Breast Flashcards
What medication is recommended for oestrogen-receptor positive breast cancer in post-menopausal women ONLY?
Anastrozole
How does Anastrozole work?
Aromatase inhibitor
It inhibits the enzyme aromatase and hence reducing the conversion of androgens into oestrogens in peripheral tissues. This is the main source of oestrogen production in postmenopausal women, compared to pre-menopausal women, where the main source of oestrogen is the ovaries.
What medication is used for women with oestrogen positive Breast Cancer who are premenopausal or post menopausal?
Tamoxifen
How does Tamoxifen work?
Its a selective oestrogen receptor modulator, meaning it antagonises oestrogen receptors on the breast cancer cells and blocks the anabolic effects of oestrogen.
What is the treatment for lactational mastitis?
1st - Continue breastfeeding
2nd - PO Flucloxacillin for 10 days
What is the most common organism in Lactational Mastitis?
Staph Aureus
How does Mastitis present?
Redness
Tender
Warm to the touch
Swelling
What are the sentinel lymph nodes?
The first few lymph nodes a cancer can spread to
What is the purpose of a sentinel lymph node biopsy?
To see if the cancer has spread from the initial location
How do you do a sentinel lymph node biopsy?
A radioactive substance and/or blue dye is injected near the tumour. During the surgery a probe is used to locate the lymph nodes containing the radioactive substance so they can be excised.
What is an intra-ductal papilloma?
A benign tumour of fibrovascular tissue that develops within the lactic ducts.
Can grow to become painful and leak blood-stained discharge
Above what age does a patient with a breast lump require urgent cancer referral to the breast team?
All women > 30 with unexplained breast lump
What is duct ectasia?
Shortening and widening of the terminal breast ducts around the nipple.
Presents as a benign breast lump with thick- green nipple discharge
Occurs after breast involution (around the time of menopause)
What is breast involution?
Process by which the breast epithelial tissue is gradually lost with aging of the mammary gland.
Mammary glands are lost as they are now redundant
What specific risk should patients undergoing a axillary node clearance be aware of?
Lymphedema causing functional arm impairment
What are the types of breast malignancy?
Ductal carcinoma in situ
Invasive ductal carcinoma
Lobular carcinoma in situ
Invasive lobular carcinoma
Mucinous carcinoma
Paget’s disease of the nipple
How do you distinguish between ductal and lobular carcinoma on a mammogram?
Calcification is seen more in ductal than lobular - hence it is more visible on mammogram
What is the most common type of breast cancer?
Invasive ductal carcinomas
What are the typical treatments for breast cancer?
Wide local excision
Mastectomy
What are the indications for a Mastectomy?
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
Patient Choice
What are indications for a Wide Local Excision?
Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm
Patient Choice
What drug is used for patients who are HER2 postive?
Herceptin
What type of chemotherapy is used in patients who are node negative that require it?
FEC chemotherapy
What type of chemotherapy is used for patients who are node positive?
FEC-D chemotherapy
What are the treatments available for duct ectasia?
None needed - reassurance
Microdochectomy - if condition is bothering patient and they are younger
Total duct excision - if symptomatic and bothering the patient and they are older
What is a microdochectomy?
A procedure to remove one or more of the milk ducts from your breast
What is Total Duct excision?
Removal of a disc of duct tissue from behind the nipple
What is a side effect of Aromatase inhibitors?
Osteoporosis
What are side effects of SERMs ( Selective Oestrogen Receptor Modulators) i.e Tamoxifen?
Amenorrhoea
Endometrial cancer
Vaginal bleeding
VTE
What is another name for Herceptin?
Trastuzumab
What is the appropriate management for fibroadenomas that are >3cm?
Surgical excision biopsy
What would be a reasonable indication for surgical excision if a fibroadenoma was <3cm ?
Cosmesis ( Aesthetic/ Body image issues)
What is a Phyllodes tumour?
Rare breast tumour that starts in the connective tissue ( fatty tissue, ligaments around area) rather that the ducts or lobules. Most are benign
A fibroepithelial lesion ( stroma and epithelial components )
What is Paget’s disease of the nipple?
Reddening
Thickening
May resemble eczema ( itchy, crusty)
Inverted nipple
Affects nipple first then areola
It is associated with underlying breast malignancy
How does eczema spread on the nipple?
Areolar then to the nipple
What is FIbroadenosis?
Fibrocystic breast disease
Most common in middle-aged women
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
What is Duct Papilloma?
Local areas of epithelial proliferation in large mammary ducts
May present with blood stained discharge
What is Fat necrosis?
More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
What is a breast abscess?
More common in lactating women
Red, hot tender swelling
Can result from mastitis
What is a key reason for Neo-Adjuvant Chemotherapy?
Try to downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy.
Reduce peri-operative risks
Better cosmetic outcome
What do Breast Cysts show on mammogram?
Halo appearance
What treatment is required following a wide local excision?
Whole breast radiotherapy
Then Anastrozole, Tamoxifen or Herceptin can be used as maintenance therapy following the radiotherapy
What sign on ultrasound indicates extracapsular breast implant rupture?
Snowstorm sign of axillary lymph nodes
Leakage of silicone is drained by lymphatic system
Who is breast cancer screening offered to?
All women age 50-70 every 3 years
A 52-year-old woman with early-stage breast cancer is undergoing breast-conserving surgery. During the procedure, the sentinel lymph node biopsy reveals two nodes with micrometastatic involvement. There are no clinical signs of further axillary disease, and the patient is scheduled for adjuvant radiotherapy.
Considering these findings, what is the most appropriate next step?
Close without additional axillary surgery
Micrometastases or 2 micrometastases on sentinel lymph node
What is Triple Negative breast cancer?
A type of breast cancer that does not have any of the receptors ( Oestrogen, Progesterone, HER2 )
Who is Periductal Mastitis common in?
Smokers
What age is screening with a mammogram as opposed to an US used?
Over 35 - more dense breast tissue
What nerve injury can be a complication of axillary node clearance?
Brachial Plexus injury
What treatment is recommended for Triple Negative breast cancer?
Aggressive
Neoadjuvant chemo
Lumpectomy/Mastectomy
Adjuvant chemo/radiation
What is cyclical mastalgia?
Breast pain associated with menstrual cycle
What is the treatment for Fat Necrosis?
Conservative as in most cases the body will break it down over time
Safety net - gets bigger or other breast changes come back
What is a radial scar?
A radial scar is a benign breast condition which can mimic a breast carcinoma. It describes idiopathic sclerosing hyperplasia of the breast ducts. Patients are typically asymptomatic, and it is usually picked up incidentally. A mammogram typically shows a star or rosette-shaped lesion with a translucent centre.
What should be monitored before and during usage of Herceptin?
Cardiac function - causes cardiotoxicity
What is a Galactocele?
A breast lesion most commonly occurring in women who have recently ceased breastfeeding. Milk builds up and stagnates within the lactiferous ducts, leading to the formation of a mobile, cyst-like lesion which can be tender.
What are risk factors for breast cancer?
Increased hormone exposure (Early menarche or late menopause
Nulliparity or late first pregnancy
Oral contraceptives or Hormonal Replacement Therapy)
BRCA1/BRCA2
Older
White
Obesity
Alcohol/Smoking
Family Hx
What is a Seroma?
A localised accumulation of fluid beneath the skin surface
What is recommended in any woman who undergoes a WLE?
Adjuvant radiotherapy
If ER+ , Tamoxifen or Anastrozole (Post-Menopasual) would also be given
If HER2 + , Herceptin would also be given
