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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
Q

Describe a Montgomery’s gland?

A

Small periareolar glands around the nipple that may develop as a cyst

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26
Q

What is Mondor’s disease?

A

Thrombophlebitis of the superficial breast veins

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27
Q

What may be evident on examination with malignant breast lumps?

A 
Size
Irregular
Fixity
Consistency
Lymph node status
Peau d' orange
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28
Q

What is the reporting for breast lumps after triple assessment?

A 
Normal or cytology insufficient
Benign
Indeterminate - probably benign
Cancer suspected
Cancer
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29
Q

What is the most common breast cancer type?

A

Infiltrating ductal carcinoma

30
Q

What is the second most common breast cancer type?

A

Ductal carcinoma in situ (DCIS)

31
Q

How is breast cancer histology assessed?

A

Type of cancer
Grade (TNM)
Receptor status (ER, Progesterone and HER2)

32
Q

Which receptors are important to look for in breast cancer?

A

ER
Progesterone
HER2

33
Q

What is the first line treatment for breast cancer?

A

Surgery (breast conserving or mastectomy)

34
Q

What are second line treatments in breast cancer?

A

Chemo (adjuvant or neoadjuvant)
Endocrine
Radiotherapy

35
Q

Which lymphatic surgery may occur in breast cancer?

A

Sentinal node sampling or axillary node clearance

36
Q

What medication is given pre menopausal in breast cancer?

37
Q

Which medication is given post menopausal in breast cancer?

A

Aromatase inhibitors

38
Q

Other than breast cancer, how else can tamoxifen be used?

A

In breast pain

39
Q

How does tamoxifen work?

A

Blocks oestrogen receptors (ER)

40
Q

Give an example of an aromatase inhibitor?

A

Anastrozole

41
Q

Which countries have the highest incidence of breast cancer?

A

North America
New Zealand and Australia
Western Europe

42
Q

What are the risk factors for breast cancer?

A 
Age
Nullparity
Obesity
Excess alcohol
First pregnancy after 30
Family history
PMH of breast cancer
Increased oestrogen exposure
Premalignant breast change
43
Q

What is considered a high risk family history of breast cancer?

A

4 plus relatives with breast or ovarian cancer
3 relatives under 60
2 relatives under 40
1 relative with bilateral breast cancer

44
Q

Outline the breast cancer screening programme?

A

Mammography every 3 years in women aged 50 - 70

45
Q

What imaging modality should be used in pre menopausal women with a high breast cancer risk?

46
Q

What are the invasive types of breast cancer?

A

Infiltrating ductal or lobular

Medullary, mucinous and tubular carcinomas

47
Q

Which breast cancers are uncommon?

A

Inflammatory carcinoma

Paget’s disease of the breast

48
Q

What percentage of invasive breast cancers are ductal?

A

80 percent

49
Q

What percentage of invasive breast cancers are lobular?

A

10 percent

50
Q

What percentage of invasive breast cancers are medullary?

51
Q

What is the clinical presentation of breast cancer?

A 
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
Q

How is breast cancer locally controlled?

A

Surgery and radiotherapy

53
Q

How are systemic micro metastases managed in breast cancer?

A

Chemotherapy
Biological agents
Bisphosphonates

54
Q

What are the common sites of breast cancer metastases?

A 
Brain
Lymph nodes
Pleura
Lungs
Skin
Liver 
Bone
55
Q

How beneficial is tamoxifen in the early treatment of breast cancer?

A

Gives 25 percent reduction in mortality over 20 years

56
Q

Where does local metastases occur in breast cancer?

A

Chest wall and skin

57
Q

What are the common sites of breast cancer recurrence?

A

Chest wall and skin

58
Q

What is the 2 year survival in metastatic disease?

A

95 percent

59
Q

How should metastatic breast cancer be treated?

A

palliative

serial application of breast cancer treatment for remission and to improve quality of life

60
Q

What is the average response time to chemo in metastatic breast cancer?

61
Q

When is anti oestrogen therapy beneficial in breast cancer treatment?

A

ER positive

62
Q

Which endocrine treatment can be given in pre menopausal breast cancer?

A

Medroxy progesterone acetate
Oophorectomy
GnRH analogues (gosarelin and lesopropelin)
SERMs e.g. tamoxifen, fulvestant

63
Q

Which endocrine treatment is used to treat post menopausal breast cancer?

A

Aromatase inhibitors e.g. anostrazole, letrazole and exemastane
Give premenopausal treatment as well

64
Q

Why should bisphosphonates be given as supportive treatment in breast cancer?

A

Oestrogen suppression in breast cancer treatment can lead to osteoporosis and bisphosphonates will help with this

65
Q

Which pathway should be followed if the patient is experiencing a lot of pain?

A

Analgesic ladder

66
Q

What is a Tx staging?

A

Primary tumour cannot be assessed

67
Q

What is T0 staging?

A

There is no evidence of a primary tumour

68
Q

What is T1 staging?

A

Tumour is 2cm or less

69
Q

What is T2 staging?

A

The tumour is between 2 and 5cm

70
Q

What is T3 staging?

A

Tumour is greater than 5cm

71
Q

What is a T4 tumour?

A

Any size with extension to the chest wall and skin

Met 3b (5 decks)

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