Breast Flashcards
Treatment for cyclical mastalgia
Good fitting bra
Low dose tamoxifen
NSAID
Bromicriptine
Danazol
Popcorn like density on mammogram
Popcorn like mammographic changes in a young female most classically represent a fibroadenoma.
Invasive ducal cancers usually are associated with spiculated mass lesions on mammographic films.
Fat necrosis may mimic malignancy on imaging and clinically rather than benign processes.
What percentage of people with atypical ductal hyperplasia may develop breast cancer
10-15%
Nodal mets in breast cancer
Nodal micrometastasis=0.2-2mm of tumour foci
Isolated tumour cells= 0.2mm or less of tumour foci in single node
Halo sign on mammogram
Benign cysts are most commonly seen in association with a halo sign which is formed by rings of compressed fat. This is seen less frequently with infiltrative lesions.
Indications for radio following mastectomy
Radiotherapy is not routinely used following mastectomy. It is considered beneficial in the following high risk groups:
• Patients with axillary nodal involvement
• T3 and T4 tumours
• Vascular invasion
• Extranodal disease
• Inflammatory breast cancer
Risk reduction in BRAC1 mastectomy
85%
BRAC1 lifetime risk of breast cancer
60-80% for breast
40-60% for ovarian
BRCA 2 lifetime risk
50-85% for breast
10-30% for ivarian
Behind which muscles are the level 2 nodes
Pec Minor
Which type of breast cancer is associated with lymphocytic infiltrate
Medullary
Side effect of trastuzumab
Cardiac toxicity
What percentage of breast cancers is due to BRAC1/2 inheritance
5%
Conditions causing increased risk of breast cancer
Atypical ducts hyperplasia
Radial scaring
Cause if gynaecomastia
• physiological: normal in puberty
• syndromes with androgen deficiency: Kallman’s, Klinefelter’s
• testicular failure: e.g. Mumps
• liver disease
• testicular cancer e.g. Seminoma secreting HG
• ectopic tumour secretion
• hyperthyroidism
• haemodialysis
• drugs
Drugs causing gynaecomastia
Drug causes of gynaecomastia
• spironolactone (most common drug cause)
• cimetidine
• digoxin
• cannabis
• finasteride
• estrogens, anabolic steroids
Very rare drug causes of gynaecomastia
• tricyclics
• isoniazid
• calcium channel blockers
• heroin
• busulfan
• methyldopa
Breast cancer screening
49-73
Every 3 years
Family breast cancer risk
1 first degree relative affected aged <40 = 1 in 6
2 first degree relatives under 40 = 1 in 3
3 first degree relatives under 60= 1 in 4
DCIS
Areas of >40mm should be consider for mastectomy
L lymph node mets -skipping level 1
3% skip level 1
Rest present there
Sensation provided by intercostobrachial nerve
Lateral chest
Medial aspect of the upper arm
Axilla (armpit)
BRCA 1 other cancer
BRCA 1 mutation= 35% risk of ovarian cancer
Side effects of trastuzumab - Herceptin
• Trastuzumab is a monoclonal antibody targeted at the HER/neu receptor
• Its main use is in HER positive breast cancer and is usually administered with chemotherapy
• It is typically given by infusion over a one year period
• Its most serious adverse effect is one of myocardial toxicity and it increases the risk of serious cardiac malfunction by 2.1%, this risk is increased when administered with anthracycline chemotherapy which is also well known to have cardiac effects.
Most comman cause of bloody nipple discharge
Intraductal papilloma
• Commoner in younger patients
• May cause blood stained discharge
• There is usually no palpable lump
Lobular breast cancers
Lobular cancers are poorly visualized on conventional imaging. Where a mastectomy is the planned treatment this is of no practical significance. However, the size of the lesion and associated other lesions will not be appreciated unless an MRI scan is performed. This will determine the safety with which breast conserving surgery could be offered. In view of the tumour location the outcome in terms of cosmesis is likely to be poor. Neoadjuvent therapy is unlikely to alter the eventual outcome here.
Breast cancer chemo regieme
Where chemotherapy is deemed necessary in the adjuvent setting, the main regime in current use combines anthracycline and taxane.
Lobular carcinoma in situ
The direct malignant potential of LCIS is unclear and at the present time advice is generally that these areas be excised in a non oncological manner. These patients require close post operative surveillance as they have a seven fold increased risk of the development of breast cancer.
