Breast Flashcards
Discrete, mobile painless lump
Fibroadenoma
What breast condition is known as a ‘breast mouse’?
Fibroadenoma
How is a fibroadenoma treated?
Watch and wait - majority will get smaller
Can do lumpectomy if >3cm
‘Lumpy tender breasts, especially just before period is due’
Fibrocystic breast disease
How is fibrocystic breast disease managed?
Reassurance, Analgesia, Good fitting bra, Warm compresses, Evening Primrose Oil
‘Painful hot red swelling in breast’
Breast abscess
Who normally get breast abscesses?
Breastfeeding women
What organism commonly causes breast abscesses?
Staph Aureus
How are breast abscesses treated?
Antibiotics +/- drainage
What breast condition commonly presents as ‘bloody/serous nipple discharge’?
Duct papilloma
What breast condition presents as a tender lump and green nipple discharge?
Duct ectasia
What predisposes to mammary duct ectasia?
Smokers
Peri-menopause
What breast condition presents as a hard irregular lump with a history of trauma to the area?
Fat Necrosis
What condition can mimic breast cancer on mammogram?
Sclerosing adenosis
What are some hormonal causes of gynaecomastia?
Teratomas (BHCG) Adrenal tumours (oestrogens) Acromegaly (GH) Prolactinoma (PRL) Cushings (cortisol)
What are some metabolic causes of gynaecomastia?
Hyperthyroidism
Primary Biliary Cirrhosis
Cirrhosis
Alcoholism
What are some drug causes of gynaecomastia?
Digoxin Cannabis Spironolactone Diamorphine Vincristine
How does breast cancer present?
Hard, irregular fixed breast lump
May or may not be mastalgia
May be nipple discharge/inversion
Skin changes (tethering, orange peel)
What are the 3 aspects of the triple assessment?
Clinical history and examination
Imaging
Biopsy
What imaging assessment is done?
Over 35s - mammogram +/- USS
Under 35s and men - USS (more dense breast tissue)
What is the commonest type of breast cancer?
Ductal
What is the cancer referred to if it has no spread further than local tissue?
‘In-Situ’ - e.g. ductal carcinoma in situ (DCIS)
What is Paget’s disease?
Eczematoid change of the nipple, which often signifies an underlying ductal malignancy
What hormone receptors should be tested in someone diagnosed with breast cancer?
E2 (oestrogen)
Her2
Progesterone
What should women under 50 with triple negative breast cancer be offered?
BRCA screening
What are some risk factors for breast cancer?
BRCA, family history, early menarche, late menopause, nulliparity, HRT, COCP, past breast cancer, obesity (oestrogen excesses basically)
Where does breast cancer commonly metastasise to?
Local = chest wall, skin, nipple Distant = collateral breast, liver, lung, brain, bone
What are the 3 main surgical stages of treatment for breast cancer?
Mastectomy/WLE
Reconstruction
Axillary surgery
When is a mastectomy performed rather than a WLE?
Multifocal tumours
Central tumours
Large tumours in small breasts
DCIS >4cm
When is radiotherapy usually given for breast cancer?
Adjuvantly (after all WLEs and some mastectomies)
When is chemotherapy given in breast cancer?
Can be given neoadjuvantly or adjuvantly.
Generally works better in younger women or those who have more adverse prognostic factors
What treatment should pre and perimenopausal women with E2+ve cancer receive?
Tamoxifen
What treatment should post menopausal women with E2+ve cancer receive?
Letrozole
What should women with Her2+ve cancer receive?
Transtuzumab (Herceptin)
Who gets breast screening and how often?
Women aged 50-70 every 3 years
How is breast screening performed?
Mammogram
