Breast Flashcards
What three aspects make up a triple assessment?
History + examination (P1-5)
Imaging (M/U 1-5)
Biopsy and histology (usually 3 cores) (B1-5)
What are risk factors for breast cancer?
Increasing age BRCA gene Early menarche or late menopause Nulliparous / later age of first pregnancy Obesity Smoking and alcohol consumption Use of HRT Not breastfeeding
What is the most common cause of clear nipple discharge?
Mammary duct ectasia
What are the two views of mammography used in triple assessment?
Oblique
Craniocaudal
What is the most common type of breast cancer?
Invasive ductal carcinoma
What treatment can be used in HER2 positive cancers?
Herceptin / trastuzumab
Which biomarker outcome has the worst prognosis in breast cancer?
Triple negative
How are lymph nodes assessed?
USS
- if all look normal, sentinel node biopsy in theatre
- if any look suspicious on USS, fine needle biopsy
- If either biopsy is positive, axillary node dissection/clearance indicated
What tool can be used to predict outcomes with different breast cancer treatments?
PREDICT tool
Helps look at benefits of different management plans e.g. addition of chemotherapy to a regimen
What are the indications for breast-conserving surgery?
T1 or T2 tumours <4cm in diameter
N0/N1/M0 cancers
Singular lesion
Patient preference
What are the indications for mastectomy?
BRCA mutation Large tumours (esp in small breasts) Multiple lesions Inflammatory breast cancer People who have had previous cancer/radiotherapy Local recurrence post-lumpectomy
What are the complications of lymph node clearance?
Lymphoedema Wound infection Pneumonitis Nerve damage: most commonly intercostobrachial nerve but can affect brachial plexus Frozen shoulder
What systemic therapy can be given in ER+ve cancers?
If premenopausal: tamoxifen for 2-5 years
- > partial oestrogen agonist but antagonist in breast cancer
- > ^ risk endometrial cancer
- > teratogenic so birth control needed for duration + 2 months
- > SE: menopausal symptoms, DVT, dysfunctional uterine bleeding
If postmenopausal: letrozole/anastrozole
- > aromatase inhibitor, prevents oestrogen synthesis
- > Increases risk fractures, osteoporosis
- > Causes menopause if pre-menopausal
- > Can be given as extended adjuvant therapy AFTER tamoxifen
In pre-menopausal women, zoladex (LRHR agent) injections can be used to temporarily deactivate the ovaries so that letrozole can be given.
Which type of breast cancer is most likely to metastasise to the brain?
HER 2+ve
Trastuzumab cannot cross the BBB
How is Herceptin/trastuzumab given?
SC or IV weekly or every 3 weeks
What treatment should all patients having breast-conserving surgery have?
Radiotherapy
3-5 week regime
Where are the most common sites of breast cancer metastasis?
Breast
Bone
Liver
Lung
How is inflammatory breast cancer usually managed?
- Chemotherapy
- Hormone therapy if receptor positive
- Surgery- total mastectomy WITHOUT immediate reconstruction
- Radiotherapy
Who is invited to breast cancer screening?
All women aged 47-73
-> mammogram every 3 years
High risk women can be invited from a younger age
What are the limitations of breast cancer screening?
- > missing a lesion / lesion arising between screens
- > uncomfortable
- > small radiation dose
- > Identifying a cancer that may never have caused a problem
- > Can get false positive results / artefact
How are calcifications investigated?
Mammogram identifies
Steotactic core biopsy + sample x-ray to ensure calcification detected
What is the follow-up for patients after a breast cancer?
Annual mammograms + clinic appointments for next 5 years
Which bacterium is most commonly responsible for lactational mastitis?
Staphylococcus aureus
What is the cause of lactational mastitis?
Milk stasis in the ducts
Can lead to the formation of a breast abscess
What are the symptoms of mastitis?
Extremely tender, warm breast
Redness - usually wedge-distribution
Breast pain
Fever
When would you suspect a breast abscess rather than mastitis?
No improvement after milk removal and oral antibiotics
Feel burning pain
More severe systemic symptoms
Extreme tenderness
How is mastitis managed?
Encourage to continue breastfeeding and if baby not feeding then express milk (or if baby not completely emptying, then express remainder)
Paracetamol/ibuprofen for pain
Warm compress and baths to help with blood flow
Oral flucloxacillin
How are breast abscesses managed?
Referral to surgeons for incision and drainage
Oral antibiotics - flucloxacillin likely
What are the features of cyclical breast pain?
Tend to occur in luteal phase of the cycle (week before the period)
Pain usually subsides when period starts
Usually stops after menopause but can occur in those on HRT
May also be associated with the starting/changing of hormonal contraception
What is the management for non-malignant breast pain?
Comfortable bras Lower fat, higher fibre diet Relaxation therapies Paracetamol and ibuprofen for pain Evening primrose oil Changing contraception
What are the features of fibroadenoma on examination?
Smooth, round, ovoid mass
Mobile
No tethering to overlying skin
Usually painless but may be tender, especially before a period
What are the features of fibroadenoma on ultrasound?
Well-defined margin, round mass Macrolobulated Uniform hypoechogenicity May have a thin echogenic rim -> may do biopsy to confirm diagnosis
In which population are breast cysts common?
> 50s, post-menopausal women
What are the features of breast cysts on ultrasound scan?
Acoustic enhancement
Dark inside due to being fluid-filled
What is the inheritance pattern of BRCA mutations?
Autosomal dominant
