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Medicine Finals > Breast > Flashcards

Breast Flashcards

1
Q

What are risk factors for breast cancer?

A

Increased oestrogen (e.g. early menarche, late menopause, combined HRT)

Obesity

Smoking

Family history

COCP has a small increase

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2
Q

What are the three breast cancer receptors?

A

Oestrogen receptor (ER)

Progesterone receptor (PR)

Human epidermal growth factor (HER2)

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3
Q

What are the two types of non invasive breast cancers?

A

Ductal carcinoma in situ

Lobular carcinoma in situ

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4
Q

Which non invasive breast cancer is most likely to progress to invasive breast cancer?

A

Lobular carcinoma in situ

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5
Q

What is the most common invasive breast cancer?

A

Invasive ductal carcinoma

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6
Q

Which invasive cancer is best seen on mammogram?

A

Invasive ductal carcinoma

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7
Q

What are the three types of invasive breast cancer?

A

Invasive ductal carcinoma

Invasive lobular carcinoma

Inflammatory breast cancer

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8
Q

Which marker is raised in inflammatory breast cancer?

A

CA15-3

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9
Q

Who is offered breast cancer screening?

A

Women aged between 50 and 70 are offered a mammogram every 3 years

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10
Q

How does breast cancer present?

A

Hard, painless lump which is tethered to the skin/chest wall

Nipple retraction

Skin dimpling

Lymphadenopathy

Peeling of the skin

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11
Q

What is the 2WW criteria for breast cancer?

A

Unexplained breast lump >30 years !!!

Unilateral nipple changes >50 years

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12
Q

What is the triple diagnostic assessment for breast cancer?

A

Clinical assessment

Imaging (ultrasound if <35 or mammogram if >35)

Biopsy - either fine needle or excision

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13
Q

Who gets an ultrasound instead of a mammogram?

A

Women under 35 years

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14
Q

What else needs to be checked if a woman is diagnosed with breast cancer? How does this affect management?

A

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

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15
Q

What are indications for a total mastectomy for breast cancer?

A

Multifocal tumour

Central tumour

Large lesion in small brast

DCIS > 4cm

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16
Q

When can a local excision be conducted in breast cancer?

A

Solitary lesion

Peripheral tumour

Small lesion in large breast

DCIS < 4cm

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17
Q

What are options for hormonal therapy for oestrogen receptor positive breast cancer?

A

In pre-menopausal women - Tamoxifen

In post-menopausal women - Aromatase inhibitors (can cause osteoporosis) e.g. Anastrozole

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18
Q

Which medication can be used in breast cancer if the HER2 receptor is positive?

A

Herceptin (Trastuzumab)

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19
Q

What is a complication of axillary lymph node removal?

A

Chronic lymphedema

Areas of lymphedema = prone to infection

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20
Q

What are adverse effects of Tamoxifen?

A

Increased risk of VTE

Increased risk of endometrial cancer

Menopausal symptoms

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21
Q

What is Paget’s disease of the nipple?

A

Eczematoid changes of the nipple - start at the nipple and expand to the areola

Associated with underlying breast malignancy

Diagnosis = Punch biopsy

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22
Q

What is fibroadenoma?

A

Benign breast lump

Small and mobile

Painless

Smooth

Welll-circumscribed

Highly mobile - called a Breast mice

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23
Q

When should a fibroadenoma be removed?

A

If larger than 3cm

24
Q

Woman with general lumpiness to her breast worse prior to her period - what is the diagnosis?

A

Fibroadenosis / fibrocystic breast changes

25
Q

How does a breast cyst present?

A

Soft, fluctuant swelling

26
Q

How is a breast cyst seen on a mammogram?

A

Halo appearance

27
Q

How does fat necrosis present?

A

Lump caused by localised degeneration/scarring

Painless, firm and irregular lump

Need to rule out cancer with biopsy

28
Q

What is duct ectasia and how does it present?

A

Dilation of the large ducts in the breast

Nipple discharge (creamy/cheesy/green)

Tenderness and pain

Nipple retraction

29
Q

What is seen on mammogram in duct ectasia?

A

Microcalcifications

30
Q

What is the most common cause of mastitis?

A

Breastfeeding

If it gets infected can be caused by staph aureus

31
Q

How does mastitis present?

A

Breast pain and tenderness

Erythema

Local warmth/inflammation

Nipple discharge

Fever

32
Q

How is mastitis managed?

A

Continue breastfeeding

If symptoms do not improve after 24/48 hrs - can try Flucloxacillin

If clearly infective e.g. discharge - go straight to Flucloxacillin

33
Q

How is nipple candida treated?

A

Topical miconazole

Baby may need miconazole gel for mouth

34
Q

What is an intraductal papilloma? How does it present? How is it investigated and treated?

A

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

35
Q

What are causes of gynaecomastia?

A 
Prolactinaemia
Antipsychotic medication
Idiopathic
Can be physiological in adolescents
Raised oestrogen - obesity, leydig cell testicular cancer, hyperthyroidism, hCG secreting tumour
Low testosterone
Spronolactone
36
Q

How can you differentiate between a fibroadenoma and a breast cyst?

A

Breast cyst is usually soft

Breast cyst often has surrounding pain

37
Q

How is a breast abscess treated?

A

Incision and drainage

38
Q

If a breast cancer lump is fixed to the deep tissue, what does this mean?

A

It is invasive

39
Q

What is the main side effect of Herceptin?

A

Can cause cardiotoxicity leading to Heart failure symptoms.

Need to do an echo prior to starting

40
Q

How does a non invasive vs. invasive breast cancer feel different on clinical examination?

A

Invasive will be fixed to the muscle

Non-invasive cannot be fixed to the muscle

41
Q

Which breast condition is associated with green/cheesy discharge?

A

Mammary duct ectasia

42
Q

Which breast conditions present with a lump which is attached to the skin

A

Either an invasive breast cancer or fat necrosis

43
Q

Which breast condition presents with a highly mobile breast lump?

A

Fibroadenoma

44
Q

Which breast condition presents with blood stained discharge?

A

Duct papilloma

45
Q

Which breast condition presents following trauma?

A

Fat necrosis

46
Q

Which breast condition presents with an extremely fast growing breast lump?

A

Phyllodes tumour

47
Q

How can you differentiate between a fibroadenoma and a lipoma?

A 
Fibroadenoma = firm, very mobile
Lipoma= soft
48
Q

How can you differentiate between breast eczema and Paget’s disease?

A

If it primarily affects the nipple = Paget’s

if it primary affects the areola = eczema

49
Q

When to do core biopsy vs. fine needle aspiration?

A

Large / hard = Core biopsy

Cystic = fine needle aspiration

50
Q

Someone over 30 has a breast lump which appears to be benign - what do you do?

A

2WW referral

51
Q

What is the main CI to Herceptin?

A

Heart disorders - need to do an echo prior to starting

52
Q

What is the main adverse effect of Anastrozole?

A

Osteoporosis

53
Q

Who needs chemotherapy for breast cancer?

A

Either before surgery to shrink size of cancer

Or after surgery if there is found to be axillary node disease

54
Q

Who needs radiotherapy for breast cancer?

A

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

55
Q

What needs to be checked prior to surgery? What do you do based on this?

A

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

56
Q

What is the main complication of axillary node clearance?

A

Lymphoedema leading to functional arm impairment

Medicine Finals (32 decks)

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