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finals > Breast > Flashcards

Breast Flashcards

1
Q

Breast cancer screening

A

Every 3 yrs 50-70

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2
Q

Explain the triple assessment for breast cancer

A
  1. History ad Examination
  2. Imaging (USS/Mammogram)
  3. Biopsy (fine needle or core)
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3
Q

Give the 4 common types of breast cancer

A
  • Invasive ductal carcinoma.
  • Invasive lobular carcinoma
  • Ductal carcinoma-in-situ (DCIS)
  • Lobular carcinoma-in-situ (LCIS)
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4
Q

Most common type of breast cancer

A
  • Invasive ductal carcinoma.
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5
Q

6 for breast cancer

A
  • BRAC1, BRAC2 genes
  • Nullparity
  • Early menarche, late menopause
  • COCP
  • 1st degree relative with premenopausal breast cancer
  • Obesity
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6
Q

When will a pt be 2 week waited for suspected breast cancer ?

A
  • 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
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7
Q

what is done prior to surgery for breast cancer in women with no palpable axillary lymphadenopathy

A
  • pre-operative axillary ultrasound before their primary surgery
  • If negative then they should have a sentinel node biopsy to assess the nodal burden
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8
Q

what is done in patients with breast cancer who present with clinically palpable lymphadenopathy,

A

axillary node clearance is indicated at primary surgery

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9
Q

when is wide local excision preferred over mastectomy ?

A

Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm

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10
Q

when is a mastectomy preferred over wide local excision for breast cancer

A

Multifocal tumour
Central tumour
Large lesion in small breast
DCIS > 4cm

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11
Q

what further treatment is recommended following wide local excision / mastectomy for T3-T4 tumours / 4 or more +ve lymph nodes

A

Whole breast Radiotherapy to reduce recurrence

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12
Q

what adjuvant hormonal therapy is used for oestrogen receptor positive breast cancers in pre menopausal women

A

Tamoxifen = increased endometrial cancer risk

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13
Q

what adjuvant hormonal therapy is used for oestrogen receptor positive breast cancers in post menopausal women

A

Aromatase inhibitors - anastrozole
Reduce peripheral oestrogen synthesis

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14
Q

What biological therapy can be used for HER2 receptor +ve breast cancers

A

Herceptin (Trastuzumab)

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15
Q

what is tamoxifen

A

SERM = selective oestrogen receptor modulator

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16
Q

4 adverse effects of tamoxifen

A

Increased VTE risk
Increased endometrial cancer risk
Hot flushes
Menstrual disturbance (vaginalbleeding, amenorrhoea)

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17
Q

4 adverse effects of anastrozole

A
  • osteoporosis
    NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
  • hot flushes
  • arthralgia, myalgia
  • insomnia
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18
Q

Presentation of fibroadenoma

A
  • Tumour of stromal / epithelial breast duct tissue
  • Women 20-40
  • Mobile, firm, smooth breast lump
  • Painless, well defined borders
  • Some will shrink, grow or stay the same
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19
Q

Management of fibroadenoma >3cm and >4cm

A
  • > 3cm = excision
  • > 4cm = Core biopsy to excluse phyllodes tumour
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20
Q

Presentation of breast cysts

A
  • Aged 30-50
  • Small discrete flutuant lump
  • Can be painful
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21
Q

Mangaemnt of breast cysts

A
  • Aspirated, those which are blood stained or persistently refill should be biopsied or excised
22
Q

Common cause of fat necrosis

A
  • Localised trauma, radiotherapy or surgery, with an inflammatory reaction resulting in fibrosis and necrosis (death) of the fat tissue. It does not increase the risk of breast cancer.
23
Q

Presentation of fat necrosis

A

Painless
Firm
Irregular
Fixed in local structures
There may be skin dimpling or nipple inversion

24
Q

what is mammory duct ectasia

A

dilation of the large ducts in the breast

25
Q

Presentation of mammary duct ectasia

A

Nipple discharge (cheese like/brown green)
Tenderness or pain
Nipple retraction (slit like) or inversion
A breast lump (pressure on the lump may produce nipple discharge)

26
Q

Finding on mammogram in mammory duct ectasia

A

Microcalcifications

27
Q

what is an intraductal papilloma

A

Local areas of epithelial proliferation in large mammary ducts = warty lesion

28
Q

Possible presentation of papilloma

A

Nipple discharge (clear or blood-stained)
Tenderness or pain
A palpable lump

29
Q

Management of papilloma

A

Surgical excision

30
Q

Presentation of mastitis

A

painful, tender, red hot breast
fever, and general malaise may be present

31
Q

management of mastitis

A
  • Continue to breastfeed, analgesia ad warm compress for 24 hrs
    10 -14 days oral flucloxacillin (as usually staph aureus)
32
Q

Complication of intreated mastitis

A

Breast abscess

33
Q

what suggests development of breast abscess

A

Swollen, fluctuant tender lump

34
Q

Management of non lactational mastitis

A
  • Co-amoxiclav
  • Erythromycin/clarithromycin (macrolides) plus metronidazole (to cover anaerobes)
35
Q

Management of breast abscess

A
  • Referral to the on-call surgical team in the hospital for management
    -Antibiotics
  • Ultrasound (confirm the diagnosis and exclude other pathology)
  • Drainage (needle aspiration or surgical incision and drainage)
  • Microscopy, culture and sensitivities of the drained fluid
36
Q

4 causes of hyperprolactinaemia

A
  1. Idiopathic
  2. Prolactinomas
  3. Endo : hypothyroid, PCOS
  4. Medications : dopamine agonists
37
Q

4 symptoms of hyperprolactinaemia and why

A

Suppresses GnRH from hypothalamus = low LH, FHS

1 ED
2. Reduced libido
3. Gynaecomastia
4. Amennorhoea

38
Q

Association with prolactinoma

A

Multiple endocrine neoplasia type 1

39
Q

Key bloods to do for galactorrhoea

A

Serum prolactin
Renal profile (U&Es)
Liver function tests (LFTs)
Thyroid function tests (TFTs)

40
Q

Management of prolactinoma

A
  • Dopamine agonists (e.g., bromocriptine or cabergoline)
41
Q

Causes of gynaecomastia and why

A

RAISED OESTROGEN,LOW TESTOSTERONE

  1. Raised prolactin (=dopamine antagonists - antipsychotics)
  2. Idiopathic
  3. Liver cirrhosis
  4. Obesity
  5. Testicular cancer = leydig cell tumour
  6. Hyperthyroid
42
Q

gynaecomastia caused by conditions that reduce testosterone

A
  • Testosterone deficiency in older age
  • Hypothalamus or pituitary conditions that reduce LH and FSH levels (e.g., tumours, radiotherapy or surgery)
  • Klinefelter syndrome (XXY sex chromosomes)
  • Orchitis (inflammation of the testicles, e.g., infection with mumps)
  • Testicular damage (e.g., secondary to trauma or torsion)
43
Q

Drugs causing gynaecomastia

A
  • Anabolic steroids (raise oestrogen levels)
  • Antipsychotics (increase prolactin levels)
  • Digoxin (stimulates oestrogen receptors)
  • Spironolactone (inhibits testosterone production and blocks testosterone receptors)
  • Gonadotrophin-releasing hormone (GnRH) agonists (e.g., goserelin used to treat prostate cancer)
  • Opiates (e.g., illicit heroin use)
  • Marijuana
  • Alcohol
44
Q

what is paget’s disease of nipple

A
  • Eczematoid change of nipple associated with underlying malignancy
45
Q

Complicationv of axillary node clearance

A

Lyphoedema causing functional arm impairment

46
Q

what chemotherapy is used for breast cancer that is axilary node positive

A

FEC-D

47
Q

Key reason for neo-adjuvant chemotherapy

A

downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy

48
Q

Histological signs of DCIS

A

Comedo necrosis

49
Q

Histologysign of mucinous carcinoma

A

Grey, gelatinous surface

50
Q
A

finals (92 decks)

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