Breast Flashcards
When to 2ww
- unexplained lump >30
- Unilateral nipple changes >50
- Skin changes
Non urgent referral - Unexplained lump in <30
Whats in triple assessment
- Clinical assessment
- Imaging = USS, mammography
- Histology = fine needle, core biopsy
Fibroadenoma
- Benign tumours of stromal/epithelial
- painless, smooth, round
- Mobile
Fibrocystic breast changes
- Benign
- stroma, ducts and lobules respond to hormons = fibrous and cystic
- lumpy, tender, size change
Mx fibrocystic
- good bra
- NSAIDs
- Heat
- Hormonal tx
Breast cysts
- Benign individual fluid filled lumps
- Smooth
- Well defined
- Mobile
- Can be fluctuant
- assess to exclude cancer
Fat necrosis
- benign lump
- localised degeneration and scarring of fat tissue #- localised trauma, radiotherapy or surgery
- Painless, firm, irregular, fixed
Lipoma
- Benign tumour of adipose
- Soft, painless, mobile, no skin changes
Non cyclical breast pain causes
- Medications = HRT
- infection
- Pregnancy
- Cancer
presentaiton mammary duct ectasia
- discharge
- tenderness
- retraction or invesrion
- breast lump
Mx MDE
- triple assessment
- Mammogram = microcalcifications
intraductal papilloma
- warty lesion in duct
- nipple discharge, pain, lump
- triple assessment
- mx = surgery
mx mastitis
- continue breastfeeding
- flucloxacillin
Mx breast abscess
- non lactational = co amoc, or macrolides plus met
- refer to on call surgery
- abx
- USS
- drainage
- culture
pagets
- eczematous change due to underlying malignancy
- suspect if eczema not resolved in 2w
- surgery
DCIS
- pre cancerous or cancerous epithelial cells of ducts
- localised
- mammogram screening pick up
- full excision
LCIS
- pre cancerous
- asymptomatic and undetectable on mammogram
- breast biopsy
- mx close monitoring
invasive ductal carcinoma
- originate in cells from breast ducts
- seen on mammogram
invasive lobular carcinoma
- cells from rbeast lobules
inflammatory breast cancer
- 1-3%
- similar px to abscess/mastitis but no response to abx
breast screening age?
- mammogram 3 yearly ages 50-70 (47-73)
who count as high risk
- 1st degree relative with breast cancer under 40
- 1st deree male relative
- 1st degree with bilateral <50
- 2 1st degree
= annual mammogram
chemoprevention for high risk
- tamoxifen if pre menopausal
- anastrozole if post
3 receptors tested for
- oestrogen receptors
- progesterone receptors
- human epidermal growth factor
triple negaive = poor prognosis
features of locally advanced cancer
- ulceration
- peau d’orange
- inflammatory breast cancer
- fixed to chest wall
- fixed, matted axillary ln
primary tx
-tx intended to cure, or to allow easier or lesser surgery
adjuvant tx
- any treatment given following primary treatment to prevent recurrence or mets
radiotherapy
- used in breast conserving surgery to reduce recurrence
3 scenarios for chemo
- neoadjuvant = shrink pre surgery
- adjuvant = after surgery to reduce recurrence
- tx of mets
meds to oestroge positive
- tamoxifen for pre menopause
- aromatase inhibitors for post = letrozole
tamoxifen is
- selective oestrogen receptor modulator
- blocks ER in breast
- Stimulates Er in bones and uterus
amromatase inhibitors work by
- aromatase converts androgens to oestrogen
- inhibs work by blocking creating of oestrogen in fat tissue
trastuzumab is
- monoclonal antibody that targets HER2
surveillance mammograms every
- yearly for 5 years
mastectomy if
- multifocal tumour
- central tumour
- large lesion in small breast
- DCIS >4cm
wide local excision if
- solitary lesion
- peripheral tumour
- small lesion large breast
- DCIS <4cm
adverse effects Tamoxifen
- mesntrual disturbance
- hot flushes
- VTE
- endometrial cancer
anastrozole adverse effects
- osteoporosis (DEXA before intiating)
- hot flushes
- arthralgia
- insomnia
