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finals > Breast > Flashcards

Breast Flashcards

1
Q

fibroadenoma?

A

‘Breast mice’
Benign non-tender firm mobile lump
No malignancy risk
If >3cm, excise

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2
Q

breast cyst?

A

Smooth discrete lump, may be fluctuant, may be painful (cyclical)
Small increased breast ca risk
Aspirate - biopsy if blood / persistently refilling
Can excise

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3
Q

sclerosing adenosis?

A

breast lump, pain
biopsy, excision not mandatory

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4
Q

epithelial hyperplasia?

A

generalised lumpiness / discrete lump
If atypical sx / FHx - malignancy risk
Leave, or excise if ca risk

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5
Q

fat necrosis?

A

40% traumatic cause, mimics carcinoma
Image, core biopsy

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6
Q

duct papilloma?

A

Growth of papilloma in single duct
Nipple discharge - clear / blood stained
No malignancy risk
Microdochectomy to tx

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7
Q

duct ectasia?

A

Dilatation + shortening of terminal breast duct - blocks with stagnant secretions
Px - nipple discharge, thick/green, nipple retraction
Mx - stop smoking, microdochectomy / total duct excision

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8
Q

periductal mastitis?

A

Younger pt than ectasia, strong association with smoking
Inflammation, abscess, mammary duct fistula
Mx - abx, drain abscess

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9
Q

breast abscess?

A

lactational mastitis common, usually S aureus
Tender, fluctuant mass on examination, fever
Abx, US-guided aspiration
Surgical debridement for skin necrosis

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10
Q

TB of breast?

A

rare, chronic breast / axillary sinus in 50%
Dx by biopsy culture / histology

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11
Q

breast cancer RFx?

A
  • Female
  • Increased oestrogen exposure - earlier period onset, later menopause
  • Dense breast - more glandular tissue
  • Obesity
  • Smoking
  • FHx 1st degree relative
  • cOCP (risk returns to normal 10yrs after stopping)
  • HRT - especially combined HRT

Genetics
- BRCA 1 - breast, ovarian, bowel, prostate risk
- BRCA 2 - breast, ovarian risk
- TP53, PTEN

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12
Q

types of breast cancer?

A

Ductal carcinoma in situ (DCIS)
Cancerous epithelial cells of breast ducts, one area, picked up on screening, potential to spread

Lobular carcinoma in situ (LCIS)
Pre-cancerous, in pre-menopause, asym, found incidentally on biopsy, increased risk invasive ca, monitor

Invasive ductal carcinoma NST (no specific type)
Not classified, originate from cells in breast ducts, see on mammogram, 80% of invasive

Invasive lobular carcinoma (ILC)
Originate from cells in breast lobules, 10% of invasive

Inflammatory breast ca
Cancer cells block lymph drainage, swollen, warm, tender, peau d’orange (pitting skin), no abx response

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13
Q

what is pagets?

A

Paget’s
Erythematous, scaly rash, breast ca involving nipple, 90% have invasive ca

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14
Q

breast cancer receptors?

A

Oestrogen receptor (ER)
Progesterone receptor (PR)
Human epidermal growth factor (HER2)

Triple negative breast cancer - none of these receptors, worse prognosis

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15
Q

where does breast cancer metastasise to?

A

lung, liver, bone, brain

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16
Q

breast cancer screening programme?

A

Mammogram every 3yrs to women 50-70yo

17
Q

what factors make someone a high risk breast cancer patients?

A

Eg, 1st degree relative:
With breast cancer <40yo
Male with breast cancer
Bl breast cancer, first diagnosed <50yo
2x 1st degree relative with breast cancer

18
Q

management of high risk breast cancer patients?

A

Genetic testing maybe
Annual mammogram
Chemoprevention
- Tamoxifen (premenopause - antioestrogen)
- Anastrozole (post-menopause, except if severe osteoporosis)

Surgery - bl mastectomy / oophorectomy

19
Q

breast cancer presentation?

A

Lump - hard, irregular, painless, fixed in place
May be tethered to skin / chest wall
Nipple retraction, discharge (blood-stained)
Skin dimpling / oedema (peau d’orange)
Lymphadenopathy (axilla)

20
Q

breast lump referral criteria?

A

2ww - unexplained breast lump >30yo / unilateral nipple discharge >50yo

Consider 2ww - unexplained axilla lump >30yo / skin changes

Consider non-urgent referral - unexplained breast lump +/- pain

21
Q

breast cancer investigations/

A
  • history + exam
  • USS / mammography
  • Biopsy - fine needle / core

USS - younger women, look at lumps

Mammogram - older, see calcifications

MRI - screening, further tumour assessment

Lymph nodes - US axilla / US-guided biopsy / sentinel node biopsy (in surgery)

TNM staging

Nottingham prognostic index to indicate survival

22
Q

breast cancer management?

A

Surgery
- Wide local excision - <4cm, solitary peripheral mass
- Mastectomy - >4cm, multifocal, central mass
- Reconstruction
- Lymph node clearance

Radio / chemo

Hormone Tx
- Tamoxifen - does increase endometrial cancer risk
- Anastrozole / letrozole
- Fulvestrant - selective oestrogen receptor down-regulator
- GnRH agonist - goserelin
- Ovarian surgery

HER2 - herceptin (trastuzumab) - MAb targeting HER2 - can affect heart function
Also perjeta, nerlynx

Yearly mammograms for 5yrs

finals (21 decks)

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