Breast Flashcards
Breast cancer screening
Every 3 yrs 50-70
Explain the triple assessment for breast cancer
- History ad Examination
- Imaging (USS/Mammogram)
- Biopsy (fine needle or core)
Give the 4 common types of breast cancer
- Invasive ductal carcinoma.
- Invasive lobular carcinoma
- Ductal carcinoma-in-situ (DCIS)
- Lobular carcinoma-in-situ (LCIS)
Most common type of breast cancer
- Invasive ductal carcinoma.
6 for breast cancer
- BRAC1, BRAC2 genes
- Nullparity
- Early menarche, late menopause
- COCP
- 1st degree relative with premenopausal breast cancer
- Obesity
When will a pt be 2 week waited for suspected breast cancer ?
- 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
what is done prior to surgery for breast cancer in women with no palpable axillary lymphadenopathy
- pre-operative axillary ultrasound before their primary surgery
- If negative then they should have a sentinel node biopsy to assess the nodal burden
what is done in patients with breast cancer who present with clinically palpable lymphadenopathy,
axillary node clearance is indicated at primary surgery
when is wide local excision preferred over mastectomy ?
Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS < 4cm
when is a mastectomy preferred over wide local excision for breast cancer
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS > 4cm
what further treatment is recommended following wide local excision / mastectomy for T3-T4 tumours / 4 or more +ve lymph nodes
Whole breast Radiotherapy to reduce recurrence
what adjuvant hormonal therapy is used for oestrogen receptor positive breast cancers in pre menopausal women
Tamoxifen = increased endometrial cancer risk
what adjuvant hormonal therapy is used for oestrogen receptor positive breast cancers in post menopausal women
Aromatase inhibitors - anastrozole
Reduce peripheral oestrogen synthesis
What biological therapy can be used for HER2 receptor +ve breast cancers
Herceptin (Trastuzumab)
what is tamoxifen
SERM = selective oestrogen receptor modulator
4 adverse effects of tamoxifen
Increased VTE risk
Increased endometrial cancer risk
Hot flushes
Menstrual disturbance (vaginalbleeding, amenorrhoea)
4 adverse effects of anastrozole
- osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer - hot flushes
- arthralgia, myalgia
- insomnia
Presentation of fibroadenoma
- 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
Management of fibroadenoma >3cm and >4cm
- > 3cm = excision
- > 4cm = Core biopsy to excluse phyllodes tumour
Presentation of breast cysts
- Aged 30-50
- Small discrete flutuant lump
- Can be painful
Mangaemnt of breast cysts
- Aspirated, those which are blood stained or persistently refill should be biopsied or excised
Common cause of fat necrosis
- 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.
Presentation of fat necrosis
Painless
Firm
Irregular
Fixed in local structures
There may be skin dimpling or nipple inversion
what is mammory duct ectasia
dilation of the large ducts in the breast
Presentation of mammary duct ectasia
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)
Finding on mammogram in mammory duct ectasia
Microcalcifications
what is an intraductal papilloma
Local areas of epithelial proliferation in large mammary ducts = warty lesion
Possible presentation of papilloma
Nipple discharge (clear or blood-stained)
Tenderness or pain
A palpable lump
Management of papilloma
Surgical excision
Presentation of mastitis
painful, tender, red hot breast
fever, and general malaise may be present
management of mastitis
- Continue to breastfeed, analgesia ad warm compress for 24 hrs
10 -14 days oral flucloxacillin (as usually staph aureus)
Complication of intreated mastitis
Breast abscess
what suggests development of breast abscess
Swollen, fluctuant tender lump
Management of non lactational mastitis
- Co-amoxiclav
- Erythromycin/clarithromycin (macrolides) plus metronidazole (to cover anaerobes)
Management of breast abscess
- 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
4 causes of hyperprolactinaemia
- Idiopathic
- Prolactinomas
- Endo : hypothyroid, PCOS
- Medications : dopamine agonists
4 symptoms of hyperprolactinaemia and why
Suppresses GnRH from hypothalamus = low LH, FHS
1 ED
2. Reduced libido
3. Gynaecomastia
4. Amennorhoea
Association with prolactinoma
Multiple endocrine neoplasia type 1
Key bloods to do for galactorrhoea
Serum prolactin
Renal profile (U&Es)
Liver function tests (LFTs)
Thyroid function tests (TFTs)
Management of prolactinoma
- Dopamine agonists (e.g., bromocriptine or cabergoline)
Causes of gynaecomastia and why
RAISED OESTROGEN,LOW TESTOSTERONE
- Raised prolactin (=dopamine antagonists - antipsychotics)
- Idiopathic
- Liver cirrhosis
- Obesity
- Testicular cancer = leydig cell tumour
- Hyperthyroid
gynaecomastia caused by conditions that reduce testosterone
- 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)
Drugs causing gynaecomastia
- 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
what is paget’s disease of nipple
- Eczematoid change of nipple associated with underlying malignancy
Complicationv of axillary node clearance
Lyphoedema causing functional arm impairment
what chemotherapy is used for breast cancer that is axilary node positive
FEC-D
Key reason for neo-adjuvant chemotherapy
downsize the tumour before surgery and allow breast conserving surgery rather than mastectomy
Histological signs of DCIS
Comedo necrosis
Histologysign of mucinous carcinoma
Grey, gelatinous surface
