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Year 4 Final > Breast > Flashcards

Breast Flashcards

1
Q

What is pagets disease of the breast?

A

eczematoid change of the nipple associated with an underlying breast malignancy and it is present in 1-2% of patients with breast cancer

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2
Q

When is trastuzumab used in breast cancer?

A

In HER2 positive patients

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3
Q

What are Anastrozole and letrozole?

A

aromatase inhibitors that reduces peripheral oestrogen synthesis

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4
Q

Adjuvant hormonal therapy is offered if tumours are positive for hormone receptors. What is used in pre menopausal women and what is used in post?

A

Tamoxifen is still used in pre- and peri-menopausal women. In post-menopausal women, aromatase inhibitors such as anastrozole are used for this purpose

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5
Q

Chemotherapy in breast cancer?

A

Cytotoxic therapy may be used either prior to surgery (‘neoadjuvanant’ chemotherapy) to downstage a primary lesion or after surgery depending on the stage of the tumour, for example, if there is axillary node disease - FEC-D is used in this situation.

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6
Q

The ‘snowstorm’ sign on ultrasound of axillary lymph nodes indicates what?

A

extracapsular breast implant rupture. It is due to leakage of the silicone, which then drains via the lymphatic system, giving the ‘snowstorm appearance’ both in the breast and the lymph nodes.

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7
Q

What is mammary duct ectasia?

A

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’

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8
Q

Diagnosis of Paget’s disease of the nipple?

A

punch biopsy, mammography and ultrasound of the breast

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9
Q

First line abx for lactational mastitis?

A

Oral flucloxacillin

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10
Q

What is seen in mammography of a breast cyst?

A

Halo appearance

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11
Q

What is used in the management of oestrogen receptor positive breast cancer in pre-menopausal women?

A

Tamoxifen

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12
Q

Age for breast screening?

A

50-70 years

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13
Q

Factors of screening?

A

sensitivity, specificity, positive predictive value and negative predictive value
Ideally should have a detectable pre invasive stage
Should detect at a pre symptom stage
Treatment should improve prognosis
Asymptomatic stage where treatment improves prognosis
Easy test
Public health problem
Cost effective

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14
Q

What is ductal carcinoma in situ?

A

DCIS is an early form of breast cancer.

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15
Q

Memory aid for sensitivty and specificty

A

Think about heroine
Bags at baggage reclaim
Dogs sniffer
Sensitvity- Sniffs every bag
Specific sniffer dog will only indicate bags with drugs

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16
Q

Who do fibroadenoma most commonly occur in?

A

Younger people of childbearing age

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17
Q

Who do breast cysts often occur in?

A

Middle aged women

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18
Q

What promotes breast development?

A

Oestrogen

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19
Q

Cause of gynaecomastia

A

Increased oestrogen production or decreased testosterone production

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20
Q

When does gynaecomastia often occur?

A

Puberty and old age

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21
Q

Drugs that cause sprinolactone?

A

Sprinolactone
Steroids
Marajuana

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22
Q

There are 3 classes of medical treatment for gynecomastia:

A

androgens (testosterone, dihydrotestosterone, danazol), anti-estrogens (clomiphene citrate, tamoxifen), and aromatase inhibitors such as letrozole and anastrozole

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23
Q

Why is tamoxifen pre menopausal women and aromatase inhibitor post menopausal women

A

AIs stop the body from making estrogen, and as a result hormone receptor-positive tumors do not get fed by estrogen and die. AIs are not given to premenopausal women because their ovaries still produce estrogen. AIs will not stop the ovaries from making the estrogen that feeds the tumor.

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24
Q

What is a triple assessment?

A

History and examination
Mammogram
Biopsy and histology

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25
Symptoms of breast cancer?
New lump in the breast or underarm (armpit). Thickening or swelling of part of the breast. Irritation or dimpling of breast skin. Redness or flaky skin in the nipple area or the breast. Pulling in of the nipple or pain in the nipple area. Nipple discharge other than breast milk, including blood. Any change in the size or the shape of the breast. Pain in any area of the breast.
26
HPC questions for breast exam
Is it related to menstral cycle Is it causing any discomfort? Painful- More likely to be a cyst Has there been an injury- May have drawn patient's attention to lump or was it always there
27
PMH questions for breast cancer?
Ovarian cancer in the past Breast cancer in the past Haematological malignancy- Rt can increase risk of breast cancer
28
DH questions for breast cancer?
Combined oral contraceptive HRT Anything that has exogenous hormones Anticoagulants- Important if going to biopsy
29
SH questions to ask breast cancer?
Alcohol is possibly the higher risk factor Smoking is possibly a risk factor but not definite BMI Social support Work
30
FH questions ask breast cancer?
BRAC1 and BRAC2 gene First and second degree relatives How many relatives Was it breast or was it ovarian cancer? Bilateral breast or one side? Male breast cancer?
31
Oestrogenic exposure to breast cancer questions to ask?
Early menarche and late menopause Number of pregnancies. Age of first pregnancy- Younger being protective Breast feeding- Thought to be protective
32
How many views do you do in mammogram?
Bilateral 2 view mammography
33
Why is mammography a less useful test in younger patients
Ionising radiation and more fibrous at this stage
34
Apart from mammogram what should you do in breast tissue?
US
35
Mammogram vs US
Mammogram is the whole breast US is just a part of the breast
36
Histology vs cytology
Histology help show how invasive the breast cancer is
37
Risk factors for histology
Infection Bleeding Pneumothorax Getting muscle or pleural tissue
38
Questions for nipple discharge?
Bilateral?- Better if it is Colour If get to squeeze the nipple does it come from many ducts or just one duct?
39
What is Paget's disease?
nipple, also known as Paget's disease of the breast, is a rare condition associated with breast cancer. It causes eczema-like changes to the skin of the nipple and the area of darker skin surrounding the nipple (areola). It's usually a sign of breast cancer in the tissue behind the nipple. Should involve the nipple Most likely not bilateral
40
Causes of gynaecomastia?
Hypogonadism. Conditions that lower testosterone production, such as Klinefelter syndrome or pituitary insufficiency, can be associated with gynecomastia. Aging. Hormone changes that occur with aging can cause gynecomastia, especially in men who are overweight. Tumors. Some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance. Hyperthyroidism. In this condition, the thyroid gland produces too much of the hormone thyroxine. Kidney failure. About half the people being treated with dialysis experience gynecomastia due to hormonal changes. Liver failure and cirrhosis. Changes in hormone levels related to liver problems and cirrhosis medications are associated with gynecomastia. Malnutrition and starvation. When your body is deprived of adequate nutrition, testosterone levels drop while estrogen levels remain the same, causing a hormonal imbalance. Gynecomastia can also happen when normal nutrition resumes.
41
2 types of breast surgery?
Lumpectomy and mastectomy
42
Aims of wide local excision
Remove all the cancer Maintain the breast so if small breast and tumour taken out will we still have a breast looking area
43
Can you give radiotherapy to the breast twice?
No not technically
44
What is inflammatory breast cancer?
rare type of breast cancer. The cancer cells block the smallest lymph channels in the breast. The lymph channels (or lymph ducts) are part of the lymphatic system. They normally drain excess tissue fluid away from the body tissues and organs. mimics lymphatic flow of the tumour
45
Types of axillary surgery?
Sentinel node biopsy and axillary clearance
46
How to identify sentinel node biopsy?
In sentinel node biopsy, a tracer material is used to help the surgeon find the sentinel nodes during surgery. The sentinel nodes are removed and tested in a lab.
47
What happens to patient with Negative axillary nodal staging?
Sentinel node biopsy
48
What happens to patient with positive axillary nodal staging?
Nodal clearance
49
What does a positive sentinel node biopsy indicate?
A clearance
50
can you do a sentinel node biopsy after a mastectomy
No as breast not there
51
does in situ disease get a biopsy
No as not removing whole breast so still could do it after
52
What is adjuvant treatment of breast cancer?
Doing something other than surgery to help downstage the cancer
53
Treatments for breast cancer
Bisphosphonates Hormonal therapy RT Biological therapy Chemotherapy Aspirin
54
What is the local treatment for breast cancer?
RT
55
Who is offered radiotherapy for breast cancer
Everyone if not having a mastectomy
56
Who gets rt after a mastectomy?
4 or more positive lymph nodes get rt Ans some other people
57
Rt side effects?
Damage to skin, fat, fibrous and connective tissue, damage to organs nearby Radiation injury to the skin
58
When can radiotherapy be done palliatively?
Bony mets
59
Adjuvant chemo reasons to give after surgery?
Her positive Lymph node involvement More invasive/higher grade Oestrogen negative
60
Chemotherapy side effects?
Immunosuppression Hair loss Diarrohea and vomiting Neutropenic sepsis Fatigue Mucosal lining issues Infertility Peripheral neuropathy
61
What can cause death due to chemotherapy side effects?
Immunosuppression and neutropenic sepsis
62
What can happen if put toxic IV into vessels?
Phlebitits
63
Why is chemo put into a central vein?
Much larger vein so less likely to get issues with phlbeitis But still at risk of infection
64
How is chemotherapy often done?
3 drugs 8 weeks apart Then switch to another drug Takes 18 weeks
65
How do we know if adjuvant chemo is working?
We don't. You can't check it. Have to guess :(
66
What can adjuvant chemo do?
Make an inoperable cancer operable Make a mastectomy into a wide local excision Make an excision smaller Inflammatory breast cancer Can also downstage the axilla
67
When can't transtuzumab not be used?
Cardiotoxicity
68
Example of biologic therapy used after chemo?
Transtuzumab
69
What is important before giving transtuzumab?
Need to have had chemo first and be HER2 positive
70
When can transumab also be given?
Neo adjuvantly and palliatively
71
What kind of drug is tamoxifen?
Selective oestrogen receptor modifier Stops modulatory effects of oestrogen
72
If pre menopausal where does the oestrogen come from?
Ovaries
73
Where does post menopausal oestrogen come from?
Fat So this is why tamoxifen can still be used if ER positive in any age
74
What kind of drug is anastrazole
Aromatase inhibitor
75
How to temporarily make someone post menopausal?
GnRH Zoladex
76
Why is bisphosphonates used after breast cancer?
Help protect from bone thinning
77
Follow up for breast cancer?
Mammography 5-10 years after diagnosis

Year 4 Final (39 decks)

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