breast

Question 1

pagets disease of the nipple what is it how des it present

Answer 1

eczematid change of the nippe associated w underlying breast malignancy

ezcema involving nipple (first then laterally spreads to areolar
(opposite in ezcema)

erthythematous and may have nipple blood/discharge

Question 2

pagets disease of nipple diagnosis

Answer 2

punch biospy
mammography
US of breast

Question 3

1st lin mx lactational mastitis

Answer 3

continue breastfeeding

analgesia
warm compress

Question 4

reasons to give oral fluclox(10-14days) in mastitis

breastfeed ?

organism

Answer 4

systemically unwell
nipple fissure present
no improve sx 12-24hr of effective milk removal
culture indicates infection

mc staph aureus

continue breastfeeding or expressing during abx tx

Question 5

biologic tx for HER2 +ve

CI

Answer 5

trastuzumab (herceptin)

Ci hx heart disorder

Question 6

hormonal therapy for oestrogen receptor +ve

Answer 6

pre or peri menopausal = tamoxifen

post menopausal = aromatase inhibitor ie letrozole anastrazole

Question 7

breast cancer referal

Answer 7

refer 2 weeks

30+ unexplained breast lump +/- pain
50+ one nipple w any: discharge, retraction, other changes of concern

consider 2 weeks
skin changes that suggest ca
30+ unexplained lump in axillla

consider non urgent refer
<30 unexplained lump +/-pain

Question 8

cytoxic chemo example

when

Answer 8

FEC -D

b4 surg to shrink lesion
after surg based on stage ie axilla node disease

Question 9

SE of aromatase inhibitors

Answer 9

osteoporosis and fractures

hot flushes
arthralgia myalgia
insomnia

Question 10

breast cancer screening

Answer 10

women 50-70yo
mammogram every 3 years

make own appointments after 70

Question 11

refer for further assesment if one first degree relative

Answer 11

female diagnosed breast Ca<40yo

male diagnosed w breast any age

bilateral breast cancer where first primary diagnosed<50yo

Question 12

refer for further assesment if two first degree

Answer 12

(or one 2nd) breast ca any age

Question 13

refer further assesment two relatives

Answer 13

1st or 2nd dgree w breast anyage
and
1st ir 2nd w ovarian ca any age

(one must be 1st degree)

Question 14

duct ectasia presentation why

Answer 14

usually age >50
nipple d/c from one or many ducts
thick and green
subareolar
mc smokers

normal variant due to breast involution during menopause -> ducts shorten and many contain insipiated material

Question 15

periductal mastitis presentation RF and tx

Answer 15

younger than duct ectasia
pt may fx of inflammation, abscess of mammary duct fistula
periareolar
recurrent infections

RF
breastfeeding
associated w smoking
duct ectasia

(build up of keratin in milk ducts = inflam and infxn)

tx coamox , abscess = drainage

Question 16

intraductal papilloma

Answer 16

papilloma in a single duct = single duct discharge

clear fluid labstix = small blood

no malignnacy risk

Question 17

breast abscess presentation n tx

Answer 17

tender fluctuant mass
system unwell

tx abx n US guided aspirration

Question 18

breast abcess complication
common cause

Answer 18

overlying skin necrosis = need surgical debridement

this may be complicated by development of subsequent mammary duct fistular

lactational mastitis (staph aureas)

Question 19

Pt breast Ca n no palpable lymphadenopathy

pre op axillary USS negative

next step

Answer 19

sentinal node biopsy to asses nodal burden

Question 20

fibroadenoma

Answer 20

develop from whole lobule

mobile firm smooth breast lump
‘breast mouse’

> 3cm surgical excision

Question 21

breast cyst

Answer 21

smooth discrete lump

small inc risk of breast Ca (esp younger women)b

Question 22

breast cyst tx

Answer 22

aspirated

blood stained or persistently refill
= biospy or excise

Question 23

fat necrosis

Answer 23

obese post menopausal women
hx of trauma

-> mammography

Question 24

side effects of tamoxifen

Answer 24

increased risk of endometrial cancer

VTE

menopausal sx

Question 25

factors for mastectomy

Answer 25

multifocal tumor
central tumor
large lesion in small breast
DCIS >4cm

Question 26

factors for wide local excision

Answer 26

solitary lesion
peripheral tumor
small lesion large breast
DCIS<4cm

Question 27

breast Ca management

Answer 27

surgery (mast or excision)

oest receptor +ve = adjuvent hormonal ie tamox letro

her2 +ve = herceptin (traztsumab)

in nodes
either remove with surgery
or radiotherapy

Question 28

how does tamox work

Answer 28

oestrogen receptor antagonsim
primarily in breast tissue (selective)

ie selective oestrogen receptor modulater (SERM)

Question 29

how do aromatase inhibitors worK?

Answer 29

aromatase enzyme = androgen–>oestrogen

therefore inhib = reduces peripheral oestrogen sythesis

Question 30

why dont use tamoxifen in pot menopause

Answer 30

post menopausal bleeding
endoetrial hyperplasia
endometrial ca

Question 31

snowstorm sign on axillary lymph noedes

Answer 31

extracapsular breast implant rupture

its due to leakage of silicone which then drains into the lymphatic draining = snowstorm in breast and lymph nodes

Question 32

breast cancer lump features

Answer 32

lump typically painless, fixed hard
breast skin changes
blood nipple discharge
inverted nipple
axillary mass

Question 33

nipple candidiasis while breastfeeding tx

Answer 33

miconazole cream for mum
nystatin suspension for baby

Question 34

breast cancer risk factors

Answer 34

oestrogen - obesity, nulliparity (1stpreg>30), early menarche, late menopause, HRT, COCP

never breastfed

genes - BRCA 1/2, ionising radiation

Question 35

triple assessment

Answer 35

clinical exam
imaging (US or mammography)
biopsy fine needle or core

Question 36

mc type breast ca

Answer 36

invasive ductal carcinoma

Question 37

prostate cancer radiotherapy = inc risk of what

Answer 37

blader colon and rectal cancer