BREAST Flashcards
1
Q
What is a fibroadenoma?
A
Common benign breast lump
2
Q
Who gets fibroadenoma’s
A
Young F (<30)
3
Q
Features of fibroadenoma
A
Not fixed to Chx wall
Smooth/rubbery
Solid
Painless
Well-circumscribed
Painless
4
Q
When may a fibroadenoma want to be removed for cosmetic purposes?
A
If the woman has small breasts
b/c can cause a large deviation
5
Q
Why do fibroadenosis + cysts occur
A
Menstrual cycle
6
Q
What age group gets fibroadenosis + cysts
A
30-50 y/o
7
Q
What may cysts + fibrous nodules feel like o/e
A
Bubble wrwap
8
Q
If cysts are multiple, what are they related to?
A
Homones
9
Q
Which quadrant of the breast has the highest % of carcinoma?
A
Upper outer quadrant
10
Q
What is the most common cancer in females?
A
Breast cancer
11
Q
What are the 2 main cell types in breast cance r
A
Ductal
Lobar
12
Q
Can you usually palpate breast carcinoma in situ
A
No
13
Q
PS breast carcinoma (5)
A
Breast mass
Pain
Nipple changes
Dimpling breast tissue
Local oedema
14
Q
Non specific Sx breast carcinoma
A
W loss
Loss appetitie
Fatigue
15
Q
Features of lump - breast carcinoma (4)
A
Hard
Spiky
Not well circumscribed
Fixed to chest wall
16
Q
How does breast carcinoma spread
A
Via direct extension
Lymphatics + bloods
Pleura + peritoneum
17
Q
Symptom + related mets: SOB
A
Lung mets + pleural effusion
18
Q
Symptom + related mets:
Headache/vision change/seizure
A
Brain mets
19
Q
Symptom + related mets: abdo pain
A
Liver mets
20
Q
Symptom + related mets: abdo distention
A
Ascites
21
Q
Symptom + related mets: bone pain, weakness, numbness
A
SC compression
22
Q
RF breast carcinoma (10)
A
= ALL TO DO W/ HIGH CIRCULATING OESTROGEN
Female
Late menopause/early menarche
OCP
HRT
FHx
Age
Nulliparity
< time breast feeding
‘Western lifestyle’
23
Q
What % breast cancers are familial
A
5-10%
24
Q
What assessment are most breast lumps referred for?
A
Triple assessment
25
What is 'triple assessment'
Combo of 3 tests
Clinical exam, radiology + pathology
26
How are biopsies of the breast performed
Either Freehand if not palpable
Stereotactic if cant be seen on mammogram
27
What is the sensitivity of triple assessment?
99%
28
Why are mammograms not useful on young patients
Because their breast tissue is very dense
So all comes up as white hence = difficult to see anything
29
USS - black circle w/ well defined margin =
cyst
30
USS - grey/black circle w/ well defined margin =
Something capsulated :)
31
USS - grey/black circle w/ ill-defined margin =
Cancer
32
Nipple discharge - what does clear mean
Physiological
33
Nipple discharge - what does milky mean (2)
Pregnancy
Hyperprolactinaemia
34
Nipple discharge - what does green discharge mean
Duct ectasia around menopause
Fibroadenotic cyst
35
Nipple discharge - what does single blood stained duct discharge mean
V worrying
36
What to do if pt has Single blood stained duct discharge
Microducetomy
37
What is most suspicious, single or multiduct discharge
Single duct
38
What is periductal mastitis
Infection of ducts beneath the nipple
39
Who is more likely to suffer from periductal mastitis (2)
Smokers
Those w/ nipple piercings
40
Mx periductal mastitis
co-amoxiclav
41
What is the most common cause of breast pain?
MSK
42
Mx cyclical breast pain
Tamoxifen/danzol
43
Mx all breast pain
Evening primrose oil
44
Breast TNM: T1
<2cm
45
Breast TNM: T2
2-5cm
46
Breast TNM: T3
>5cm
47
Breast TNM: T4
Fixed to chest wall
Or Peau d'orange
48
Breast TNM: N0
No nodes
49
Breast TNM: N1
Mobile ipsilateral nodes
50
Breast TNM: N2
Fixed nodes
51
Breast TNM: M0
No distant mets
52
Breast TNM: M1
Distant mets
53
Further Ix if you suspect a patient of having mets
Liver USS
CXR
Bone scan
54
What is another name for breast conserving surgery?
WLE - Wide local excision
55
What does WLE involve
Excising tumour w/ 1cm margin
Making sure microscopically margins are clear
56
When is a mastectomy used? (4)
Multifocal disease
High tumour:breast
Disease recurrence
Pt choice
57
What are the 2 types of axillary surgery
Sentinel node biopsy
Axillary node clearance
58
What is sentinel node biopsy
Remove the 1st LN into which tumour drains
This involves using a blue dye
Node is removed + sent for histological analysis
59
What is Axillary node clearance
Remove all nodes in axilla
60
What treatment is most surgery combined with?
Radiotherapy
61
When to consider using chemo for Tx breast cancer
If nodal disease
High grade tumours
62
Chemotherapeutic agents used in breast cancer (3)
Anthracyclines
Cyclophosphamides
methotrexate
63
What additional Tx is given to pt who are either HER2 or ER +ve - pre-menopausal
5 y of tamoixfen
64
What additional Tx is given to pt who are either HER2 or ER +ve - post menopausal
Aromastase inhibitors e.g. letrazole, aromisin
65
What additional Tx is given to pt who are HER2 +ve
Herceptin
66
If there are mets, what Tx is recommended
Surgery for Sx relief
Radiotherapy for palliation
67
What is the NPI
Nottingham porgnostic index which assesses survival and risk relapse
68
How is the NPI calculated?
Size (cm x 0.2) + grade (1-3) + nodes (0 = 1point, 1-3 = 2 points, >3 = 3 points)
69
10 y survival rate (after surgery) NPI <2.4
95%
70
10 y survival rate (after surgery) NPI 2.4-3.4
85%
71
10 y survival rate (after surgery) NPI 3.4-4.4
70%
72
10 y survival rate (after surgery) NPI 4.4-5.4
50%
73
10 y survival rate (after surgery) NPI >5.4
20%
74
Age at which breast cancer screening starts
47-50
75
How often are women screen for breast cancer?
Every 3 years
76
When does breast screening end
After 73 y/o
77
If a women is older than 73 can she been screened?
No but she can request a scan
78
Which type of breast cancer has the poorest prognosis?
HER2+
79
which cancer is use of tamoxifen associated with?
Endometrial
80
Mastectomy vs WLE - multifocal tumour
Mastectomy
81
Mastectomy vs WLE - DCIS >4cm
Mastectomy
82
Mastectomy vs WLE - DCIS <4cm
WLE
83
Mastectomy vs WLE - peripheral tumour
WLE
84
Mastectomy vs WLE - Central tumour
Mastectomy
85
Mastectomy vs WLE - solitary lesion
WLE
86
SE Axillary Node Clearance (3)
Lymphoedema
Cellulitis
Frozen shoulder
87
What are the 4 types of ductal carcinoma in situ?
Comedo
Cribiform
Micropapillary
Solid
88
Which DCIS is most likely to form microcalcifications?
Comedo
89
When does DCIS require mastectomy? (3)
Multifocal
Large
High nuclear grade
90
What is high nuclear grade DCIS associated with (2)
Loss p53
Increased erbB2
91
Growth pattern - DCIS vs Lobular carcinoma in situ
Ductal - more common
Ductal - multigrowth pattern
Lobular - single growth pattern
Lobular - doesnt form microcalcifications
92
Mx low grade lobular carcinoma in situ
Monitoring
93
features of intraductal papilloma
blood stained discharge
usually no palpable lump
94
age group intraductal papilloma
younger patients
95
intraductal papilloma - benign or malignant?
benign
96
biologic agent used in HER + breast cancers
Trastuzumab
97
biologic agent used in HER + breast cancers
Trastuzumab
98
Parasthesia post mastectomy - which nerve supplies patch under armpit
intercostobrachial
99
what is a Phyllodes tumour
rare breast tumour of the stromal/connective tissue
100
Are Phyllodes tumours benign or malignant?
benign
101
Medullary breast cancer - defining feature
marked lymphocytic infiltrate
102
prognosis medullary breast cancer
v good
103
mucinous breast cancinoma - PS
soft breast lump
Macroscopically there is a grey, gelatinous surface
104
prognosis mucinous breast carcinoma
v good
105
Drugs causing gynaecomastia - DISCO
D igitalis
I soniazid
S pironolactone
C imetidine
O estrogen
106
causes of gynaecomastia - METOCLOPERAMIDE
METOCLOPRAMIDE
M etoclopramide
E ctopic oestrogen
T rauma skull/tumour breast, testes
O rchitis
C imetidine, Cushings
L iver cirrhosis
O besity
P araplegia
R A
A cromegaly
M ethyldopa
I soniazid
D igoxin
E thionamide
107
Paget's disease of the nipple vs eczema of the nipple
eczema of the nipple will usually originate in the areolar area
pagets will usually originate in the nipple first and then spread to the areolar area
108
Ix Paget's disease of the nipple
punch biopsy
109
why is tamoxifen associated with increased risk of endometrial cancer?
because although it acts as a oestrogen receptor antagonist in the breast
it can act as an oestrogen receptor agonist in the endometrium
110
inflammatory breast carcinomas - aggressive or benign
aggressive
111
inflammatory breast carcinomas - associated with which states
pregnancy
lactation
112
BRCA1 positive young female screening
yearly breast MRI
113
damage to long thoracic nn in axillary surgery -->
winging scapula
114
damage to thoracodorsal trunk in breast surgery -->
loss of supply to the latissimus dorsi mm
