptoms of CES?
* 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
72
Signs of CES?
* hypotonia
* leg weakness
* hyporeflexia
* leg sensory changes - may have abnormal sensation along a single dermatome
73
Bladder and bowel signs of CES?
* Reduced sensation around perianal area
* Loss of anal tone (on PR examination)
* Palpable bladder
74
DDs of cauda equina?
conus medullaris and cord compression
75
conus medullaris?
- 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.
76
cord compression?
* 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.
77
triple assessment?
* history and exam
* imaging
* pathology (biopsies)
78
breast history?
79
examination of the breast?
* 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
80
P scoring for breast examination?
81
supraclavicular fossa nodes in BC?
once the cancer has spread to the supraclavicular nodes, classed as metastatic as no longer surgically curable
82
imaging for BC?
* mammography
* high res US
* mri - useful for assessment of implants, high risk screening
83
Fine needle aspiration cytology (FNA)
* wide core needle biopsy
* discriminates pre-cancerous DCIS and invasive cancers
* oestrogen sensitivity can be assessed
84
Mammotome biopsy (vaccum)?
* Large needle with facility to apply suction.
* Capable of large volume biopsy in cases of diagnostic doubt.
* May remove small benign lesions without surgery.
85
Mammotome biopsy -?
* Time consuming process
86
congenital breast diseases?
* 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
87
Benign masses - cysts?
* Common cause of dominant breast mass
* May occur at any age, but uncommon in post menopausal women
* Fluctuates with menstrual cycle
88
characteristics of a breast cyst?
* Well demarcated from the surrounding tissue
* Characteristically firm and mobile
* May be tender
* Difficult to differentiate from solid mass
89
treatment of breast cysts?
aspiration
90
fibroadenomas?
* 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)
91
who do fibroadenomas commonly affect?
* Commonly found in women between the ages of 15 and 35 years
92
fibroadenomas can increase in size with?
* Cause is unknown, thought to be due to hormonal influence
* May increase in size during pregnancy or with estrogen therapy
93
phylloides tumour?
* Rapidly growing
* One in four malignant
94
how do phylloides tumours appear?
* Create bulky tumors that distort the breast
* May ulcerate through the skin due to pressure necrosis
95
Tx of phylloides tumours?
wide excision
96
fat necrosis?
* rare
* secondary to trauma
97
appearance of fat necrosis lumps?
* tender, ill defined mass
* occassionally there is skin retraction
98
galactocele?
* milk filled cyst from over distension of a lactiferous duct
* presents as a firm, non tender mass in the breast
99
where are galactoceles common?
upper quadrants behind the aerola
100
duct ectasia?
* generally in older women
* dilatation of the subareolar ducts can occur
101
what can occur w duct ectasia?
* a palpable retro-areolar mass, nipple discharge or retraction can be present
102
gynaecomastia?
* 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
when is gynaecomastia common?
* Common in infancy, adolescence and adult life (Physiological)
* Pseudogynecomastia may be seen in obese individuals
104
causes of gynaceomastia?
* Causes include; drugs (e.g. digoxin?, chronic diseases, Testicular Tumours.
105
management of normal cyclic breast pain and fibrocystic change?
* exam & breast pain leaflet
* star flower oil
* ibf gel
* bra fitting service
* analgesia
106
management of mastitis?
pus aspiration/ surgical incision and drainage
107
nipple discharge?
* majority of cases benign
* most common cause is lactational
* other: overstim, prolactin secreting tumours, hypothyroidism, drugs
108
suspicious nipple discharge?
* unilateral, spontaneous, bloody discharge is suspicious (Intraduct Papilloma/DCIS/Invasive cancer)
109
breast infection - mastitis?
* Most common in lactating female
* Dry, cracked fissured areola/nipple complex provides portal for infection
* Usually caused by Staph/Strep organisms
110
Tx of mastitis?
* Treat with heat, continued breast feeding,
* Antibiotics for 10-14 days to cover staph and strept infections
111
breast abcesses?
* 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
Tx of breast abcesses?
* Treated by USS guided aspiration and Antibiotics
* Surgical drainage only if skin necrosis (ie: Abcess about to rupture through the skin)
113
most common cancer in women in the UK?
breast
114
RF of breast cancer?
* 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
Breast Cancer Screening Programme(NHSBSP)?
* All women aged 50-70 years (
* On demand after 70
* Mammography every 3 years (2 Views)
116
- of breast cancer screening?
* X ray dose may contibribute <1:100000 extra cancers
117
grade 1 vs 3 cancers?
* grade 1 cancers are more similar to normal breast
* grade 3 cancers are more aggressive
118
Nottingham prognostic index?
* prognosis if no treatment other than surgery occurs
* Grade (1-3) + Nodes (1-3) + 0.2x size (cm)
119
TNM staging?
120
breast conservation surgery?
* small tumour
* no prev radiotherapy to the breast
* pre-op chemo may allow breast convservation
121
masectomy indications?
* large tumour
* multifocal cancer
122
lymphatic drainage of the breast?
97% to axillary nodes and 3% to internal mammary nodes
123
axilla anatomy?
* Superior – axillary vein
* Lateral – Latissimus dorsi
* Medial – Serratus anterior
* Anterior – Pectoralis major
124
Posterior and inferior borders of the axilla?
* Posterior – Subscapularis and lat dorsi
* Inferior – clavipectoral fascia and skin
125
key structures to preserve in surgery for BC?
* Long thoracic nerve of bell
* Thoracodorsal pedicle
126
Types of axillary node staging?
axillary node clearance, axillay node sampling
127
axillay node clearance?
* removal of AN in staging and management of BC
* high complication rates: shoulder stiffness, seroma, pain and numbness
* lymphoedema
128
axillary node sampling?
* SLNB - sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present
129
adjuvant therapies?
- endocrine therapies
- chemotherapy
- radiotherapy
- herceptin
130
aromatase inhibitors?
- Aromatase inhibitors-Anastrozole, Letrozole, Exemestane
- prevent conversion of androgen -> oestrogen
131
GNRH agonists?
Zoladex - reduced oestrogen production
132
Tamoxifen?
SERM
133
tamoxifen complications?
* hot flushes
* nausea
* vaginal bleeding
* rarely: thrombosis and endometrial cancer
134
selective aromatase inhibitors?
* cuts off oestrogen supply
* Only used in Post Menopausal women, (can’t block oestrogen production by the ovaries).
* may cont to osteoporosis
135
adjuvant chemo and neoadjvant chemo?
* Adriamycin and Cyclophosphamide, (AC), cycles 3 weeks apart.
* Taxanes.
* 6 cycles of Chemotherapy
136
Adjuvant radiotherapy?
* ALWAYS after wide local excision (local recurrence rate 35% w/o)
* use of post mastectomy radiotherapy for high risk cancers
137
herceptin?
* monoclonal ab
* interferes w HER2 receptors
* injection/ 3 weeks for a year
138
herceptin -?
cardiomyopathy
139
immediate breast recons +
better cosmesis
140
immediate breast recons -?
* May delay chemotherapy or radiotherapy if complications
* Radiotherapy may spoil result
141
breast implants complications?
* capsular formation
* infection
* rupture
* shape changes w age and gravity
142
implants after a masectomy?
* after a mastectomy subcutaneous placement carries a high risk of implant loss, wrinkling and infection
* so a partial or fully submuascular is preffered
143
types of breast flaps?
* lats dorsi flap
* TRAM Flap(Transverse Rectus Abdominis Flap)
* DIEP Flap (Deep Inferior Epigastric Artery Flap) Free Flap
144
grade vs stage?
* high grade = rapid growth and spread
* stage: how far has it spread - TNM classification
145
benign disease?
* cells retain features similar to normal tissue
* normal mitosis
* cells retain cohension
* expanding pattern of growth
146
malignant features?
* 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
most common type of breast cancer?
invasive ductal - 90%
148
Invasive ductal breast cancer?
* Hard lump, skin tethering.
* Easily seen on mammogram.
149
invasive lobular breast cancer affects ?%
8
150
invasive lobular BC?
* 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
rare breast cancers?
* mucinous, tubular
* secondary tumours presenting as breast lumps - MM, renal, lymphoma
152
ductal carcinoma in situ?
* Do not usually present with clinical findings.
* Principally detected on screening. mammogram [calcification] or incidental finding on a biopsy.
153
LCIS?
* Rate of progression uncertain, usually slow.
154
Which age groups are cysts common in?
* very common 40-50 yrs
* rare over 60s
155
what makes breast cysts more common?
HRT
156
how can cysts present?
* may be flat, smooth and fluctant or tense and painful
* freq multiple and bilateral
157
who do fibroadenomas commonly affect?
* Mobile discrete nodule most frequent in 15-30 yrs.
158
Phylloides tumours?
* closely resemble fibroadenoma
* locally aggressive/borderline malignant
159
breast screening programme?
* over 50s
* recalled if abnormalities
* assessment clinic - history, clinical exam, biopsy and ultrasound
160
triple assessment?
* examination
* imaging - mammography and/or US
* sampling - core biopsy or fine needle aspiration cytology
161
presentation of breast cancer?
* lump
* inverted nipple or dimpling
* inflammation
* discharge - usually blood stained
162
others risks of BC?
* Age at menopause and menarche
* alcohol intake
* older mothers
* BRCA 1/2
* higher oestrogen levels
163
What does screening do?
* 3-yearly
* 2 view mammography
* detection of pre symptomatic disease in the well
164
types of surgery for BC?
* 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
how are lymph nodes staged?
* Lymph node staging by removing the sentinel node, axillary sampling or clearance for all invasive tumours.
166
which breast cancer patients will have radiotherapy?
* 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
endocrine therapy for breast tumours?
* Oestrogen receptor positive tumours need endocrine therapy
* HER2 positive tumours need trastuzumab for 12 months
168
if it's difficult to decide whether the cancer will benefit from chemo?
gene array test - oncotype Dx
169
To justify screening we need to satisfy the following conditions:
*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
benefits of breast screening ?
* less deaths from BC
* more conservative surgery
* improved breast awareness
* reassurance
171
disadvantages of breast screening?
* 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
aims of BC screening?
* to detect invasive cancers
* to persuade 70% of invited women to attend
* to reduce mortality from BC by 25% in the screened population
173
* microcalcifications due to ductal carcinoma in situ
174
Features of a BC lump?
- painless, hard, irregular, fixed
* may distort the breast and alter the shape/ contour
175
benign lumps?
* most lumps under 50 are benign - smooth mobile and often tender
176
nipple pain, redness, swelling w discharge?
* nipple pain redness and swelling w discharge is caused by periductal masitis
* related to smoking
177
imaging for women under 35?
ultrasound
178
imaging for women over 40?
mammography
179
imaging for where the breast is dense?
* MRI where the breast is dense or an oncogene is suspected
180
breast screening detects many cases of?
DCIS
181
Advantages and disadvantages of breast screening?
182
Latissimus Dorsi Myocutaneous Flap Reconstruction ?
* 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
TRAM/DIEP Flaps ?
* Uses anterior abdominal wall tissue
* Transverse Rectus Abdominis Myocutaneous Flap (taking rectus muscle)
* Deep Inferior Epigastric Perforator Flap (no muscle taken)
184
- of TRAM/ DIEP flaps?
* higher risk of flap loss and wound morbidity
* variable reaction to radiotherapy
* patient gets a 'tummy tuck'
185
lipomodelling?
* 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
breast conserving surgery: indications ?
* 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
cancer is the ? most common cause of death
2nd
188
oncogenes vs TSGs?
* oncogenes normally act in a cell to promote cell /
* TSG normally act to downregulate cell growth and promote differentiation or programmed cell death
189
hyperplasia?
too much reproduction of cells - can be a normal reaction e.g. to hormonal stimuli or tissue damage
190
dysplasia?
excessive proliferation of cells which appear abn in size, shape and organisation
191
cancer in situ?
cells carry features of malignancy w/o penetrating basement membrane. Will usually develop into invasive cancer w time.
192
invasive cancer?
penetrates the BM
193
types of cancer?
- carcinomas
- sarcomas
- leukemias/ lymphomas
194
carcinomas?
- 85%
- from epithelium which lines or covers organs.
195
sarcomas?
- 6%
- arise from connective tissues eg muscle, bone and fatty tissue.
196
leukemias/ lymphomas?
- 5%
- occur in the bone marrow / lymphatic system.
197
causes of cancer - environment/ lifestyle?
198
causes of cancer - infection?
199
causes of cancer - inherited?
200
cancer presentation
201
tumours that rarely metastasise?
* brain tumours
* BCC, mesothelioma
* larynx
202
tumours that commonly metastasise?
* lung, breast
* prostate, colon
203
lung cancer commonly spreads to?
adrenals, and skin
204
205
radiological Ix of cancer?
* Plain X-ray
* Contrast studies
* CT scan – cross sectional info
* MRI – anatomical / pathological info
* PET – functional info
* Bone scan – useful for bone mets
206
haematological investigations of cancer?
* FBC
* bone marrow
* myeloma proteins
* changes often non spec in common solid tumours
207
biochemical Ix of cancer?
* liver enzymes
* serum calcium
* proteins, electrolytes
* tumour markers - PSA, CEA, CA125, HCG
208
2 types of breast pain?
* cyclical - related to MC
* non-cyclical
209
cysts features?
* 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
cysts are rare over?
60
211
212
features of a malignant lump?
* 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
how to examine the axilla?
with the arm down, fingers would point up the armpit
214
benefits of BC mammography in BC screening?
* promotes early identification of treatable cancers
* reduces mortality rate
* increases choice of Tx options
215
risks of mammography?
* some cancers r missed
* some identified cancers are not curable
* false positives
* overdiagnosis may lead to unecessary treatment
216
operable primary BC tX?
* surgery will usually be the first treatment
* neoadjuvant endocrine surgery in post menopaisal women w ER positive breast cancers
217
locally advanced primary breast cancer?
* core biopsy and staging investigations
218
metastatic BC tx?
* Following symptomatic presentation of distant mets, aim of treatment is to palliate symptoms and maintain QOL
219
US in breast screening?
- 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
what can cause lymphoedema?
* From surgery to LN, radiotherapy or tumour obstruction of LN areas
221
Mx of lymphedema?
* management is decongestive lymphatic therapy - compression bandaging, skin care and decongestive lymphatic therapy
* MLD - manual lymph drainage - light massages
222
surgery for lymphoedema?
* surgery - complex decongestive therapy - liposuction, debulking operations and bypass procedure
223
FHx in breast cancer risk?
* 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
prevention of BC in high risk women?
- mastectomy
- meds
225
Medications used for BC prevention?
* tamoxifen - can be used for pre and post menopausal women
* anastrazole - aromatase inhibitor - post-menopausal women
* raloxifene - post menopausal women
226
BRCA-1?
mutation on chromosome 17 - breast and ovarian cancer
227
BRCA-2?
chromosome 13 mutation. More of a risk factor in BC in men
228
BRCA-2 mutation is also associated with which types of cancer?
pertioneal, endometrial, fallopian, pancreatic and prostate cancer
229
Features of BC reflecting metastatic spread?
The bone (bone pain), liver (malaise, jaundice), lungs (shortness of breath, cough) and brain (confusion, seizures)
230
ductal carcinomas in situ?
* non-invasive malignancies that may progress to invasive malignancy
* comedi DCIS is a high grade type that has an increased risk of malignancy
231
invasive ductal carcinoma?
* comprises 70-80% of invasive breast cancer
232
LCIS?
* a.k.a as lobular neoplasia
* tends to be incidentally found on biopsy
233
ILC - invasive lobular carcinoma?
* 2nd most common invasive breast caNcer
* relationship w post-meno hormone therapy
234
changes to the breast skin associated w malignancy?
* Change to normal appearance
* Skin tethering
* Oedema
* Peau d’orange
235
nipple changes associated w malignancy
* Inversion
* Discharge, especially if bloody
* Dilated veins
236
fiberoadenomas affect?
Common in women under the age of 30 years
237
Fiberoadenomas features?
Often described as 'breast mice' due as they are discrete, non-tender, highly mobile lumps
238
Fibroadenosis (fibrocystic disease, benign mammary dysplasia) affects
Most common in middle-aged women
239
Who does fibroadenosis affect?
- Lumpy' breasts which may be painful.
- Symptoms may worsen prior to menstruation
240
breast cancer features?
Characteristically a hard, irregular lump. There may be associated nipple inversion or skin tethering
241
Paget's disease of the breast?
intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the nipple/areola
242
Mammary duct ectasia?
- Dilatation of the large breast ducts
- Most common around the menopause
243
How does mamary duct ectasia present?
- 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
Duct papilloma presentation?
- Local areas of epithelial proliferation in large mammary ducts
- Hyperplastic lesions rather than malignant or premalignant
- May present with blood stained discharge
245
Fat necrosis is most common in?
- More common in obese women with large breasts
- May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is
246
How does fat
necorosis present?
- 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
Breast abcess?
- More common in lactating women
- Red, hot tender swelling
