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3A REVISION > BREAST > Flashcards

BREAST Flashcards

1
Q

What is mastalgia and how common is it?

A

Breast pain, over 50% of women suffer at some point

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2
Q

How common is breast cancer?

A

1 in 8 women, most common in females in UK

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3
Q

On breast examination, give 7 red flag symptoms for breast cancer

A 
Painless lump
Skin distortion
Bloody nipple discharge
Nipple inversion
Axillary lymphadenopathy
Ulcers
Paget's nipple disease
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4
Q

Give risk factors for breast cancer (10)

A 
Increasing age
Family history of breast/ovarian cancer (BRCA1/2)
Young age at menarche
Late menopause
Nulliparity
Obesity 
HRT
Not breastfeeding
Past breast cancer
Alcohol
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5
Q

What is the triple assessment test?

A

Clinical examination
Radiological imaging (mammography, USS)
Pathology (histology, cytology)

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6
Q

What is mammography?

A

Low dose X rays of the breast, where the breast is compressed between 2 plates to flatten tissue and improve resolution

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7
Q

What is breast screening?

A 
To detect cancer at pre-invasive stage
Mammography for all women between 50 and 70 every 3 years
After 70 if self organised
Under 50 if high risk
Trial between 47-73
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8
Q

What is shown on mammogram in ductal carcinoma in situ?

A

Microcalcification

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9
Q

What is shown on mammogram in carcinoma?

A

Irregular spiculated mass

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10
Q

When is breast ultrasound used?

A

When there is a known lesion or suspicious area already identified

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11
Q

How are patients under 25 investigated for breast cancer?

A

Histology or cytology only, ultrasound if clinically suspicious

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12
Q

How are patients 25-40 investigated?

A

Breast ultrasound plus histology or cytology

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13
Q

How are patients over 40 investigated?

A

Mammography and ultrasound and either histology or cytology

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14
Q

When is MRI offered for breast cancer? (3)

A

Annually between 30-50 if high risk family history for screening
To assess extent of diffuse cancers and lymph node involvements
To assess possible recurrence of breast cancer after treatment

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15
Q

How is tissue diagnosis done in breast cancer? (2)

A

Fine needle aspiration cytology

Core biopsy

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16
Q

What is fine needle aspiration cytology?

A

Needle being passed through a lump many times whilst applying suction to the syringe

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17
Q

What is core biopsy?

A

Needle fired into the lesion to remove a core of tissue, with US guidance
Increased accuracy of diagnosis

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18
Q

What increases breast cancer risk in men? (4)

A

Age
Family history
Klinefelter’s
Possible use of oestrogens

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19
Q

Disadvantages of breast cancer screening? (4)

A

Time to attend mammograms
Psychological distress waiting for results
Procedures such as biopsy that are negative
Overdiagnosis - cancer diagnosis that would never have become symptomatic

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20
Q

How much has breast cancer screening reduced mortality by?

A

15-30%

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21
Q

What is pre-invasive disease in breast cancer?

A

Ductal carcinoma in situ

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22
Q

Two histological types of invasive breast cancer?

A

Ductal - invasive ductal carcinoma most common

Lobular - more diffuse

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23
Q

How is breast cancer graded?

A

1 - well differentiated cells, low mitotic rate

3 - badly differentiated, high mitotic rate

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24
Q

What is the immunophenotype of a breast cancer?

A

If it is oestrogen receptor, progesterone receptor or HER-2 receptor positibe

25
Q

What is oestrogen receptor positive cancer?

A

Expressed on >50%
Good prognosis
Cancer is sensitive to oestrogen which stimulates the tumour
Anti-oestrogens will help

26
Q

What is progesterone receptor positive cancer?

A

Indicator of sensitivity to anti-oestrogens

Good prognosis

27
Q

What is HER-2 receptor positive cancer?

A 
Expressed in 15%
Poor prognosis
Receptor for epidermal growth factor
More aggressive cancer
Use trastuzumab
28
Q

What is triple negative breast cancer?

A

Cancers which do not express oestrogen receptors, progesterone receptors of HER-2 receptors
Very aggressive
Common in younger patients

29
Q

Where does breast cancer metastasise to? (4)

A

Bone, liver, brain, lungs

30
Q

How is stage 1-2 cancer treated?

A

Wide local excision surgery or mastectomy (+/- reconstruction) with axillary node sampling/clearance or sentinel node biopsy
Radiotherapy to remaining breast if conserved
Adjuvant chemotherapy

31
Q

Why is radio/chemotherapy used in breast cancer?

A

To target micro-metastases and prevent recurrence
May be used to shrink a tumour before surgery
Palliation for mets

32
Q

When is hormonal therapy used in breast cancer?

A

All women with oestrogen sensitive breast cancer

33
Q

What hormonal therapy is used in breast cancer adjuvant to surgery?

A

Tamoxifen - selective oestrogen receptor modulator - inhibits breast oestrogen receptors
Aromatase inhibitors - prevent peripheral conversion of androgens to oestrogens in post menopausal women

34
Q

How is Her-2 receptor positive breast cancer treated?

A

Trastuzumab (herceptin) adjuvant to surgery

35
Q

How is locally advanced breast cancer treated (stage 3)?

A

Non surgically - hormonal, chemo/radiotherapy

May be offered surgery depending on response

36
Q

What is paget’s disease of the nipple?

A

Eczematous change of the nipple due to an underlying malignancy

37
Q

How is stage 4 metastatic breast cancer treated?

A

Endocrine therapy if oestrogen or HER-2 positive
Radiotherapy to reduce pain
Chemotherapy
Bisphosphonates for bones

38
Q

Name some types of breast reconstructions? (6)

A 
External prosthesis
Skin sparing mastectomy
Silicone/saline implant
Acellular dermal matrix and dermal sling with implant
Latissimus dorsi flap +/- implant
TRAM flap
39
Q

Give 4 signs of surgically significant (potential malignancy) nipple discharge

A

Persistent
Unilateral
Spontaneous
Bloody or clear

40
Q

What are 3 causes of bloody nipple discharge?

A

Duct papilloma
Duct ectasia
Invasive/in situ carcinoma

41
Q

What is duct ectasia?

A

Lactiferous duct becomes blocked, can cause greenish or bloody discharge
Benign

42
Q

What is duct papilloma?

A

Benign warty growth, usually with clear or bloody discharge

43
Q

What is galactorrhoea?

A

Milky discharge, may be physiological or due to drugs

44
Q

What are the two types of breast infection?

A

Lactational (usually peripheral breast) and non lactational (usually central i.e. duct ectasia)

45
Q

Treatment of breast infection?

A

Aspiration
Lactational - flucloxacillin
Non-lactational - flucloxacillin plus metronidazole

46
Q

How is breast pain classified?

A

Cyclical or non cyclical

47
Q

Treatment of cyclical breast pain? (4)

A

Reassure
Proper bra
Danazol - weak androgen
Tamoxifen - short term

48
Q

Treatment of non cyclical breast pain?

A

NSAIDs

Exclude other causes i.e. cardiac, MSK

49
Q

What is breast nodularity?

A

Variation of normal - lumpy breasts, often cyclical so should reexamine after period

50
Q

What is a fibroadenoma?

A

Common benign mobile lump especially <35yrs

1/3rd shrink, 1/3rd stay the same, 1/3rd enlarge (surgery to remove)

51
Q

What is a breast cyst?

A

Abnormal response of part of the breast to hormonal stimulation, common between 40-60
Drain

52
Q

What is gynaecomastia?

A

> 2cm lump of breast tissue behind the male nipple

53
Q

What is pseudogynaecomastia?

A

Deposition of fat in overweight men

54
Q

Physiological cause of gynaecomastia?

A

Imbalance of oestrogen and testosterone

55
Q

Pathological causes of gynaecomastia? (3)

A

Drugs - spironolactone, anabolic steroids, oestrogen
Marijuana
Testicular failure or tumours

56
Q

How is gynaecomastia treated?

A

Remove cause i.e. drug

Possible excision if embarrassment

57
Q

If BRCA1/2 gene is present, what is lifetime risk of developing breast cancer?

A

80%

58
Q

What is the treatment of women with BRCA1/2 genes?

A

Prophylactic mastectomy, reduces cancer chance by 90%

3A REVISION (17 decks)

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