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Fifth Year Medicine > Breast > Flashcards

Breast Flashcards

1
Q

What pathological changes might be observed in the breast histology of someone with fibrocystic change?

A

Adenosis (± sclerosis) = more glands in lobules
Fibrosis
Cysts
Apocrine metaplasia (exocrine glands)
Epithelial hyperplasia
Papillomatosis (papillary projectes ie warts)

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2
Q

What forms the M score in triple assessment?

A 
M= Mammogram findings, U = ultrasound findings
M1- normal
M2- benign
M3- probably benign
M4- probably malignant
M5- malignant
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3
Q

What letters comprise someone’s triple assessment breast score?

A

P 1-5 (for palpation)
U 1-5 or M 1-5 (for mammogram or USS)
C 1-5 (after fine needle aspiration)

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4
Q

In the triple assessment, where are specimens taken from for the cytology score?

Name 3 sources

A

Breast tissue
Lymph node
Nipple discharge

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5
Q

What is not part of the triple assessment, fine needle aspiration or biopsy?

A

Biopsy

May get core biopsy or punch biopsy

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6
Q

What are the two views that are used in mammogram?

A

Mediolateral oblique

Craniocaudal

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7
Q

Who is offered breast screening?

A

Those aged 47-73
Every 3 years

Mammography

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8
Q

With breast carcinoma in situ, how do the features of ductal and lobular types differ?

A

DCIS- unilateral, unifocal, palpable clinically or radiologically
LCIS- bilateral, multifocal, not detectable clinically or radiologically often

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9
Q

Where in the breast do invasive carcinomas arise?

A

At the terminal duct lobular unit, where extralobular ducts meet intralobular ducts

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10
Q

Which types of invasive breast cancer are associated with a good prognosis?

A

Tubular
Mucinous (colloid)
Lobular

(No special type = relatively poorer prognosis)

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11
Q

What 3 features determine breast cancer grading?

A
  1. Degree of tubular and glandular formation
  2. Nuclear pleomorphism
  3. Mitotic count
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12
Q

When might you need to use MRI imaging to investigate a breast?

A

In lobular cancers- deep in breast without microcalcification so often can’t be detected on examination or mammogram

Dense breasts- HRT or pre-menopausal
Discordant clinical + radiographic findings (P2 U5 C3)

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13
Q

Which two imaging modalities are used for breast cancer staging?

A

CT- CAP

Bone scan

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14
Q

When would you stage the breast?

A

Locally advanced: skin or muscle involvement, node +ve
Inflammatory cancer
Recurrence

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15
Q

What is the difference in Rx given for pre and post menopausal women in neo-adjuvant treatment prior to breast conserving surgery?

A

Pre- chemo
Post- letrozole (aromatase inhibitor)

Neo-adjuvant is given prior to surgery

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16
Q

Who gets radiotherapy for breast cancer?

A

All who are having breast conserving surgery

+ Mastectomy patients with:
>5cm of disease
more than 4 nodes +ve
+ve margins once breast is removed

17
Q

Herceptin in breast cancer targets…?

A

HER2 +ve cells

Monoclonal antibody given with chemotherapy
Monitor heart function

18
Q

Breast cancer of what grade gets offered chemo?

A

Grade 3 (highest grade)

19
Q

When considering chemo for breast cancer, what combinations of hormone receptor findings would make you consider offering it?

A 
Triple negative (for ER, PR, HER2)
Or HER2 positive
20
Q

What lifetime risk of breast cancer warrants the offer of risk reducing mastectomy?

A

> 30%

21
Q

In breast screening, how many people report on the mammograms

A

Double reporting

Looking at 2 views of the breast: mediolateral oblique + craniocaudal

22
Q

What is duct ectasia and how does it present?

A

Blockage of lactiferous duct, leads to clogging

PC: greenish discharge

23
Q

What are the T stages for breast cancer in TNM staging?

A

Tx- size cannot be assessed
Tis- DC (in situ)
T1 5cm
T4 Spread into chest wall or beyond

24
Q

How can T1 stages of breast cancer in TNM staging be stratified?

A

T1mi

25
Q

How is N staging stratified in the TNM staging of breast cancer?

A

Nx- can’t be assessed (ie previously removed)
N1- axillary lymph nodes +ve, but nodes are mobile

N2- A. axillary lymph nodes adhering to surrounding tissue
B. Internal mammary lymph node +ve (behind sternum)

N3- lymph nodes in axilla + internal mammary lymph nodes
Or elsewhere in the body

26
Q

How is the M stage of breast cancer TNM staging defined?

A

M0- no metastases

M1- spread to other parts of the body

27
Q

In the triple assessment of the breast, on palpation what does score P1-5 mean?

A 
P1- normal
P2- benign cyst or fibroadenoma
P3- probably benign
P4- probably malignant
P5- malignant
28
Q

Indications for MRI in suspected breast cancer?

A

Lobular cancers (often bilateral)
Dense breasts- young or on much HRT
Discordant PUC values
FHx- time to menstrual cycle

29
Q

Why is a breast biopsy needed if a woman has already had cytology?

A

Biopsy tells definitive diagnosis- type of cancer or type of benign lesion, and grade etc

30
Q

What does peau d’orange suggest in breast cancer?

A

Lymphatic obstruction/involvement

31
Q

How does needle biopsy help differentiate breast cancer?

A

Whether it’s ductal or lobular in type

32
Q

What is the cut off age for deciding between ultrasound and mammogram?

A

35 years

33
Q

In suspected breast cancer, what are you looking for on nodes to indicate on USS that they are abnormal?

A

Enlarged cortex (middle bit) >2.5mm

Indicates node is reactive
NOT just node size (in Afro-Carribbeans may have naturally larger nodes)

34
Q

Indications for breast MRI

A

Dense breasts in known cancer on contralateral side
Lobular carcinoma- as often bigger than seen on mammogram
Screening in high risk patients (BRCA +)
Previous Hodgkins
Implant pathology

35
Q

Complications of axillary lymph node clearance in breast cancer?

A

Lymphoedema
Prolonged drainage
Infection
Frozen shoulder, numbness

36
Q

Indications for radiotherapy following surgical Rx of breast cancer

A

After:
wide local excision for cancer or ductal carcinoma in situ.
post mastectomy with vascular and lymphatic involvement.

37
Q

What investigation is needed if giving patient’s herceptin for HER2 positive breast cancer?

A

Echocardiogram- can cause myocardial damage

Fifth Year Medicine (32 decks)

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