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Breast Flashcards

1
Q

How does menstruation affect breast pain?

A

Can make it worse or relieves it

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2
Q

What percentage of breast pain is breast cancer?

A

2.7 percent

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3
Q

What are the initial steps in assessing a breast lump or breast pain?

A

History
Examination
Mammogram

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4
Q

What is the second step in assessing breast pain?

A

Pain charts - looking at timing and severity

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5
Q

What are the initial concerns when dealing with breast pain?

A

Correctly fitting bra
Weight
Exercise can make the pain worse
Stressors

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6
Q

How is breast pain treated?

A

Reassurance
Evening primrose oil or phytoestrogens
Reduced fat intake
Medications (tamoxifen, dazolol, zoladex, bromocriptine)

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7
Q

What is done in the breast one stop clinic?

A

History and examination
Triple assessment of mammography + USS + cytology/histology
Same day diagnosis

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8
Q

What are the histological features of fibroadenoma?

A

Made up of stomal tissue and proliferative epithelium

Arise from lobular unit

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9
Q

In over 40s, what consideration must be made when dealing with fibroadenoma?

A

Differentiate from cancer

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10
Q

Which other condition is easily mistaken for fibroadenoma?

A

Phyllodes tumour

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11
Q

What the features of a phyllodes tumour?

A

Rare - less than one percent of breast lumps
Women generally older
Fibroepithelial tumour

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12
Q

How is a phyllodes tumour treated?

A

Wide local excision

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13
Q

How are breast cysts classified?

A

Microcyst and macrocyst

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14
Q

When do breast cysts normally present?

A

Perimenopause

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15
Q

How is a breast cyst managed?

A

Aspiration

Surgical excision occasionally needed

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16
Q

Which condition can lead to breast fibrosis?

A

Involution of breast (epithelial tissue lost with ageing of mammary gland)

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17
Q

What are the clinical features of sclerosing adenosis?

A

Painful palpable mass

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18
Q

What are the histological features of sclerosing adenosine?

A

Stromal sclerosis
Proliferative adenosine
Micro calcification
Myoepithelial proliferation

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19
Q

Is a radial scar an example of a sclerotic or fibrotic lesion?

A

Yes

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20
Q

What size is a radial scar?

A

Less than 1cm

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21
Q

What size is a complex sclerosing lesion?

A

Greater than 1cm

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22
Q

What are the clinical features of both radial scars and complex sclerosing lesions?

A

Asymptomatic

Hard to differentiate from malignancy

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23
Q

Give examples of Non-ANDI (aberrations in normal development and involution) breast lumps?

A 
Infections
Lipomas
Montgomerys gland
Mondor's disease
Male gynaecomastia
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24
Q

How are infectious lumps classified?

A

Lactational or non lactational

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25
Describe a Montgomery's gland?
Small periareolar glands around the nipple that may develop as a cyst
26
What is Mondor's disease?
Thrombophlebitis of the superficial breast veins
27
What may be evident on examination with malignant breast lumps?
``` Size Irregular Fixity Consistency Lymph node status Peau d' orange ```
28
What is the reporting for breast lumps after triple assessment?
``` Normal or cytology insufficient Benign Indeterminate - probably benign Cancer suspected Cancer ```
29
What is the most common breast cancer type?
Infiltrating ductal carcinoma
30
What is the second most common breast cancer type?
Ductal carcinoma in situ (DCIS)
31
How is breast cancer histology assessed?
Type of cancer Grade (TNM) Receptor status (ER, Progesterone and HER2)
32
Which receptors are important to look for in breast cancer?
ER Progesterone HER2
33
What is the first line treatment for breast cancer?
Surgery (breast conserving or mastectomy)
34
What are second line treatments in breast cancer?
Chemo (adjuvant or neoadjuvant) Endocrine Radiotherapy
35
Which lymphatic surgery may occur in breast cancer?
Sentinal node sampling or axillary node clearance
36
What medication is given pre menopausal in breast cancer?
Tamoxifen
37
Which medication is given post menopausal in breast cancer?
Aromatase inhibitors
38
Other than breast cancer, how else can tamoxifen be used?
In breast pain
39
How does tamoxifen work?
Blocks oestrogen receptors (ER)
40
Give an example of an aromatase inhibitor?
Anastrozole
41
Which countries have the highest incidence of breast cancer?
North America New Zealand and Australia Western Europe
42
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 ```
43
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
44
Outline the breast cancer screening programme?
Mammography every 3 years in women aged 50 - 70
45
What imaging modality should be used in pre menopausal women with a high breast cancer risk?
MRI
46
What are the invasive types of breast cancer?
Infiltrating ductal or lobular | Medullary, mucinous and tubular carcinomas
47
Which breast cancers are uncommon?
Inflammatory carcinoma | Paget's disease of the breast
48
What percentage of invasive breast cancers are ductal?
80 percent
49
What percentage of invasive breast cancers are lobular?
10 percent
50
What percentage of invasive breast cancers are medullary?
5 percent
51
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 ```
52
How is breast cancer locally controlled?
Surgery and radiotherapy
53
How are systemic micro metastases managed in breast cancer?
Chemotherapy Biological agents Bisphosphonates
54
What are the common sites of breast cancer metastases?
``` Brain Lymph nodes Pleura Lungs Skin Liver Bone ```
55
How beneficial is tamoxifen in the early treatment of breast cancer?
Gives 25 percent reduction in mortality over 20 years
56
Where does local metastases occur in breast cancer?
Chest wall and skin
57
What are the common sites of breast cancer recurrence?
Chest wall and skin
58
What is the 2 year survival in metastatic disease?
95 percent
59
How should metastatic breast cancer be treated?
palliative | serial application of breast cancer treatment for remission and to improve quality of life
60
What is the average response time to chemo in metastatic breast cancer?
20 months
61
When is anti oestrogen therapy beneficial in breast cancer treatment?
ER positive
62
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
63
Which endocrine treatment is used to treat post menopausal breast cancer?
Aromatase inhibitors e.g. anostrazole, letrazole and exemastane Give premenopausal treatment as well
64
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
65
Which pathway should be followed if the patient is experiencing a lot of pain?
Analgesic ladder
66
What is a Tx staging?
Primary tumour cannot be assessed
67
What is T0 staging?
There is no evidence of a primary tumour
68
What is T1 staging?
Tumour is 2cm or less
69
What is T2 staging?
The tumour is between 2 and 5cm
70
What is T3 staging?
Tumour is greater than 5cm
71
What is a T4 tumour?
Any size with extension to the chest wall and skin

Met 3b (5 decks)

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