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Breast Flashcards

1
Q

What features of a breast cancer indicate mastectomy instead of wide local excision?

A

Multifocal tumour
Central lesion
Large lesion in small breast
DCIS >4cm

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2
Q

What features of a breast cancer indicate wide local incision instead of mastectomy?

A

Solitary lesion
Peripheral lesion
Small lesion in large breast
DCIS >4cm

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3
Q

When is radiotherapy indicated following surgical removal of breast cancer?

A

All patients who have had a wide local excision

Patients who have had a mastectomy if T3-T4 disease or 4 or more positive axillary lymph nodes

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4
Q

What adjuvant therapy can be used for women with oestrogen receptor positive breast cancer?

A

Tamoxifen

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5
Q

What are 3 important side effects of Tamoxifen?

A

Increased risk of endometrial cancer
Increased risk of VTE
Menopausal symptoms

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6
Q

What is commonest biological therapy used in breast cancer?
When is it indicated?
When is it contraindicated?

A

Trastuzumab (Herceptin)
Indicated in HER2 positive tumours (although it is only effective in up to a quarter of these cases)
Contraindicated in women with history of heart disorders

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7
Q

What is the first step of management for a woman presenting with a new breast lump?

A

Triple Assessment

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8
Q

What features of nipple discharge are indications for Triple Assessment?

A

Blood stained
Persistent
Aged >50

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9
Q

Patient presents to GP with inflammation of her right breast which has not improved despite completing antibiotics course. What should the GP do now?

A

Refer to clinic for triple assessment

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10
Q

What is the grading of core biopsy samples?

A 
B1 - unsatisfactory sample/normal
B2 - benign
B3 - atypia, probably benign
B4 - suspicious of malignancy
B5 - malignant
B5a - carcinoma in situ
B5b - invasive carcinoma
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11
Q

What are the development abnormalities of the breast?

A
  • Hypoplasia (one or both breasts don’t develop)
  • Juvenile hypertrophy (breasts don’t stop growing)
  • Accessory breast tissue/nipples (can occur anywhere along the “milk line” from axilla to groin)
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12
Q

What are the benign conditions of the breast?

A 
gynaecomastia
fibrocystic change
fibroadenoma
hamartoma
scleroising lesions (scleroising adenosis and radial scar)
fat necrosis
duct ectasia
acute mastitis/abscess
Phyllodes tumour
Intraduct papilloma
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13
Q

What are the causes of gynaecomastia?

A 
Hormones:
- exogenous - anabolic steroids
- endogenous - endocrine disorder
Cannabis
Liver disease
Prescription drugs (e.g. spironolactone)
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14
Q

When is the commonest time for fibrocystic change to occur?

A

Age 40-50/the decade before the menopause

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15
Q

What often causes fibrocystic change to resolve?

A

Menopause

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16
Q

What are the clinical features of fibrocystic change?

A

Lumpiness - smooth discrete lumps
Cyclical pain
sudden pain - cyst rupture
sometimes asymptomatic and picked on screening

17
Q

Gross pathology: several cysts, blue and domed containing pale fluid, lined by apocrine epithelium. What is the most likely diagnosis?

A

Fibrocystic change

18
Q

What is fibrocystic change?

A

Localised dilatation of lobular and terminal ductules (presumably due to obstruction) forming cysts. Usually thin walled, and lined by apocrine epithelium (should be lined with columnar or cuboidal epithelium - metaplasia)

19
Q

How is fibrocystic change managed?

A

Exclude malignancy
Reassure
Excise if necessary (e.g. due to pain)

20
Q

What benign breast condition is a circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution (formed from a disordered collection of lobules, stroma, and fat)?

A

Hamartoma

21
Q

In which groups of women are fibroadenomas typically seen?

A

Young women

African women

22
Q

30 year-old female patient presents with a new breast lump. O/E it is rubbery, sooth and mobile. She has no other symptoms. What is the most likely diagnosis? What is your initial management?

A
  • Fibroadenoma

- Triple Assessment

23
Q

What is a fibroadenoma?

A

Localised hyperplasia
Biphasic tumour: epithelium and stroma
grey-white, rubbery, circumscribed lesion

24
Q

What are sclerosing adenosine and radial scar?

A

benign, disorderly proliferation of acini and stroma
Sclerosing adenosis: proliferation of the terminal duct lobular unit
Radial scar (complex sclerosing lesion): dense fibroelastic core (with central puckering), radiating stellate connective tissue fibrosis containing distorted ductules

25
Q

What are 2 causes of fat necrosis?

A

Local trauma

Warfarin therapy

26
Q

What is the process of fat necrosis?

A

Damage and disruption of adipocytes
Initial necrosis is accompanied by haemorrhage and followed by acute inflammatory reaction (infiltration by foamy macrophages)
Subsequent fibrosis and scarring and calcification
Can result in a firm lump, retraction of the nipple, or fixation of the skin (all of these also occur in cancer)

27
Q

What condition is characterised by progressive dilatation of large or intermediate ducts, with surrounding chronic predicate inflammation and fibrosis?

A

Duct Ectasia

28
Q

What are the clinical features of Duct ectasia?

A
  • affects sub-areolar ducts
  • pain
  • acute episodic inflammatory changes
  • bloody +/or purulent discharge (contains foamy macrophages which are in the ducts)
  • fistula formation
  • nipple retraction and distortion
  • associated with smoking
  • “bag of worms” on palpation
29
Q

What is the management of duct ectasia?

A

Treat acute infections
Smoking cessation
excise ducts
exclude malignancy

30
Q

What are the 2 main causes of mastitis or abscess?

A

Breast feeding

Duct ectasia

31
Q

What are the organisms associated with mastitis due to breastfeeding?

A 
Staph aureus (most common cause - from baby's mouth) - can treat with flucloxacillin
Strep pyogenes (acute pyogenic mastitis via abrasion of the nipple)
32
Q

65 year-old female presents with right breast lump. Pathology report says it is a benign biphasic tumour with cellular stromal overgrowth, and compressed “leaf-like” clefts of epithelium. What is the most likely diagnosis?

A

Phyllodes tumour

33
Q

40 year-old female presents with unilateral bloody nipple discharge. Investigation shows that there are papillary fronds containing fibrovascular core and covered by myoepithelium and epithelium in the sub-areolar ducts. Epithelium is benign. What is the most likely diagnosis?

A

Intraduct papilloma

34
Q

80 year-old female presents with a breast lump. She had breast cancer 15 years ago which was treated with wide local excision and adjuvant radiotherapy. What is the likely diagnosis?

A

Radiation-induced angiosarcoma

35
Q

Where does breast carcinoma arise from?

A

Glandular epithelium of terminal duct lobular unit

Reproduction (10 decks)

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