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Finals Revision > Breast > Flashcards

Breast Flashcards

1
Q

What three aspects make up a triple assessment?

A

History + examination (P1-5)
Imaging (M/U 1-5)
Biopsy and histology (usually 3 cores) (B1-5)

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2
Q

What are risk factors for breast cancer?

A 
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
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3
Q

What is the most common cause of clear nipple discharge?

A

Mammary duct ectasia

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4
Q

What are the two views of mammography used in triple assessment?

A

Oblique

Craniocaudal

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5
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

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6
Q

What treatment can be used in HER2 positive cancers?

A

Herceptin / trastuzumab

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7
Q

Which biomarker outcome has the worst prognosis in breast cancer?

A

Triple negative

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8
Q

How are lymph nodes assessed?

A

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
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9
Q

What tool can be used to predict outcomes with different breast cancer treatments?

A

PREDICT tool

Helps look at benefits of different management plans e.g. addition of chemotherapy to a regimen

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10
Q

What are the indications for breast-conserving surgery?

A

T1 or T2 tumours <4cm in diameter
N0/N1/M0 cancers
Singular lesion
Patient preference

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11
Q

What are the indications for mastectomy?

A 
BRCA mutation
Large tumours (esp in small breasts)
Multiple lesions
Inflammatory breast cancer
People who have had previous cancer/radiotherapy
Local recurrence post-lumpectomy
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12
Q

What are the complications of lymph node clearance?

A 
Lymphoedema
Wound infection
Pneumonitis
Nerve damage: most commonly intercostobrachial nerve but can affect brachial plexus
Frozen shoulder
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13
Q

What systemic therapy can be given in ER+ve cancers?

A

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.

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14
Q

Which type of breast cancer is most likely to metastasise to the brain?

A

HER 2+ve

Trastuzumab cannot cross the BBB

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15
Q

How is Herceptin/trastuzumab given?

A

SC or IV weekly or every 3 weeks

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16
Q

What treatment should all patients having breast-conserving surgery have?

A

Radiotherapy

3-5 week regime

17
Q

Where are the most common sites of breast cancer metastasis?

A

Breast
Bone
Liver
Lung

18
Q

How is inflammatory breast cancer usually managed?

A
  1. Chemotherapy
  2. Hormone therapy if receptor positive
  3. Surgery- total mastectomy WITHOUT immediate reconstruction
  4. Radiotherapy
19
Q

Who is invited to breast cancer screening?

A

All women aged 47-73
-> mammogram every 3 years

High risk women can be invited from a younger age

20
Q

What are the limitations of breast cancer screening?

A
  • > 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
21
Q

How are calcifications investigated?

A

Mammogram identifies

Steotactic core biopsy + sample x-ray to ensure calcification detected

22
Q

What is the follow-up for patients after a breast cancer?

A

Annual mammograms + clinic appointments for next 5 years

23
Q

Which bacterium is most commonly responsible for lactational mastitis?

A

Staphylococcus aureus

24
Q

What is the cause of lactational mastitis?

A

Milk stasis in the ducts

Can lead to the formation of a breast abscess

25
Q

What are the symptoms of mastitis?

A

Extremely tender, warm breast
Redness - usually wedge-distribution
Breast pain
Fever

26
Q

When would you suspect a breast abscess rather than mastitis?

A

No improvement after milk removal and oral antibiotics
Feel burning pain
More severe systemic symptoms
Extreme tenderness

27
Q

How is mastitis managed?

A

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

28
Q

How are breast abscesses managed?

A

Referral to surgeons for incision and drainage

Oral antibiotics - flucloxacillin likely

29
Q

What are the features of cyclical breast pain?

A

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

30
Q

What is the management for non-malignant breast pain?

A 
Comfortable bras
Lower fat, higher fibre diet
Relaxation therapies
Paracetamol and ibuprofen for pain
Evening primrose oil
Changing contraception
31
Q

What are the features of fibroadenoma on examination?

A

Smooth, round, ovoid mass
Mobile
No tethering to overlying skin
Usually painless but may be tender, especially before a period

32
Q

What are the features of fibroadenoma on ultrasound?

A 
Well-defined margin, round mass
Macrolobulated
Uniform hypoechogenicity 
May have a thin echogenic rim 
-> may do biopsy to confirm diagnosis
33
Q

In which population are breast cysts common?

A

> 50s, post-menopausal women

34
Q

What are the features of breast cysts on ultrasound scan?

A

Acoustic enhancement

Dark inside due to being fluid-filled

35
Q

What is the inheritance pattern of BRCA mutations?

A

Autosomal dominant

Finals Revision (23 decks)

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