Breast Flashcards
How does menstruation affect breast pain?
Can make it worse or relieves it
What percentage of breast pain is breast cancer?
2.7 percent
What are the initial steps in assessing a breast lump or breast pain?
History
Examination
Mammogram
What is the second step in assessing breast pain?
Pain charts - looking at timing and severity
What are the initial concerns when dealing with breast pain?
Correctly fitting bra
Weight
Exercise can make the pain worse
Stressors
How is breast pain treated?
Reassurance
Evening primrose oil or phytoestrogens
Reduced fat intake
Medications (tamoxifen, dazolol, zoladex, bromocriptine)
What is done in the breast one stop clinic?
History and examination
Triple assessment of mammography + USS + cytology/histology
Same day diagnosis
What are the histological features of fibroadenoma?
Made up of stomal tissue and proliferative epithelium
Arise from lobular unit
In over 40s, what consideration must be made when dealing with fibroadenoma?
Differentiate from cancer
Which other condition is easily mistaken for fibroadenoma?
Phyllodes tumour
What the features of a phyllodes tumour?
Rare - less than one percent of breast lumps
Women generally older
Fibroepithelial tumour
How is a phyllodes tumour treated?
Wide local excision
How are breast cysts classified?
Microcyst and macrocyst
When do breast cysts normally present?
Perimenopause
How is a breast cyst managed?
Aspiration
Surgical excision occasionally needed
Which condition can lead to breast fibrosis?
Involution of breast (epithelial tissue lost with ageing of mammary gland)
What are the clinical features of sclerosing adenosis?
Painful palpable mass
What are the histological features of sclerosing adenosine?
Stromal sclerosis
Proliferative adenosine
Micro calcification
Myoepithelial proliferation
Is a radial scar an example of a sclerotic or fibrotic lesion?
Yes
What size is a radial scar?
Less than 1cm
What size is a complex sclerosing lesion?
Greater than 1cm
What are the clinical features of both radial scars and complex sclerosing lesions?
Asymptomatic
Hard to differentiate from malignancy
Give examples of Non-ANDI (aberrations in normal development and involution) breast lumps?
Infections Lipomas Montgomerys gland Mondor's disease Male gynaecomastia
How are infectious lumps classified?
Lactational or non lactational
Describe a Montgomery’s gland?
Small periareolar glands around the nipple that may develop as a cyst
What is Mondor’s disease?
Thrombophlebitis of the superficial breast veins
What may be evident on examination with malignant breast lumps?
Size Irregular Fixity Consistency Lymph node status Peau d' orange
What is the reporting for breast lumps after triple assessment?
Normal or cytology insufficient Benign Indeterminate - probably benign Cancer suspected Cancer
What is the most common breast cancer type?
Infiltrating ductal carcinoma
What is the second most common breast cancer type?
Ductal carcinoma in situ (DCIS)
How is breast cancer histology assessed?
Type of cancer
Grade (TNM)
Receptor status (ER, Progesterone and HER2)
Which receptors are important to look for in breast cancer?
ER
Progesterone
HER2
What is the first line treatment for breast cancer?
Surgery (breast conserving or mastectomy)
What are second line treatments in breast cancer?
Chemo (adjuvant or neoadjuvant)
Endocrine
Radiotherapy
Which lymphatic surgery may occur in breast cancer?
Sentinal node sampling or axillary node clearance
What medication is given pre menopausal in breast cancer?
Tamoxifen
Which medication is given post menopausal in breast cancer?
Aromatase inhibitors
Other than breast cancer, how else can tamoxifen be used?
In breast pain
How does tamoxifen work?
Blocks oestrogen receptors (ER)
Give an example of an aromatase inhibitor?
Anastrozole
Which countries have the highest incidence of breast cancer?
North America
New Zealand and Australia
Western Europe
What are the risk factors for breast cancer?
Age Nullparity Obesity Excess alcohol First pregnancy after 30 Family history PMH of breast cancer Increased oestrogen exposure Premalignant breast change
What is considered a high risk family history of breast cancer?
4 plus relatives with breast or ovarian cancer
3 relatives under 60
2 relatives under 40
1 relative with bilateral breast cancer
Outline the breast cancer screening programme?
Mammography every 3 years in women aged 50 - 70
What imaging modality should be used in pre menopausal women with a high breast cancer risk?
MRI
What are the invasive types of breast cancer?
Infiltrating ductal or lobular
Medullary, mucinous and tubular carcinomas
Which breast cancers are uncommon?
Inflammatory carcinoma
Paget’s disease of the breast
What percentage of invasive breast cancers are ductal?
80 percent
What percentage of invasive breast cancers are lobular?
10 percent
What percentage of invasive breast cancers are medullary?
5 percent
What is the clinical presentation of breast cancer?
Mass and pain in the axilla Palpable mass in the breast Thickening and pain in the breast Nipple discharge +/- retraction Peau d' orange (inflammatory) Fixed and hard lump
How is breast cancer locally controlled?
Surgery and radiotherapy
How are systemic micro metastases managed in breast cancer?
Chemotherapy
Biological agents
Bisphosphonates
What are the common sites of breast cancer metastases?
Brain Lymph nodes Pleura Lungs Skin Liver Bone
How beneficial is tamoxifen in the early treatment of breast cancer?
Gives 25 percent reduction in mortality over 20 years
Where does local metastases occur in breast cancer?
Chest wall and skin
What are the common sites of breast cancer recurrence?
Chest wall and skin
What is the 2 year survival in metastatic disease?
95 percent
How should metastatic breast cancer be treated?
palliative
serial application of breast cancer treatment for remission and to improve quality of life
What is the average response time to chemo in metastatic breast cancer?
20 months
When is anti oestrogen therapy beneficial in breast cancer treatment?
ER positive
Which endocrine treatment can be given in pre menopausal breast cancer?
Medroxy progesterone acetate
Oophorectomy
GnRH analogues (gosarelin and lesopropelin)
SERMs e.g. tamoxifen, fulvestant
Which endocrine treatment is used to treat post menopausal breast cancer?
Aromatase inhibitors e.g. anostrazole, letrazole and exemastane
Give premenopausal treatment as well
Why should bisphosphonates be given as supportive treatment in breast cancer?
Oestrogen suppression in breast cancer treatment can lead to osteoporosis and bisphosphonates will help with this
Which pathway should be followed if the patient is experiencing a lot of pain?
Analgesic ladder
What is a Tx staging?
Primary tumour cannot be assessed
What is T0 staging?
There is no evidence of a primary tumour
What is T1 staging?
Tumour is 2cm or less
What is T2 staging?
The tumour is between 2 and 5cm
What is T3 staging?
Tumour is greater than 5cm
What is a T4 tumour?
Any size with extension to the chest wall and skin