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Finals > Breast > Flashcards

Breast Flashcards

1
Q

Things to look for in breast exam

A
  • assymetry
  • scars
  • implants
  • tethering
  • nipple eversion/inversion
  • nipple discharge
  • colour
  • peau d’orange
  • paget’s disease of the nipple
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2
Q

what is peau d’orange

A

irregular patch of skin assoc with inflammatory breast cancer

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3
Q

what is paget’s disease of the nipple

A

erythematous, scaly rash of nipple

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4
Q

how to assess a breast lump

A
  • location
  • size
  • shape
  • consistency
  • margins
  • mobile or fixed
  • tenderness
  • skin colour
  • nipple discharge
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5
Q

what does assessment of a breast lump entail

A

triple assessment
- clinical
- imaging
- histology

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6
Q

signs suggestive of breast cancer

A
  • Lumps that are hard, irregular, painless or fixed in place
  • tethered lumps
  • Nipple retraction
  • Skin dimpling or oedema (peau d’orange)
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7
Q

what is fibroadenoma

A

common benign tumours of stromal/epithelial breast duct tissue
- smooth and mobile
- 20 to 40 yrs
- painless
- well circumscribed
- <3cm

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8
Q

what is fibrocystic breast changes

A
  • response to oestrogen and progesterone to become fibrous and cystic
  • benign
  • lumpiness
  • breast pain/tenderness
  • fluctuation of breast size
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9
Q

Mx of fibrocystic breast change

A
  • supportive bra
  • NSAIDs
  • avoid caffeine
  • apply heat to the area
  • hormonal treatments (danazol and tamoxifen)
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10
Q

What are breast cysts

A
  • benign individual fluid filled lumps
  • 30-50yrs
  • smooth, well circumscribed, mobile lump
  • possibly fluctuant
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11
Q

what is fat necrosis

A

benign lump formed by localised degeneration and scarring of fat tissue in the breast
can be assoc with oil cyst
no increased risk of cancer

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12
Q

trigger for fat necrosis

A

trauma
radiotherapy
surgery

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13
Q

presentation of fat necrosis

A

painless, firm, irregular, fixed in local structures, dimpling or nipple inversion

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14
Q

what is a lipoma

A

benign tumours of adipose tissue
soft, painless, mobile, no skin changes
conservative mx

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15
Q

what is a galactocele

A
  • in lactating women after stopping breastfeeding
  • breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk.
  • firm, mobile, painless lump, beneath the areola
  • benign
  • resolve without mx
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16
Q

what is a phyllodes tumour

A

rare tumours of connective tissue of the breast
40-50 yrs
large and fast growing
benign, borderline or malignant

Mx- surgical removal

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17
Q

what is mastalgia

A

breast pain
cyclical or non-cyclical

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18
Q

what is cyclical breast pain

A
  • related to hormonal fluctuations
  • more common
  • bilateral and generalised pain
  • heaviness
  • aching
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19
Q

what is non-cyclical breast pain

A
  • 40 to 50yrs
  • more localised
    can be caused by:
  • medications (contraceptives)
  • infection (mastitis)
  • pregnancy
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20
Q

what do you need to exclude with mastalgia presentation

A
  • cancer
  • infection (mastitis)
  • pregnancy
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21
Q

Mx of mastalgia

A
  • supportive bra
  • NSAIDs
  • avoid caffeine
  • heat
  • hormonal treatments (danazol and tamoxifen)
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22
Q

what is gynaecomastia

A

enlargement of the glandular breast tissue in males

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23
Q

causes of gynaecomastia

A
  • prolactinoma
  • dopamine antagonists (antipsychotics)
  • idiopathic
  • physiological
  • obesity
  • testicular cancer (leydig)
  • hyperthyroidism
  • hCG secreting tumour
  • testosterone deficiency
  • Klinefelter’s
  • anabolic steroids
  • spironolactone
  • alcohol, opiates & weed
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24
Q

Mx of gynaecomastia

A

treat underlying cause
if persistent
- tamoxifen
- surgery

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25
Q

what is galactorrhoea

A

breast milk production not associated with pregnancy or breastfeeding. Breast milk is produced in response to the hormone prolactin

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26
Q

causes of hyperprolactinaemia

A
  • idiopathic
  • prolactinoma
  • endocrine disorder: hypothyroidism and PCOS
  • antipsychotic meds
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27
Q

other sx assoc with galactorrhoea

A

Prolactin suppresses gonadotropin-releasing hormone (GnRH) by the hypothalamus, leading to reduced LH and FSH release.

  • Menstrual irregularities, particularly amenorrhoea
  • Reduced libido
  • Erectile dysfunction
  • Gynaecomastia
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28
Q

conditions that cause non milk nipple discharge

A
  • Mammary duct ectasia
  • Duct papilloma
  • Pus from a breast abscess
29
Q

what is mammary duct ectasia?

A

benign condition where there is dilation of the large ducts in the breasts
inflammation –> intermitten discharge (white, grey, green)

30
Q

demographic for mammary duct ectasia

A

perimenopausal
smoking = RF

31
Q

presentation of mamary duct ectasia

A
  • Nipple discharge
  • Tenderness or pain
  • Nipple retraction or inversion
  • A breast lump (pressure on the lump may produce nipple discharge)
32
Q

Mx of mammary duct ectasia

A

can self resolve
- supportive bra
- warm compress
- abx if infection
-surgical excision of affected duct

33
Q

what is intraductal papilloma

A

warty lesion that grows within one of the ducts in the breast. It is the result of the proliferation of epithelial cells.
benign
can be assoc with hyperplasia/ breast cancer

34
Q

presentation of intraductal papilloma

A
  • 35-55 yrs
  • Nipple discharge (clear or blood-stained)
  • Tenderness or pain
  • A palpable lump
35
Q

Mx of intraductal papilloma

A

complete surgical excision

36
Q

what is lactational mastitis

A

inflammation of breast tissue and is a common complication of breastfeeding. It can occur with or without associated infection.

37
Q

causes of mastitis

A

obstruction
infection (staph A)

38
Q

presentation of lactational mastitis

A
  • Breast pain and tenderness (unilateral)
  • Erythema in a focal area of breast tissue
  • Local warmth and inflammation
  • Nipple discharge
  • Fever
39
Q

Mx of lactational mastitis

A
  • continue breastfeeding
  • heat pack and analgesia
  • flucloxacillin for infection
40
Q

complication of lactational mastitis

A

breast abscess

41
Q

what is candida of the nipple

A

Candidal infection of the nipple can occur, often after a course of antibiotics

42
Q

presentation of candida of the nipple

A
  • Sore nipples bilaterally, particularly after feeding
  • Nipple tenderness and itching
  • Cracked, flaky or shiny areola
  • Sx in the baby, such as white patches in the mouth and on the tongue (oral thrush), or candidal nappy rash
43
Q

mx of candida of the nipple

A

Mother and baby need treatment:

  • Topical miconazole 2% to the nipple, after each breastfeed
  • Treatment for the baby (e.g., oral miconazole gel or nystatin)
44
Q

what is a breast asbcess

A

collection of pus within an area of the breast, usually caused by a bacterial infection. This may be a:

  • Lactational abscess
  • Non-lactational abscess
45
Q

what is pus

A

thick fluid produced by inflammation.
It contains dead white blood cells of the immune system and other waste from the fight against the infection

46
Q

causes of breast abscess

A
  • Staph A (MC)
  • Streptococcal species
  • Enterococcal species
  • Anaerobic bacteria (such as Bacteroides species and anaerobic streptococci)
47
Q

presentation of breast abscess

A
  • acute
  • Nipple changes
  • Purulent nipple discharge
  • Localised pain
  • Tenderness
  • Warmth
  • Erythema
  • Hardening of the skin or breast tissue
  • Swelling
  • swollen fluctuant tender lump
  • fever
48
Q

Mx of breast abscess

A

analgesia
abx
incision and drainage
MC&S of fluid

49
Q

most common cancer in the UK

A

breast

50
Q

RFs for breast cancer

A
  • increased oestrogen exposure
  • obesity
  • smoking
  • FH
  • female
  • more dense breast tissue
  • COCP
  • HRT
51
Q

genes involved with breast cancer

A

BRCA 1(chr17) and 2 (chr13)
also increases ovarian cancer

52
Q

types of breast cancer

A
  • ductal carcinoma in situ
  • lobular carcinoma in situ
  • invasive ductal carcinoma
  • invasive lobular carcinoma
  • inflammatory breast cancer
  • paget’s disease of the nipple
  • medullary
  • mucinous
  • tubular
53
Q

describe DCIS

A
  • Pre-cancerous or cancerous epithelial cells of the breast ducts
  • Localised to a single area
  • Often picked up by mammogram screening
  • Potential to spread locally over years
  • Potential to become an invasive breast cancer (around 30%)
  • Good prognosis if full excised and adjuvant treatment is used
54
Q

describe LCIS

A
  • A pre-cancerous condition occurring typically in pre-menopausal women
  • Usually asymptomatic and undetectable on a mammogram
  • Usually diagnosed incidentally on a breast biopsy
  • Represents an increased risk of invasive breast cancer in the future (around 30%)
  • Often managed with close monitoring (e.g., 6 monthly examination and yearly mammograms)
55
Q

describe invasive ductal carcinoma

A
  • Originate in cells from the breast ducts
  • 80% of invasive breast cancers fall into this category
  • Can be seen on mammograms
56
Q

Describe invasive lobular carcinomas

A
  • Around 10% of invasive breast cancers
  • Originate in cells from the breast lobules
  • Not always visible on mammograms
57
Q

describe inflammatory breast cancer

A
  • 1-3% of breast cancers
  • Presents similarly to a breast abscess or mastitis
  • Swollen, warm, tender breast with pitting skin (peau d’orange)
  • Does not respond to antibiotics
  • Worse prognosis than other breast cancers
58
Q

describe paget’s disease of the nipple

A
  • Looks like eczema of the nipple/areolar
  • Erythematous, scaly rash
  • Indicates breast cancer involving the nipple
  • May represent DCIS or invasive breast cancer
  • Requires biopsy, staging and treatment, as with any other invasive breast cancer
59
Q

what is breast cancer screening

A

mammogram every 3 years 50-70yrs

60
Q

presentation of breast cancer

A
  • Lumps that are hard, irregular, painless or fixed in place
  • Lumps may be tethered to the skin or the chest wall
  • Nipple retraction
  • Skin dimpling or oedema (peau d’orange)
  • Lymphadenopathy, particularly in the axilla
61
Q

referral criteria for suspected breast cancer

A
  • An unexplained breast lump in patients aged 30 or above
  • Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)
  • An unexplained lump in the axilla in patients aged 30 or above
  • Skin changes suggestive of breast cancer
62
Q

breast imaging modalities

A
  • USS in <30s
  • mammograms >30
63
Q

breast cancer receptors

A
  • Oestrogen receptors (ER)
  • Progesterone receptors (PR)
  • Human epidermal growth factor (HER2)

Triple-negative breast cancer is where the breast cancer cells do not express any of these three receptors. This carries a worse prognosis, as it limits the treatment options for targeting the cancer.

64
Q

most common sites of metastasis in breast cancer

A

2Ls and 2Bs

  • L: lungs
  • L: liver
  • B: bones
  • B: brain
65
Q

Mx of breast cancer

A
  • surgery (mastectomy or breast-conserving +radiotherapy)
66
Q

hormone treatments for breast cancer

A

ER positive
- tamoxifen for premenopausal
- aromatase inhibitors (post menopausal)

67
Q

mx for HER2 positive BC

A

Herceptin
Perjet
NERATINIB

68
Q

which hormonal therapy is used for oestrogen receptor positive breast cancer

A

Tamoxifen- premenopausal (TAMPON)
Anastrazole- postmenopausal (ANCIENT)

69
Q

inheritance pattern of BRCA gene

A

autosomal dominant, therefore children have 50% chance of inheritance so do siblings

Finals (12 decks)

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