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BREAST Flashcards

1
Q

In a history what do you ask for about the presence of lump and charcatersitics?

A
  1. Site
  2. Size
  3. Duration
  4. Onset
  5. Change in symptoms
  6. Pain
  7. Skin changes
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2
Q

What questions about nipples do you ask in a history?

A
  1. Discharge: amount, colour, consistency
  2. Bleeding
  3. . Inversion
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3
Q

What associated symptoms do you ask about in a breast history?

A
  1. Relationship to LMP + Sx
  2. Pain
  3. Skin changes
  4. FLAWS
  5. Back pain or breathlessness
  6. . Any other lumps or gland swelling
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4
Q

What are breast cysts?

A

‘lumpy’ breasts associated with pain and tenderness that fluctuate with the menstrual cycle

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5
Q

What are risk factors for breast cysts?

A
  1. obesity
  2. nulliparity
  3. oestrogen replacement therapy
  4. late-onset menopause
  5. later age at first childbirth
  6. Age 30-50 years
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6
Q

What are symptoms of breast cysts?

A
  1. Mastalgia: Pain may be cyclical or non-cyclical
    diffuse and bilateral but may be localised to an area of the breast often associated with a ruptured cyst
  2. Diffuse symmetrical lumpiness through both breasts
  3. Nipple discharge
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7
Q

What are some differential diagnosis for breast cysts?

A 
Chest wall pain
Costochondritis
Fibroadenoma
Breast cancer
Intracystic papilloma
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8
Q

What are complications of breast cysts?

A

LT Breast cancer

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9
Q

What are the investigations for a breast cyst?

A
  1. Mammography
  2. Breast ultrasound
  3. Cyst aspiration (symptomatic)
  4. Biopsy (to exclude breast cancer or a high risk pathology) – if palpable solid mass or imaging studies
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10
Q

What is a positive finding on a mammogram for a breast cyst?

A

dense breasts, circumscribed density

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11
Q

What is an positive ultrasound finding for breast cysts?

A

Breast cysts, solid mass

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12
Q

What is a positive finding for a breast cyst in cysts aspiration?

A

straw-coloured, bloody fluid

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13
Q

What is a positive finding for a biopsy for a breast cyst?

A

apocrine metaplasia, fibrosis, cyst formation, and proliferative changes, atypical ductal hyperplasia

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14
Q

What is the management plan for a breast cyst?

A

Supportive measure (reassurance), analgesia and observation of nipple discharge

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15
Q

What is the prognosis for breast cysts?

A

can relapse

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16
Q

What is breast mastitis?

A

Breast inflammation

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17
Q

What is the common epidemiology of someone with breast mastitis?

A
  1. 15-45 y/o
  2. Especially those who are breast-feeding (6-8 weeks/weaning)
  3. > 30y/o smokers are also at risk
  4. Staphylococcus aureus = most common pathogen
    • Can enter through cracked skin e.g nipple
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18
Q

What are the symptoms of breast mastitis?

A
  1. generalized swelling of breast, inflamed overlying skin – nipple may be cracked
  2. redness, firm
  3. very tender + uncomfortable, warm to touch
  4. Flu like symptoms: fever, aches,
    chills, generally unwell
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19
Q

How does non-lactational breast mastitis present?

A

present with
a history of previous infections with
less pronounced systemic upset

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20
Q

What are the complications of breast mastitis?

A
  1. Breast abscess = collection of pus in the breast tissue due to infection
  2. Mammary fistula
  3. Rarely overlying skin may undergo necrosis
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21
Q

What is the investigations for someone with breast mastitis?

A
  • Focused history
  • Physical exam: temp
  • Pregnancy test (if unexpected)
  • US of an erythematous breast area
  • Diagnostic needle aspiration drainage
  • cytology of nipple discharge or sample from FN aspiration
  • Milk aspirate, discharge or biopsy tissue for culture and sensitivity
  • histopathological examination of biopsy tissue
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22
Q

What is the management of a suspected breast abcess?

A
  • IV or oral Abx
  • US guided FNA
  • Therapeutic + diagnostic uses
  • FBC + blood cultures (if systemic infection)
  • Surgical incision + drainage
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23
Q

What is the management of breast mastitis?

A
  • If lactational: ENCOURAGE BREAST FEEDING
  • Analgesia
  • Abx sometimes required
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24
Q

What is the prognosis of breast mastitis?

A

•Untreated: breast abscess may discharge onto skin surface
•Non-lactational breast abscesses tend to re-occur
Mastitis recover in 2-3 dys

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25
Q

What is breast cancer?

A

malignancy of breast tissue

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26
Q

What is the most common type of breast cancer?

A

invasive ductal carcinoma

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27
Q

What are risk factors for breast cancer?

A
  • Age
  • FHx – 1st degree relative
  • Obesity
  • ↑ Oestrogen exposure
  • Early menarche (<11)
  • Late menopause (>55)
  • HRT/OCP
  • EtOH consumption
  • Fatty diet
  • Previous radiation to the chest
  • Nulliparity (not having any children)
  • Familial breast cancer – 5% of cases
  • BRCA1/2: harmful BRCA mutation 60-80% lifetime risk of developing Breast Ca
  • Associations with Ovarian and Pancreatic Ca
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28
Q

What are the site and skin changes in breast cancer?

A
  1. Increased size
  2. lump
  3. skin changes:
    - Armpit skin thickening
    - peau d’orange
    - skin dimpling
    - nipple discharge (sometimes bloody)
    - nipple inversion
    - eczematous-looking skin (Paget’s)
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29
Q

What is the consistency of the lump in breast cancer?

A
  1. hard lump
  2. irregular margins
  3. redness
  4. non-compressible
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30
Q

How tender is the lump in breast cancer?

A

generally painless, inflammatory breast Ca: painful, warm

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31
Q

How fixed is the lump in breast cancer?

A

tethered to underlying tissue, not free to move

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32
Q

What are the symptoms of metastases in bone cancer?

A
  1. bone pain
  2. shortness of breath
  3. rarely neurological symptoms
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33
Q

What is non-invasive breast cancer?

A

DCIS

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34
Q

What is invasive breast cancer?

A

infiltrative ductal carcinoma (75%), infiltrative lobular carcinoma,
Paget’s disease of the breast

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35
Q

What are the differentials for breast cancer?

A

Lung cancer
Osteosarcoma
Breast sarcoma
Brain cancer

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36
Q

What imaging is usually done for breast cancer?

A
  • > 35yrs: mammogram

* <35yrs: USS

37
Q

What biopsy is done for breast cancer?

A
  1. Fine needle aspiration
  2. Core needle biopsy
  3. Open (surgical) biopsy
38
Q

Where does breast cancer usually metastasise to?

A

liver, lung, bones

39
Q

What imaging is used for breast cancer?

A
  • CXR
  • Liver USS
  • CT (brain/chest)
  • Bone scan
40
Q

What bloods are ordered for breast cancer?

A

FBC, U+Es, calcium, bone profile, LFTs, ESR

41
Q

When do you have an urgent referral?

A

referral if >30 unexplained breast lump, >50 symtpoms or change to one nipple

42
Q

How do you evaluate a breast lump?

A
  • triple assessment (clinical examination, mammogram + US (m only if >35) and biopsy
    1. Hx and examination
    2. Imaging< <35=USS and >35 MMG
    3. Pathology: FNA and biopsy
43
Q

What are the surgical options for management of breast cancer?

A
  1. Total mastectomy
  2. Lumpectomy
  3. Sentinel LN biopsy or axillary LN clearance
44
Q

What are the medical treatments for breast cancer?

A
  1. ER antagonists e.g tamoxifen

2. Aromatase inhibitors e.g letrozole

45
Q

What are the other treatments for breast cancer?

A 
1. Chemotherapy
•	Neo-adjuvant or adjuvant
2. Monoclonal antibodies
3. Radiotherapy
•	Reduces risk of recurrence post-surgery
46
Q

What is the prognosis for breast cancer?

A

2 view mammogram every 3 years women 47-73

47
Q

What else may be present in Breast Cancer?

A

axillary lymphadenopathy

48
Q

What are different types of Breast Cancer?

A
  • begins as an in-situ carcinoma:
    1. Ductal carcinoma in situ (if left untreated turn to invasive ductal carcinoma)
    2. Lobular carcinoma in situ (LCIS) – doesn’t form into invasive
49
Q

What is the patho of breast cysts?

A
  1. obules fill with fluid
  2. Oestrogen causes fluid to be produced
  3. Post menopause leads to estrogen levels fall leads cysts usually stop forming
  4. HRT leads to cysts
50
Q

When are breast cyst unlikely to form?

A

after menopause unless of HRT

51
Q

Are there systemic signs in breast cyst?

52
Q

What are breast cysts associated with?

A
  1. Most common >35 yo
  2. Well circumscribed mass
  3. Sudden Enlargement
  4. Fluctuant
  5. No systemic signs / symptoms
53
Q

When is an USS and when is MMG done for breast cyst?

A
  • <40 yo : USS

* > 40 yo : USS + MMG

54
Q

What does USS show in breast cyst?

A

USS = fluid filled well circumscribed + disappears after aspiration

55
Q

How is a breast cyst managed if it is large and painful?

A
  1. USS guided aspiration

2. . If solid lesion seen after aspiration then Biopsy

56
Q

What are DDx for breast erythema and pain?

A
  1. Mastitis
  2. Breast Abscess
  3. Breast Cancer
57
Q

What are infectious causes of mastitis?

A
  1. Lactational (breast feeding)
  2. Duct ectasia
  3. Staphyloccocus aureus
58
Q

What are non-infectious causes of mastitis?

A
  1. Idiopathic granulomatous inflammation

2. Foreign body reaction

59
Q

What are key features of a breast abscess?

A
  1. Localised area of infection
  2. Walled off
  3. Pus
    May or may not be ass with Mastitis
60
Q

What is the key way to differentiate breast asbcess and mastisis

A

IN CAPSULE/LUMP and mastitis is more like diffuse redness

61
Q

What is the Mx of mastitis if lactational/non-severe

A
  1. Warm compress
  2. Analgesia
  3. Continue Breastfeeding
62
Q

What is the management of mastitis if non-lactational/serve

A
  1. Flucloxacillin (MRSA = Trimethoprim)

2. Analgesia

63
Q

What would make mastitis severe?

A

pus, not getting better with warm compress and if breast milk culture positive etc

64
Q

How is a breast abscess managed?

A
  1. Incision + Drainage + Culture
  2. IV / PO Abx (doxycycline)
  3. Analgesia
65
Q

What are 4 key types of BC and how common are they?

A
  1. Invasive Ductal Carcinoma (most common) goes beyond the ducts
  2. Invasive Lobular Carcinoma (2nd most common)
  3. Ductal Carcinoma-in-situ
  4. Lobular Carcinoma-in-situ
66
Q

What are Breast Cancer lumps like?

A

irregular/lumpy

67
Q

What is Paget’s disease of the Breast?

A
  1. Nipple or Areola
  2. Sign that there might be underlying Breast Ca
  3. Uncommon to have it w/out Breast Ca
  4. 90% cases = Invasive Breast Cancer
68
Q

What are Symptoms of Paget’s disease of nipple?

A
  1. Itching in burning in nipple and/or areola area
  2. Pain and sensitivity
  3. Flattening of nipple
  4. Only one breast affected
  5. Lump
  6. Yellow or bloody nipple discharge
69
Q

When is a 2WW referral necerssary?

A
  1. ≥ 30 yo + unexplained breast lump w/ or w/out pain
  2. ≥ 50 yo lump + any symptoms in one nipple:
    • Discharge
    • Retraction
    • Other changes of concern
70
Q

When should you consider a 2WW referral?

A
  1. Skin changes that suggest breast Ca

2. ≥ 30 yo + unexplained lump in axilla

71
Q

When should you do a non-2ww referral (non-urgent)?

A

≤ 30 yo unexplained breast lump with or without pain

72
Q

If it is an invasive cancer after doing triple assemsent what else needs to be checked?

A

receptor status

73
Q

What receptors are checked?

A
  1. ER (oestrogen receptor)
  2. PR (progesterone receptor)
  3. HER2
74
Q

How is management of BC organised?

A
  1. Lymph nodes
  2. Surgery / radiotherapy
  3. Receptors
75
Q

How do you manage if there is clinical axillary lymphadenopathy?

A

axillary lymph node clearance

76
Q

How do you manage is there is no clinical axillary lymphadenopathy?

A
  1. USS + SLNB

2. +/- Axillary lymph node clearance

77
Q

What is an SLNB?

A

-Sentinel Lymph node biopsy
(hypothetical first group of lymph nodes draining a cancer)
-If positive take them out

78
Q

Why are axillary lymph nodes important?

A

drain 75% of lymph from breasts

79
Q

When is a masectomy done?

A
  1. Mutifocal tumour
  2. Central
  3. Large lesion in small breast
  4. DCIS>4ccm
  5. Pt choce
80
Q

When is a wide local excision done?

A
  1. Solitary lesion
  2. Peripheral
  3. Small lesion in last breast
  4. DCIS<4cm
  5. Pt choice
81
Q

When is radiotherapy done after masectomy?

A

if T3/4 or >4 +ve LN

82
Q

What is always done after wide local excision?

A

radiotherapy

83
Q

What chemo can be given in BC?

A
  • Neoadjuvant (to shrink tumor before surgery

* Adjuvant (alongside)

84
Q

If the cancer is ER+ve and patient is pre or peri menopausal what medication is given?

A

Tamoxifen
(Selective Oestrogen Receptor Modulator)
Hormonal Therapy

85
Q

If the cancer if ER +VE and the patient is post-menopausal what medication is given?

A
  1. Anastrazole
  2. Letrozole
    (aromatase inhibitor)
    Biological Therapy
86
Q

If the cancer is HER2+ve what medication is given?

A
  1. Trastuzumab
  2. (Herceptin)
    Biological Therapy
87
Q

Who is screening given to?

A 
-Registered with GP
Who:
1.	Women
2.	Trans mes
3.	Trans women
4.	Non-binary
88
Q

When is screening given?

A
  1. 50-70yo
  2. Every 3 years
    (mammogram)

Z Year3 Conditions (13 decks)

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