Breast Flashcards
What adjuvant therapy is used in oestrogen receptor (ER) positive breast cancer?
Pre- or peri-menopausal: tamoxifen (selective oestrogen receptor modulator - SERM)
Post-menopausal: Anastrazole (aromatase inhibitor)
When is herceptin used in breast cancer?
It is a monoclonal antibody (biological therapy) that is used for patients who have HER2+ breast cancer
What are the indications for a mastectomy vs wide local excision?
Mastectomy:
* Multifocal tumour
* Central tumour
* Large lesion in small breast
* DCIS > 4cm
Wide local excision:
* Solitary lesion
* Peripheral tumour
* Small lesion in large breast
* DCIS < 4cm
What are the indications for radiotherapy post-breast surgery?
Wide local excision: all women (reduces risk of recurrence by 2/3)
Mastectomy: T3-T4 tumours or if four or more positive axillary nodes
When do you offer abx in mastitis?
- if systemically unwell
- if nipple fissure present
- if symptoms do not improve after 12-24 hours of effective milk removal
- if culture indicates infection
What is the definitive management of a breast abscess?
Incision and drainage
What is the 2WW referral criteria for breast cancer?
Refer if:
* aged 30 and over and have an unexplained breast lump with or without pain or
* aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern
Consider referring if:
* with skin changes that suggest breast cancer or
aged 30 and over with an unexplained lump in the axilla
What level of referral should you do in people aged under 30 with an unexplained breast lump with or without pain?
Non-urgent
What is the common presentation of periductal mastitis?
Smokers and may present with recurrent infections. May present with features of inflammation, abscess or mammary duct fistula
Occurs at a younger age than duct ectasia
Treatment is with co-amoxiclav
What are adverse effects of Selective oEstrogen Receptor Modulators (SERM)?
- menstrual disturbance: vaginal bleeding, amenorrhoea
- hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
- venous thromboembolism
- endometrial cancer
What are adverse effects of aromatase inhibitors?
- osteoporosis - NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
- hot flushes
- arthralgia, myalgia
- insomnia
What is the typical appearance of inflammatory breast cancer?
- Progressive, erythema and oedema of the breast
- Absence signs of infection such as fever, discharge or elevated WCC and CRP
- Elevated CA 15-3
What abx is offered in mastitis?
Oral flucloxacillin for 10-14 days
As the most common organism causing infective mastitis is Staphylococcus aureus
What does the NHS Breast Screening Programme consist of?
Women between the ages 50-70 years are offered a mammogram every 3 years
What is the most common type of breast cancer?
Invasive ductal carcinoma (no special type)
Accounts for 70-80% of all breast cancers
What is the difference between invasive ductal carcinoma and invasive lobular carcinoma?
Invasive ductal carcinoma: originates in the cells that line the milk ducts of the breast and then invades the surrounding tissue (calcification is seen on mammogram)
Invasive lobular carcinoma: begins in the lobules (the glands that produce milk) and can spread to other areas of the body
What are the features of duct ectasia?
- Patients usually present with nipple discharge, which may be from single or multiple ducts (usually present age >50 years)
- The discharge is often thick and green
- Normal during breast involution that occurs during the menopausal period
What are features of an 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
What are the features of fibroadenomas?
- Develop from a whole lobule
- Mobile, firm, smooth breast lump - a ‘breast mouse’
- 12% of all breast masses
- Over a 2 year period up to 30% will get smaller
- No increase in risk of malignancy
- If >3cm surgical excision is usual
What is the mechanism of Selective oEstrogen Receptor Modulators (SERM)?
Complete or partial antagonism of the oestrogen receptor
Examples:
* Complete - raloxifene
* Partial - tamoxifen
What is the management of cyclical mastalgia?
- Supportive bra
- Standard oral or topical analgesia
- Flaxseed oil and evening primrose oil sometimes used but not NICE-licensed
- If conservative measures do not improve within 3 months, refer
What is a side effect of axillary node clearance?
Arm lymphedema and functional arm impairment
What should you ask if a patient is presenting with dry skin around the nipple?
If they have any other dry skin around the body - will most likely be eczema as opposed to Paget’s disease
Risk factors for breast cancer
Female sex
AGE AGE AGE
High BMI
Dense Breasts
Alcohol
Previous breast cancer + radiation exposure
Urban living
Nulliparous, not breast feeding
Family history
Early menarch and late menopause
