Breast👙 Flashcards
What does a ‘snowstorm’ sign in USS indicate?
The ‘snowstorm’ sign on ultrasound of axillary lymph nodes indicates extracapsular breast implant rupture.
What is the typical appearance of inflammatory breast cancer?
Typical appearance (progressive, erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP) and an elevated CA 15-3.
What is mammary duct ectasia?
Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’
What is fat necrosis?
More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted
What is the definition of cyclical mastalgia?
Breast tenderness which comes and goes with the menstrual cycle. Thought to be associated with changes to hormone levels during the menstrual cycle.
What pathogen is commonly implicated in breast abscess?
Staphylococcus Aureus.
For which genetic conditions would you be offered MRI breast screening?
Patients between 25 and 60 years with BRCA gene carriage confirmed (or similar high risk genes) Patients between 20-70 years if they have Li Fraumeni or tp53 mutation.
For which genetic conditions would you be offered MRI breast screening?
Patients between 25 and 60 years with BRCA gene carriage confirmed (or similar high risk genes) Patients between 20-70 years if they have Li Fraumeni or tp53 mutation.
What is intraductal papilloma?
- Growth of papilloma in a single duct
- Usually presents with clear or blood stained discharge originating from a single duct
- No increase in risk of malignancy
When would you use Tamoxifen in breast cancer treatment?
It is used in pre-menopausal and post-menopausal women who have ER +ve breast cancer.
When would you use trastuzumab (Herceptin)?
This is the most common type of biological therapy used for breast cancer. It is only useful in the 20-25% of tumours that are HER2 positive. It cannot be used in patients with a history of heart disorders.
What is the most common cause of blood stained nipple discharge?
Intraductal papillomata are the commonest cause of blood stained nipple discharge in younger women. There is seldom any palpable mass. An ultrasound is required and possibly a galactogram.
When do you refer for surgical excision for fibroadenoma?
Surgical excision if >3cm
What is the epidemiology of breast cancer?
Most common cancer in women. 1 in 8 women will develop breast cancer in their lifetime.
The median age is 62
What gene mutation increases risk of breast cancer in males?
BRCA2. Other risk factors include the use of estrogens, Klinefelter’s syndrome.
Between what age are women screened in the UK?
Between the ages of 47 and 73
What are the common histological types of invasive breast cancer?
Ductal (70%) and lobular (10%)
Rarer subtypes include tubular, mucinous and medullary but treatment is the same regardless
What are the receptors that can be affected in breast cancer?
Oestrogen receptor, the progesterone receptor or the HER-2 receptor (Human Epidermal growth factor receptor type)
Is Oestrogen receptor positive breast cancer a marker of good or bad prognosis?
The oestrogen receptor is expressed on more than half of all breast cancers, (the rate of positivity is roughly equivalent to the age of the patient). It denotes that the cancer is sensitive to oestrogen which stimulates tumour growth and also that anti-oestrogen therapy will help to control the disease. It is a marker of good prognosis because the women can be treated with anti-oestrogens and the cancers tend to be less biologically aggressive. The Progesterone receptor is also an indicator of sensitivity to anti-oestrogens (the ER and PgR are linked).
Is HER-2 Receptor positive breast cancer a good or a bad prognostic factor?
The Her-2 receptor is over expressed in 15% of all breast cancers and is a poor prognostic marker. It is a receptor for the epidermal growth factor receptor (her-2) and if this receptor is up regulated, i.e. there are more copies on the cell surface than in normal cells, the growth pathway is up-regulated and the cells behave in a very aggressive manner.
What is the standard mastectomy technique used?
Done through a transverse incision and which leaves the pectoralis major and minor muscle behind. This gives a good cosmetic result.
Give some indications for mastectomy
- Patients choice
- Large tumour relative to the patient’s breast such that breast conservation surgery would remove more than 20% of the breast volume.
- Multifocal or multicentric
- Sub-areolar tumour
- Contraindication to radiotherapy
- Failed conservation surgery
- Very strong family history in a young patient with breast cancer
- Bilateral prophylactic mastectomy in breast cancer gene carriers
- Local recurrence after wide local excision
- Inflammatory breast cancer
What is an axillary node clearance?
This is the standard procedure in a woman who has known axillary nodal disease either detected on a pre-operative ultrasound scan of the axilla (standard in all women with cancer) or because she has had a positive sentinel node biopsy (see below). Axillary clearance involves removal of all of the lymph nodes in the axilla, of which there are usually between 10 and 25.
What are some complications of axillary node clearance?
Seroma formation (60%), need for a drain postoperatively, shoulder stiffness, permanent or temporary paraesthesia under the arm due to damage to the intercostobrachial nerve, lymphoedema
