Breast Flashcards
What are risk factors for breast cancer?
Increased oestrogen (e.g. early menarche, late menopause, combined HRT)
Obesity
Smoking
Family history
COCP has a small increase
What are the three breast cancer receptors?
Oestrogen receptor (ER)
Progesterone receptor (PR)
Human epidermal growth factor (HER2)
What are the two types of non invasive breast cancers?
Ductal carcinoma in situ
Lobular carcinoma in situ
Which non invasive breast cancer is most likely to progress to invasive breast cancer?
Lobular carcinoma in situ
What is the most common invasive breast cancer?
Invasive ductal carcinoma
Which invasive cancer is best seen on mammogram?
Invasive ductal carcinoma
What are the three types of invasive breast cancer?
Invasive ductal carcinoma
Invasive lobular carcinoma
Inflammatory breast cancer
Which marker is raised in inflammatory breast cancer?
CA15-3
Who is offered breast cancer screening?
Women aged between 50 and 70 are offered a mammogram every 3 years
How does breast cancer present?
Hard, painless lump which is tethered to the skin/chest wall
Nipple retraction
Skin dimpling
Lymphadenopathy
Peeling of the skin
What is the 2WW criteria for breast cancer?
Unexplained breast lump >30 years !!!
Unilateral nipple changes >50 years
What is the triple diagnostic assessment for breast cancer?
Clinical assessment
Imaging (ultrasound if <35 or mammogram if >35)
Biopsy - either fine needle or excision
Who gets an ultrasound instead of a mammogram?
Women under 35 years
What else needs to be checked if a woman is diagnosed with breast cancer? How does this affect management?
Need to palpate the axillary lymph nodes
If they are palpable - axillary node clearance is required (radiotherapy)
If they are not palpable - do a pre-op axillary ultrasound to see if a sentinel node biopsy is needed
What are indications for a total mastectomy for breast cancer?
Multifocal tumour
Central tumour
Large lesion in small brast
DCIS > 4cm
When can a local excision be conducted in breast cancer?
Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm
What are options for hormonal therapy for oestrogen receptor positive breast cancer?
In pre-menopausal women - Tamoxifen
In post-menopausal women - Aromatase inhibitors (can cause osteoporosis) e.g. Anastrozole
Which medication can be used in breast cancer if the HER2 receptor is positive?
Herceptin (Trastuzumab)
What is a complication of axillary lymph node removal?
Chronic lymphedema
Areas of lymphedema = prone to infection
What are adverse effects of Tamoxifen?
Increased risk of VTE
Increased risk of endometrial cancer
Menopausal symptoms
What is Paget’s disease of the nipple?
Eczematoid changes of the nipple - start at the nipple and expand to the areola
Associated with underlying breast malignancy
Diagnosis = Punch biopsy
What is fibroadenoma?
Benign breast lump
Small and mobile
Painless
Smooth
Welll-circumscribed
Highly mobile - called a Breast mice
When should a fibroadenoma be removed?
If larger than 3cm
Woman with general lumpiness to her breast worse prior to her period - what is the diagnosis?
Fibroadenosis / fibrocystic breast changes
How does a breast cyst present?
Soft, fluctuant swelling
How is a breast cyst seen on a mammogram?
Halo appearance
How does fat necrosis present?
Lump caused by localised degeneration/scarring
Painless, firm and irregular lump
Need to rule out cancer with biopsy
What is duct ectasia and how does it present?
Dilation of the large ducts in the breast
Nipple discharge (creamy/cheesy/green)
Tenderness and pain
Nipple retraction
What is seen on mammogram in duct ectasia?
Microcalcifications
What is the most common cause of mastitis?
Breastfeeding
If it gets infected can be caused by staph aureus
How does mastitis present?
Breast pain and tenderness
Erythema
Local warmth/inflammation
Nipple discharge
Fever
How is mastitis managed?
Continue breastfeeding
If symptoms do not improve after 24/48 hrs - can try Flucloxacillin
If clearly infective e.g. discharge - go straight to Flucloxacillin
How is nipple candida treated?
Topical miconazole
Baby may need miconazole gel for mouth
What is an intraductal papilloma? How does it present? How is it investigated and treated?
Warty lesion that grows within one of the ducts
Nipple discharge - may be blood stained
May be tenderness/pain
Triple assessment is required
Treated with excision
What are causes of gynaecomastia?
Prolactinaemia Antipsychotic medication Idiopathic Can be physiological in adolescents Raised oestrogen - obesity, leydig cell testicular cancer, hyperthyroidism, hCG secreting tumour Low testosterone Spronolactone
How can you differentiate between a fibroadenoma and a breast cyst?
Breast cyst is usually soft
Breast cyst often has surrounding pain
How is a breast abscess treated?
Incision and drainage
If a breast cancer lump is fixed to the deep tissue, what does this mean?
It is invasive
What is the main side effect of Herceptin?
Can cause cardiotoxicity leading to Heart failure symptoms.
Need to do an echo prior to starting
How does a non invasive vs. invasive breast cancer feel different on clinical examination?
Invasive will be fixed to the muscle
Non-invasive cannot be fixed to the muscle
Which breast condition is associated with green/cheesy discharge?
Mammary duct ectasia
Which breast conditions present with a lump which is attached to the skin
Either an invasive breast cancer or fat necrosis
Which breast condition presents with a highly mobile breast lump?
Fibroadenoma
Which breast condition presents with blood stained discharge?
Duct papilloma
Which breast condition presents following trauma?
Fat necrosis
Which breast condition presents with an extremely fast growing breast lump?
Phyllodes tumour
How can you differentiate between a fibroadenoma and a lipoma?
Fibroadenoma = firm, very mobile Lipoma= soft
How can you differentiate between breast eczema and Paget’s disease?
If it primarily affects the nipple = Paget’s
if it primary affects the areola = eczema
When to do core biopsy vs. fine needle aspiration?
Large / hard = Core biopsy
Cystic = fine needle aspiration
Someone over 30 has a breast lump which appears to be benign - what do you do?
2WW referral
What is the main CI to Herceptin?
Heart disorders - need to do an echo prior to starting
What is the main adverse effect of Anastrozole?
Osteoporosis
Who needs chemotherapy for breast cancer?
Either before surgery to shrink size of cancer
Or after surgery if there is found to be axillary node disease
Who needs radiotherapy for breast cancer?
Whole breast radiotherapy is recommended to all women who have had a wide local excision
it is also recommended to women who have had a mastectomy if T3-T4 tumours and for those with four or more positive axillary nodes
What needs to be checked prior to surgery? What do you do based on this?
Need to check if the axillary lymph nodes are palpable
If yes –> Axillary node clearance indicated
If no –> Pre-op axillary ultrasound. If ultrasound is positive need to do a sentinel node biopsy
What is the main complication of axillary node clearance?
Lymphoedema leading to functional arm impairment
