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Finals > Breast > Flashcards

Breast Flashcards

1
Q

What is the most common form of breast cancer?

A

Ductal carcinoma - in situ/invasive and show up on mammograms

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2
Q

Apart from ductal what is the other main type of breast cancer?

A

Lobular - in situ/invasive, not always visible on mammograms

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3
Q

What is inflammatory breast cancer?

A

Presents similarly to a breast abscess or mastitis, swollen, warm, tender breast with peau d’orange - worse prognosis and does not respond to antibiotics

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4
Q

What is paget’s disease of the nipple?

A

Looks like eczema of the nipple/areolar, may have discharge or become inverted, may also have lump behind the nipple

Different to eczema because it affects nipple then areola as opposed to the opposite way round

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5
Q

How likely are you to develop breast cancer if you have BRCA1/2?

A

1 = 60-80%
2 = 40%

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6
Q

What is the inheritance pattern of BRCA1/2?

A

Autosomal dominant

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7
Q

What are the risk factors for breast cancer?

A

Age, family history (1st degree relative), oestrogen exposure (early menarche, late menopause, never having child, not having breast fed), radiation to chest, HRT, COCP, obesity, smoking, past breast/ovarian cancer

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8
Q

What are the signs and symptoms of breast cancer?

A

Lumps, nipple discharge, nipple inversion, skin tethering, skin in area red/hot, ulceration, systemic features

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9
Q

What is the triple assessment?

A

Clinical examination - breast examination, ask about previous lumps, symptoms, family history etc.

Radiology:
USS <30 years old
Mammography and USS >30 years

Histology: fine needle aspiration or USS guided core biopsy

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10
Q

What lymph node assessment is done in breast cancer?

A

Before surgery everybody is offered axillary USS and USS guided biopsy of any abnormal nodes

During surgery - done if no abnormal lymph nodes are found, uses sentinel lymph node biopsy

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11
Q

What tests can be done to categorise breast cancer lumps?

A

Oestrogen receptor status and HER2 status - helps guide chemotherapy choice and prognosis

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12
Q

What are the surgical options for removing breast cancer?

A

Lumpectomy, wide local excision, quadrantectomy, mastectomy +/- axillary clearance (if in axillary nodes)

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13
Q

What are the risks are associated with axillary clearance?

A

Increases risk of chronic lymphedema in that arm

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14
Q

What is the use of radiotherapy in breast cancer?

A

Allows for breast conserving surgery with equal outcomes to full mastectomy in patients with early breast cancer, also reduces local recurrence

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15
Q

What are the side effects of radiotherapy?

A

General fatigue, local skin irritation and swelling, fibrosis and shrinking of breast tissue, long term skin colour changes, requires daily treatments for 3-5 weeks

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16
Q

When the breast cancer is ER positive what medications can be given?

A

Pre-meopausal women = tamoxifen

Postmenopausal women = aromatase inhibitors e.g. anastrozole

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17
Q

What is given to people with HER2 positive breast cancer?

A

Herceptin - monoclonal antibody that disrupts HER2 receptor

Given every 3 weeks for 1 year following initial treatment

18
Q

What are the contraindications to herceptin?

A

Congestive heart failure and other heart conditions

19
Q

What does neoadjuvant and adjuvant therapy mean?

A

Neoadjuvant - intended to shrink tumour prior to surgery

Adjuvant - after surgery to reduce recurrence

20
Q

What is the follow up for women after completing breast cancer treatment?

A

Total mastectomies - none required
Early breast cancer - yearly mammograms for 5 years, then based on risk category

21
Q

How often do women have breast screening and during what ages?

A

Every 3 years in women aged 50-70

22
Q

What is a fibroadenoma, how does it present and how is it treated?

A

Most common type of breast lump

Small, mobile, smooth, firm, well circumscribed lump

Hormone dependent and may regress naturally or after menopause - no treatment required

23
Q

What is a fibrocystic breast disease/fibroadenosis, how does it present and how is it treated?

A

Benign breast disease that is common in menstruating women, related to hormonal changes around menstrual cycle

Bilateral breast lumpiness, bilateral pain/tenderness, fluctuation in breast size - occurs prior to menstruating and resolves afterwards

Treatment - supportive clothing, NSAIDs, consider stopping hormonal contraception

24
Q

What is a breast cyst, how does it present and how is it treated?

A

A discrete collection of fluid in breast tissue, common between 30 and 60 years especially around menopause

Smooth, well circumscribed, mobile, possibly fluctuant lump, can be painful

Treatment = needle aspiration or local excision

25
Q

What is an intraductal papilloma, how does it present and how is it treated?

A

Benign warty lesion usually located behind the areola, women in 40s are more likely

Small lump and a sticky blood stained discharge

26
Q

What is a breast abscess, how does it present and how is it treated?

A

An acute usually bacterial infection of the breast tissue, may be associated with fever, pus, discharge from the nipple, local erythema, tenderness an d heat

Treat with antibiotics, may require incision and drainage surgically

27
Q

What is a fat necrosis, how does it present and how is it treated?

A

A lump formed by local degeneration/scarring of fat tissue, inflammatory reaction to local trauma or breast surgery

A firm, irregular, fixed lump that may cause skin dimpling or nipple inversion

May resolve spontaneously or treat with surgical excision

28
Q

What is a lipoma, how does it present and how is it treated?

A

Benign collection of fat

Soft, painless and mobile lump can be up to 20cm in size

Treat conservatively or surgical excision

29
Q

What is a phyllodes tumour, how does it present and how is it treated?

A

Large fast growing periductal stromal cell neoplasm, most common between 40 and 50

Can be benign, borderline or malignant so requires local excision

30
Q

What is the 2ww referral criteria for suspected breast cancer?

A

A discrete lump with fixation that enlarges or there is a family history

Women over 30 with persistent breast or axillary lump or focal lumpiness after their menstrual period

Previous breast cancer with new suspicious symptoms

Skin or nipple changes suggestive of breast cancer

Unilateral bloody nipple discharge

31
Q

What is the most common cause of mastitis?

A

Obstruction in the ducts and accumulation of milk - regularly expressing milk can prevent this from occurring

32
Q

Aside from accumulation of milk what is the other cause of mastitis?

A

Infection - bacteria enter at nipple and back track into duct causing infection and inflammation

33
Q

What is the most common bacterial cause of mastitis?

A

Staph aureus

34
Q

What are the symptoms of mastitis?

A

Unilateral breast pain and tenderness, erythema, warmth, inflammation, nipple discharge, fever

35
Q

What is the management of mastitis caused by blocked ducts?

A

Continue breastfeeding, expressing milk, breast massage, simple analgesia

36
Q

What is the management if infection is suspected in mastitis?

A

Flucloxacillin PO for 10-14 days (erythromycin if allergic)

Still continue to breastfeed even if infection is suspected

37
Q

What is a side effect of antibiotic treatment associated with infective mastitis? (mum and baby)

A

Candida of the nipple - recurrent mastitis as it creates cracked skin and an entrance for infection

Associated with oral thrush and candidal nappy rash in infant

38
Q

What are the symptoms of candida of the nipple?

A

Sore nipples bilaterally, nipple tenderness and itching, cracked areola

39
Q

How is candida of the nipple treated (mum and baby)?

A

Topical miconazole 2% to nipple after each breastfeed

Oral miconazole gel or nystatin for baby

40
Q

What is duct ectasia, how does it present and what is the management?

A

Women around menopasue the breast ducts shorten and dilate

Cheese like nipple discharge and slit like retraction of the nipple

No treatment required

Finals (21 decks)

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