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Yr 4 - PassMed Corrections > Breast > Flashcards

Breast Flashcards

1
Q

Breast cancer risk in DCIS vs LCIS?

A

LCIS –> associated with increased risk of breast cancer in BOTH breasts

DCIS –> associated with increased risk of breast cancer in affected breast ONLY

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2
Q

Does DCIS or LCIS have a higher risk of malignancy in the future?

A

LCIS

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3
Q

What are the 2 types of invasive ductal carcinoma?

A

1) Tubular

2) Mucinous

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4
Q

Who is mucinous invasive ductal carcinoma more commonly seen in?

A

Older women after menopause

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5
Q

How does invasive ductal carcinoma typically metatasise?

A

Via the lymphatic vessels

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6
Q

What is the most common type of breast cancer in males?

A

Invasive ductal carcinoma

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7
Q

Which type of breast cancer is associated with low E-Cadherin expression?

A

Invasive lobular carcinoma

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8
Q

What is required to distinguish between Paget’s and eczema?

A

Punch biopsy

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9
Q

What type of cancer does peau d’orange of the breast indicate?

A

Inflammatory breast cancer

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10
Q

Describe the breast cancer screening program

A

50-70 y/o every 3 years

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11
Q

When is anastrozole contraindiated in the chemoprevention of breast cancer in postmenopausal women?

A

In severe osteoporosis

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12
Q

what type of nipple discharge is often deemed benign?

A

Bilateral, clear, milky

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13
Q

In which area of the breast do most breast cancers arise?

A

Upper outer quadrant

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14
Q

What is the NICE criteria for a 2 week wait referral for suspected breast cancer?

A

1) ≥30 y/o with unexplained breast lump

2) ≥50 y/o with unilateral nipple changes

3) ≥30 y/o with unexplained lump in axilla

4) Skin changes suggestive of breast cancer

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15
Q

What imaging modality is used for breast cancer assessment in younger women (<30/40)?

Why?

A

Ultrasound as more dense breasts (more glandular tissue)

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16
Q

What can mammograms pick up that may be missed by US?

A

Calcifications

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17
Q

What is US of the breast useful in differentiating?

A

Helpful in distinguishing solid lumps (e.g. fibroadenoma or cancer) from cystic lumps (fluid-filled)

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18
Q

What imaging may be recommended after a mammogram?

A

MRI

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19
Q

What imaging may be recommended for screening in women at higher risk of developing breast cancer (e.g., strong family history)?

A

MRI

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20
Q

What are the 2 options for biopsy in breast cancer triple assessment?

A

1) Core biopsy

2) Fine needle aspiration

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21
Q

What is fine needle aspiration (FNA)?

A

Uses a single fine needle to collect cells to allow for cytology.

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22
Q

When is FNA typically used in breast lump assessment?

A

Often used for smaller more cystic lumps and is usually performed under US guidance.

23
Q

What is a core biopsy?

A

Uses a wider needle often performed under US guidance.

It takes a core of tissue, which provides much more information about the cancer and its involvement with surrounding tissues leading to a higher diagnostic yield compared to FNA.

24
Q

Does a core biopsy or FNA give a higher diagnostic yield?

A

Core biopsy

25
Q

Why is a sentinel lymph node biopsy performed in breast cancer?

A

Can be done during breast cancer SURGERY where the initial US does not show any abnormal nodes.

26
Q

If cancer cells are found in the lymph nodes in breast cancer, what is offered?

A

Removal of the axillary lymph nodes.

27
Q

Why should you avoid taking blood or putting a cannula in the arm on the side of previous breast cancer removal surgery?

A

There is a higher risk of complications and infection due to the impaired lymphatic drainage on that side.

28
Q

When is radiotherapy used in breast cancer?

A

Radiotherapy is usually used in patients with breast-conserving surgery to reduce the risk of recurrence.

29
Q

What is the aim of neoadjuvant chemo?

A

Shrink size of tumour before surgery

30
Q

What is the aim of adjuvant chemo?

A

Given after surgery to reduce risk of recurrence

31
Q

What test can be done in breast cancer to predict the chance of recurrence (and decide if adjuvant chemotherapy is needed)?

A

Oncoptype DX breast recurrence score assay

32
Q

What is a key side effect of chemo in pre-menopausal women?

A

Premature ovarian failure

33
Q

What can be given to help prevent premature ovarian failure in chemo?

A

GnRH agonists e.g. goserelin

34
Q

What is tamoxifen?

A

SERM

It either blocks or stimulates oestrogen receptors, depending on the site of action.

35
Q

Where does tamoxifen STIMULATE oestrogen receptors? (2)

A

1) Endometrial tissue (increases risk of endometrial cancer)

2) Bones (can help prevent osteoporosis)

36
Q

What is the 1st line pharmacological option for hormone therapy in ER-positive breast cancer in postmenopausal women?

A

Aromatase inhibitors (Letrozole, Anastrozole, Exemestane)

37
Q

How long is tamoxifen/aromatase inhibitors given for in women with ER positive breast cancer?

A

5-10 years

38
Q

Which monoclonal antibody is used for breast cancers that express HER2?

A

Trastuzumab (Herceptin)

39
Q

What is a key side effect of Herceptin?

A

Cardiotoxicity

40
Q

What is another monoclonal antibody that targets the HER2 receptor?

A

Pertuzumab (Perjeta)

41
Q

Reconstructive surgery is offered to all patients having a mastectomy.

What are the 2 options?

A

1) Immediate reconstruction, done at the time of the mastectomy

2) Delayed reconstruction, which can be delayed for months or years after the initial mastectomy

42
Q

After mastectomy, what are the options for reconstructing the breast(s)?

A

1) Breast implants (inserting a synthetic implant)

2) Flap reconstruction (using tissue from another part of the body to reconstruct the breast)

43
Q

Which type of non-invasive breast cancer typically occurs in pre-menopausal women?

A

LCIS

44
Q

What is recommended after a woman has had a wide-local excision of a breast tumour?

A

Whole breast UNILATERAL radiotherapy (may reduce the risk of recurrence by around two-thirds)

45
Q

When is axillary node clearance indicated in breast cancer?

A

1) Palpable lymphadenopathy

2) If at sentinel node biopsy, ≥3 involved nodes are found

46
Q

When is a sentinel lymph node considered negative (and axillary clearance not indicated)?

A

1) micrometastases

2) ≤2 macrometastases

Close, don’t dissect.

47
Q

What is a key side effect of anastrozole?

A

Osteoporosis

48
Q

What neoadjuvant chemo is indicated in breast cancer patients with confirmed nodal involvement?

A

FEC-D chemotherapy, followed by wide local excision and whole breast radiotherapy.

49
Q

Length of flucloxacillin in lactational mastitis?

A

10-14 days

50
Q

What may occur after puerperal mastitis is treated with antibiotics?

A

Candida of the nipple –> can in turn cause candida of baby’s mouth

51
Q

What is a radial scar?

A

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.

51
Q

What will a mammogram show in a radial scar?

A

A mammogram typically shows a star or rosette-shaped lesion with a translucent centre.

52
Q

Mx of fat necrosis of the breast?

A

Often conservative

53
Q
A

Yr 4 - PassMed Corrections (36 decks)

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