Breast Flashcards by Esme Cosham

Breast cancer risk in DCIS vs LCIS?

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

LCIS

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What are the 2 types of invasive ductal carcinoma?

1) Tubular

2) Mucinous

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Who is mucinous invasive ductal carcinoma more commonly seen in?

Older women after menopause

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How does invasive ductal carcinoma typically metatasise?

Via the lymphatic vessels

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

Invasive ductal carcinoma

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

Invasive lobular carcinoma

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

Punch biopsy

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

Inflammatory breast cancer

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Describe the breast cancer screening program

50-70 y/o every 3 years

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

In severe osteoporosis

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what type of nipple discharge is often deemed benign?

Bilateral, clear, milky

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

Upper outer quadrant

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

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

Why?

Ultrasound as more dense breasts (more glandular tissue)

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

Calcifications

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What is US of the breast useful in differentiating?

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

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What imaging may be recommended after a mammogram?

MRI

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

MRI

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

1) Core biopsy

2) Fine needle aspiration

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What is fine needle aspiration (FNA)?

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

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When is FNA typically used in breast lump assessment?

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

What is a core biopsy?

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.

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

Core biopsy

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

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

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

Removal of the axillary lymph nodes.

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

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

When is radiotherapy used in breast cancer?

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

What is the aim of neoadjuvant chemo?

Shrink size of tumour before surgery

What is the aim of adjuvant chemo?

Given after surgery to reduce risk of recurrence

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

Oncoptype DX breast recurrence score assay

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

Premature ovarian failure

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

GnRH agonists e.g. goserelin

What is tamoxifen?

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

Where does tamoxifen STIMULATE oestrogen receptors? (2)

1) Endometrial tissue (increases risk of endometrial cancer) 2) Bones (can help prevent osteoporosis)

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

Aromatase inhibitors (Letrozole, Anastrozole, Exemestane)

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

5-10 years

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

Trastuzumab (Herceptin)

What is a key side effect of Herceptin?

Cardiotoxicity

What is another monoclonal antibody that targets the HER2 receptor?

Pertuzumab (Perjeta)

Reconstructive surgery is offered to all patients having a mastectomy. What are the 2 options?

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

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

1) Breast implants (inserting a synthetic implant) 2) Flap reconstruction (using tissue from another part of the body to reconstruct the breast)

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

LCIS

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

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

When is axillary node clearance indicated in breast cancer?

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

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

1) micrometastases 2) ≤2 macrometastases Close, don't dissect.

What is a key side effect of anastrozole?

Osteoporosis

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

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

Length of flucloxacillin in lactational mastitis?

10-14 days

What may occur after puerperal mastitis is treated with antibiotics?

Candida of the nipple --> can in turn cause candida of baby's mouth

What is a radial scar?

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.

What will a mammogram show in a radial scar?

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

Mx of fat necrosis of the breast?

Often conservative