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Finals > Breast > Flashcards

Breast Flashcards

1
Q

Differentials for nipple discharge

A

Physiological
Galactorrhoea
Hyperprolactinaemia
Mammary duct ectasia
Carcinoma
Intraductal papilloma

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2
Q

Common causes of breast pain

A

Cyclical pain = hormonal changes
Non-cyclical = medication (hormonal contraceptives), infection (mastitis), pregnancy

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3
Q

Management for cyclical breast pain

A

Wear supportive bra
Simple analgesia (NSAIDs)
Avoid caffeine
Apply heat to area
Hormonal Tx = danazol, tamoxifen

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4
Q

Risk factors for breast cancer

A
  • Lobular Carcinoma In Situ
  • Late first childbirth (>35)
  • Alcohol consumption
  • ADH
  • HRT for greater than 5 years
  • COCP (returns to normal 10 yrs after stopping pill)
  • Obesity (post menopausal)
  • BRCA 1 and 2
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5
Q

What is the screening programme for breast cancer?

A

Mammography (XR)
o MRI screening for BRCA gene carriers from age 30
o Offered every 3 years to women aged 50-70

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6
Q

Presentation of breast cancer

A
  • Fixed, hard, irregular non-tender lump
  • Nipple discharge
  • Nipple indrawing
  • Nipple inversion
  • Skin tethering
  • Skin dimpling or oedema
  • Lymphadenopathy (particularly in axilla)
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7
Q

What are the different types of breast cancer?

A
  • Ductal carcinoma in situ (DCIS)
  • Lobular carcinoma in situ (LCIS)
  • Invasive ductal carcinoma (no special type) = most common
  • Invasive lobular carcinoma
  • Inflammatory breast cancer
  • Paget’s disease of nipple = Eczematoid change of nipple, starts at nipple and spreads to areola
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8
Q

Investigations for breast cancer

A
  • Mammography (older women) or USS (younger women)
  • MRI scanning = Women at higher risk of developing breast cancer
  • Core biopsy or fine needle aspiration
  • Lymph node assessment
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9
Q

What is the 2WW referral criteria for breast cancer?

A
  • Unexplained breast lump if aged 30+
  • Unilateral nipple changes in patients aged 50+
  • Consider for unexplained lump in axilla if aged 30+
  • Consider for skin changes suggestive of cancer
  • Non-urgent referral for lumps if aged <30
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10
Q

Surgical management options for breast cancer

A

o Breast conservation + whole breast radiotherapy = solitary lesion, peripheral, small lesion in large breast, <4cm
o Mastectomy = multifocal, central, large lesion in small breast, >4cm
o Axillary clearance

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11
Q

What are the pharmacological options for breast cancer?

A

Chemotherapy
o Neoadjuvant therapy = shrink tumour before surgery
o Adjuvant therapy = after surgery to reduce recurrence

Hormone treatment given for (5-10 years) Oestrogen receptor +ve
o 1st line = tamoxifen (premenopausal women)
o Aromatase inhibitors (letrozole) for postmenopausal women

Biological therapy
o Trastuzumab (Herceptin) = targets HER2 receptor
o Pertuzumab (Perjeta) = HER2 receptor
o Neratinib (nerlynx)

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12
Q

When is radiotherapy given in breast cancer?

A

o Whole breast radiotherapy recommended after a woman has had wide-local excision
o For mastectomy, RT offered for T3-T4 tumours and those with 4+ positive axillary nodes

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13
Q

What follow up is given for women treated with breast cancer?

A

Surveillance mammograms yearly for 5 years

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14
Q

Where does breast cancer metastase to?

A

Lungs, liver, bones, brain (2L and 2B)

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15
Q

Complication of breast surgery

A

Chronic lymphoedema
Axillary web syndrome
Brachial plexus injury

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16
Q

What are the side effects of radiotherapy?

A

o General fatigue
o Local skin and tissue irritation and swelling
o Fibrosis of breast tissue
o Shrinking of breast tissue
o Long term skin colour changes

17
Q

How does a fibroadenoma present?

A
  • Painless, Smooth, Round, firm, mobile lump
  • Well circumscribed
  • Usually up to 3cm
  • More common in younger women (20-40)
18
Q

Management for a fibroadenoma

A

> 3cm = surgical excision

19
Q

What is a breast cyst?

A

benign, individual fluid-filled lump

20
Q

How does a breast cyst present?

A
  • Painful and fluctuate in size over menstrual cycle
  • Smooth
  • Well-circumscribed
  • Mobile
  • Possibly fluctuant
21
Q

What is Fat necrosis in the breast?

A

benign lump formed by localised degeneration and scarring of fat tissue in breast

22
Q

What can trigger fat necrosis?

A

Localised trauma
Radiotherapy
Surgery

23
Q

How does fat necrosis present?

A
  • Painless, firm, irregular lump
  • Fixed in local structures
  • Skin dimpling or nipple inversion
24
Q

How does a lipoma present?

A
  • Soft, painless, mobile lump
  • Do not cause skin changes
25
Q

What are the differentials of a breast lump?

A

Breast cancer
Fibroadenoma
Breast cyst
Fat necrosis
Lipoma

26
Q

What are the risk factors for a breast abscess?

A

Smoking
Damage to nipple = nipple eczema, candida infection, piercings
Underlying breast disease

27
Q

What are the causes of a breast abscess/mastitis?

A
  • Staph. Aureus
  • Streptococcus
  • Enterococcal
  • Anaerobic bacteria
28
Q

How dose a breast abscess/mastitis present?

A
  • Acute onset (few days)
  • Swollen, fluctuant, tender lump
  • Nipple changes
  • Purulent nipple discharge
  • Localised pain
  • Warmth
  • Erythema
  • Hardening of skin or breast tissue
29
Q

What is the management of lactational mastitis

A

o Continue breastfeeding and expressing milk
o Breast massage
o Heat packs, warm showers
o Single analgesia
o Abx (flucloxacillin or erythromycin for 10-14 days) = infection suspected or symptoms not improve

30
Q

What is the management of non-lactational mastitis

A

o Analgesia
o Abx (co-amoxiclav or erythromycin + metronidazole)
o Treatment of underlying cause

31
Q

What is the treatment of a breast abscess?

A

o Referral to on-call surgical team
o Abx
o US
o Drainage = needle aspiration or surgical incision and drainage
o MCS of drained fluid

32
Q

Adverse affects of tamoxifen

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

33
Q

Adverse affects of aromatase inhibitors (letrozole and anastrozole)

A

osteoporosis = NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia

Finals (23 decks)

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