Breast Flashcards
What happens in duct ectasia
dilatation of large breast ducts
common around menopause (as ducts shorten and dilate), accumulating green / yellow fluid
may cause slit like retraction of the nipple
S/S of duct ectasia
tender lump near arola
green / yellow multiduct nipple discharge
management of duct ectasia
generally conservative
if troublesome, consider total / partial duct excision
presentations of nipple discharge and what condition they suggest
green nipple discharge > duct ectasia in smoker
yellow nipple discharge > duct ectasia in PM women
milky, multi duct > prolactinoma
Cancer, DICS, papilloma > blood stained
what happens in fat necrosis
common in obese women with large breasts
after trauma
how does fat necrosis present
firm, round, hard irregular lump
what is acute mastitis
infection of the breast usuallly caused by staph aureus
affects 1 in 10 breastfeeding women
associated with NIPPLE INJURY and SMOKING
what are S/S of acute mastitis
coryzal symptoms
nipple dischaarge
red tender breast - with cellulitis and generalised soreness
CONSIDER POSSIBILITY OF ABSCESS
risk factors for mastitis/ abscess
smoker
breastfeeding
diabetic
how do you manage acute mastitis
non-severe / lactational:
- simple analgesia
- warm complress
- continue breastfeeding
severe / non-lactational:
- fluclox 500mg QDS 10 days
how does a breast abscewss present
discrete hot red lump
walled off collection of ppus
how do you manage a breast abscess
US diagnostic - confirms walled off collection of pus
Then: US guided aspiration + antibiotics + review in 24-48h
If necrotic abscess / skin necrosis: incision and drainage + fluid culture
what is a fibroadenoma
“breast mouse” (discrete, non tender, mobile)
who is fibroadenoma common in
common in women <30 years old
what is mx of fibroadenoma
<4cm: conservative (will shrink)
>4cm, surgical excision
how do you investigate a fibroadenoma
US and biopsy
how does fibrocystic change / fibroadenosis present
lumpy breast
may be painful
bilatral
changes with menstruation
in middle aged women
how do you manage fibrocystic change
conservative
who do intraductive papillomas affect
40-60yo
local areas of epithelial proliferation in large mammary ducts
how doe intraductal papillomas presend
blood-stained discharge
what is a phylloides tymour
most benigh, few very aggressive
enlarging mass in women >50
intraductal papilloma mx
duct excision
how does breast cancer present
POST MENOPAUSAL WOMAN
fixed mass
skin tethering, dimpling
palpable LN in axilla
what are RF for breast cancer
genetics (BRCA genes, p53 mutation)
FH: 1st degree relative pre-menopausal breast cancer
oestrogen exposure (nulliparity, 1st preg >30yo, early menarche, late menopause, COCP, combined HRT)
past breast cancer
not breastfeeding
radiation
obesity
what are protective factors for BC
multiparity
breastfeeding
oral contraceptives (controversial)
how does breast cancer present externally on the nipple
Paget’s disease of the nipple
- eczematous change
- pruritic
what screening is done for breast cancer
50-71 years old
every 3 years
mammogram
when do you do urgent 2ww referral for bc
>30, unexplained breast lump with / without pain
>50 if single nipple discharge or retraction
what assessment do you do for BC
triple assessment
- hx and exam
- imaging (USS<40, mammography >40)
- pathology (FNA, core biopsy)
what other info does histology tell you about breast cancer?
Receptor status
- Oestrogen receptor
- Progesterone receptor
- HER2 receptor
what are the two most common types of breast cancer
Invassive ductal carcinoma (most common)
invasive lobular carcinoma (second most common)
What additional Ix do you need to do for breast cancer patients? what does this mean for future ix
USS axilla
if normal - sentinel node biopsy
if abnormal - axillary node clearance of ALL LYMPH NODES
what further investigation is needed in woman <40 with breast cancer after she’s had triple test, US etc
CALL BACK for mammography and MRI
what lymph system do breast cancers drain to
75%: lateral axillary nodes
25%: parasternal nodes or opposite breast
How do you manage BC surgically
MASTECTOMY vs WIDE LOCAL EXCISION
overall, this should be up to patient choice
Mastectomy:
- muttifocal / central tumour
- large lesion in small breast !
WLE:
- solitary, peripheral tumour
- small lesion in large breast!
What othher therapies are available for breast cancer tx
Radiotherapy
Hormone therapy
Chemo
When is radiotherapy recommended
after WLE
after mastectomy in >4xm, +ve LN
when can you do hormone therapy in breast cancer
ONLY if ESTROGEN receptor +ve
wat is prognostic index for chemo
nottinghham prognostic inded
When MUST you refer for 2ww pathway
>30 with unexplained breast lump
>50 with nipple discharge, retraction or other changes (think PAGET’S)
When can you give Hormone therapy in beast cancer=
If ER +ve ONLY
What hormone therapies can you give depending on age
Pre/perimenopausal: tamoxifen (SERM)
post-menopausal: anastrozole/letrozole (aromatase inhibiitiors)
side effects of tamoxifen
amenorrhoea
endometrial cancer
PV bleed
VTE
side effects of anastrozle /letrozole and why
OSTEOPOROSIS
because they are aromatase inhibitorrs, so they reduce oestrogen synthesis, causing osteoporosis
when can you give BIOLOGICAL therapy
if HER2 positive
when do you give chemotherapy for breast cancer
if LN involved of Triple neg / HER2+ve
why can you give NEOadjuvant chemo (i.e. before surgery)
to shrink tumour size before surgery /(this may allow to do WLE rather than mastectomy)
which condition causes blood stained discharge without a palpable mass?
intraductal papilloma! it is essentially just some local epithelal proliferation
cx of axillary node clearance
lymphoedema
functional arm impairment
what is inflammatory breast cancer
type of IDC (Invasive Ductal Carcinoma)
cancerous cells block the lymph drainage, causing an inflamed appearance of the breast
what does inflammatory breast cancer look like
SWOLLEN AND RED BREAST
but inflammatory markers are normal
