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Y4 Cancer > Breast > Flashcards

Breast Flashcards

1
Q

PC - extremely mobile, smooth and firm breast lumps
younger patient
“breast mouse”

A

fibroadenoma

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2
Q

How would you manage a fibroadenoma?

A

> 3cm surgical excision

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3
Q

PC - smooth, discrete and fluctuant breast mass
peri-menopausal woman

A

Breast cyst

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4
Q

How would a breast cyst be managed?

A

aspirated as small risk of cancer, esp if young
*if blood stained or persistently refilling biopsy and excise

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5
Q

PC - breast lump or pain, mammographic changes that mimic cancer
*distortion of lobular unit without hyperplasia

A

sclerosing adenosis

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6
Q

PC - hard, irregular lump. dimpling of skin, nipple changes
obese woman, mechanical trauma, recent surgery

A

fat necrosis - imaging and core biopsy

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7
Q

PC - tender lump, green-brown discharge

A

mammary duct ectasia

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8
Q

how do you manage mammary duct ectasia?

A

none
microdochetomy if young

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9
Q

What are some differentials for nipple discharge?

A

physiological breast feeding
galactorrhoea
hyperprolactinaemia
mammary duct ectasia - thick and green, smoker
carcinoma - blood stained
intraductal papilloma - blood stained, no lump, young

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10
Q

PC - painless, hard, ,irregular lump, nipple inversion or skin tethering

A

breast cancer

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11
Q

PC - dry, reddening and thickening, eczematous changes of breast and areola

A

pagets disease of the breast
*associated with underlying malignancy

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12
Q

PC - progressive erythema and oedema of breast in absence of signs of infection, WCC & CRP etc

A

inflammatory BC

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13
Q

What is the most common type of breast cancer?

A

invasive ductal carcinoma

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14
Q

Where does ductal carcinoma in situ arise from?

A

epithelial cells lining the ducts
*no BM invasion, u/L

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15
Q

where does lobular carcinoma in-situ arise from?

A

epithelial cells inside the lobules (secretory units made of many acini cells) confined to the acini cells
*pre-menopausal women. b/L usually

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16
Q

What are the 2 types of cancers that have invaded the BM?

A

invasive ductal carcinoma - cells have no particular features under microscope
invasive lobular carcinoma

17
Q

What is the pathophysiology of breast cancer?

A

BRCA 1, BRCA 2 mutations –> acquired or inherited
- glandular cells become malignant with oncogene mutations
- HER2 oncogene overexpression - for cell survival

18
Q

What is BRCA 1 associated with?

A

*chromosome 7
increased risk of bowel, prostate and breast cancer

19
Q

What is BRCA 2 associated with?

A

*chromosome 13
increases men’s risk of BC, lower risk than BRCA 1

20
Q

What are some risk factors for developing BC?

A

oestrogen exposure - nulliparity, combined HRT, COCP, early menarche, late menopause
high BMI
FHx
age
female
alcohol intake, smoking

21
Q

How might breast cancer present?

A

lump - painless, irregular, craggy, hard
nipple changes - dimpling, skin changes, Peau d orange, discharge
constitutional sx
mets sx
pagets disease!

22
Q

How does breast screening work?

A

females
50-71 y/o –> mammogram
30 - BRCA + MRI
20 - p53 + MRI

23
Q

What are some risks with the breast cancer screening programme?

A

male patients
trans patients
homeless people may not hear about from GP

24
Q

What are the urgent 2ww referral criteria for BC?

A

30+ unexplained lump with or without pain
50+ nipple discharge, retraction or other concerning changes

25
Q

What is included in the triple assessment for BC?

A

clinical assessment and hx
imaging - b/L USS <30 and mammo >30
biopsy - fine needle, sentinel node or USS guided

26
Q

What other investigations are needed in suspected BC?

A

FBC for anaemia, infection, neutropenia
LFT - mets
CRP - infection
U&E - renal function pre imaging and management
bone profile - hypercalcaemia and mets

imaging - CT thorax, abdo, pelvis, PET, CXR, CT head

hormone receptors - oestrogen, progesterone, HER2

27
Q

What is the relevance of hormone receptors in BC management?

A

oestrogen - binds to nucleus on cancer cell and causes proliferation, if negative prognosis worse as less like parent cell
HER2 - proliferative and anti-apoptosis signals hence prognostically worse

*can target in treatment!

28
Q

What methods of surgery can be offered in BC?

A

wide local with 1cm margin - solitary, peripheral, small
mastectomy - multifocal, central, large
sentinel node - prevent spread

29
Q

What are the risks of breast cancer surgery?

A
  • infection, anaesthetic risk, nerve or vessel damage, bleeding risk, VTE, body image
  • Seroma - collection of serous fluid which could become infected
  • Lymphoedema - swelling due to impaired lymph drainage, difficult to treat so avoid!!
    • avoid cannulation, BP measurement and blood taking on the arm on the side of mastectomy as further contributing
30
Q

What kind of chemo regimens can be given in BC?

A

neo-adjuvant to allow for WLE > mastectomy
adjuvant - reduce recurrence and destroy any micro-mets
preventative in hormone negative disease

31
Q

What are the risks with chemo?

A

short term - hair loss, fatigue, N+V, infection risk
long term - infertility, osteoporosis, cardiac, leukaemia

32
Q

What is the consideration for radiotherapy in BC?

A

adjuvant - target residual cells
axillary nodes
bony mets
reduce risk of recurrence in WLE

33
Q

What are some risks with radiotherapy?

A

CVS risks
lung pneumonitis
radiation dermatitis
rib #

34
Q

What hormone therapies are considered in BC?
+ what are some risks?

A

aromatase inhibitor - post-menopausal women to prevent peripheral conversion of fat to oestrogen

tamoxifen - competitive oestrogen inhibition, in pre-menopausal

*VTE and endometrial cancer risk

35
Q

What is the implication of immunotherapy in BC?
+ risk?

A

HER2 proto-oncogene mutations and MAB target

*skin toxicity, hepatotoxicity, GI tox, pneumonitis

36
Q

What are some indications for poor prognosis in BC?

A
  • short disease free interval
  • triple negative cancers
  • BRCA 1+2
  • brain and spine metastases
  • lack of response to previous cancer treatments

Y4 Cancer (15 decks)

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