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Phase 4 > Breast > Flashcards

Breast Flashcards

1
Q

What types of breast reconstruction are there?

A

Tissue expander
- silicone implants

Latissimus dori myocutaneous flap

Abdominal flaps

  • Transverse rectus abdominis myocutaneous flap
  • Deep inferior Epigastric Perforator flap

Nipple reconstruction

  • tatoo
  • skin flaps

surgery to reduce contralateral breast

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2
Q

What types of surgery may be carried out on the breast?

A

Lumpectomy

Wide local excision

Quadrantectomy
- quadrant is removed

Mastectomy

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3
Q

When is axillary clearance offered?

A

When invasive cancer cells are noted in the axilla.

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4
Q

What is a major complications of clearing the axillary nodes?

A

Lymphoedema

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5
Q

Mammograms vs Ultrasound:

A

Ultrasound:

  • used more in younger women
  • good at distinguishing solid lumps from cysts

Mammogram

  • used more in elderly women
  • picks up calcification better than US
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6
Q

What is done to assess the lymph nodes?

A

Ultrasound of the lymph nodes prior to surgery.
- if unusual them biopsy is taking

During surgery

  • blue dye or radioactive isotope used to fine sentinel node
  • this is biopsied.
  • if clear - leave nodes, if positive then clear nodes
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7
Q

What tests are performed on all tumours?

A

ER testing

Her2 testing

*if these are both negative then Gene testing is offered.

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8
Q

What are some of the symptoms of radiotherapy to the breast?

A 
General fatigue from the radiation 
Local skin irritation and tissue swelling 
Fibrosis of the breast 
Shrinking of the breast 
Long term skin discolouration of skin
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9
Q

When assessing the sentinel node, when is the radioactive isotope injected? and when is the blue dye injected?

A

Radioactive isotope - morning of surgery / day before surgery

Blue dye - prior to operation
- within 10-15mins will be present

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10
Q

What are the indications for mastectomy?

A 
Large tumour on a small breast 
>1 tumour present on breast 
Diffuse DCIS 
Radiotherapy contraindicated 
Recurrence of cancer
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11
Q

When is neoadjuvant therapy indicated?

A

Very large tumours

- to shrink

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12
Q

What is the grade of the breast cancer based upon?

A

Nuclear pleomorphism
Number of mitosis
Degree of gland formation

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13
Q

What treatment is given to Her2 positive cancers and how is it given and what are some common side effects?

A

Trastuzumab
- IV or Subcut
- every 3 weeks for 1 year
Can effect heart - must be monitored and contraindicated in women with heart failure.

Side effects:

  • tumour pain
  • headaches
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14
Q

What treatment is given to ER positive cancers?

A

Premenopausal women = tamoxifen

Post-menopausal = Aromatase inhibitors (Letrozole

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15
Q

When is chemotherapy used in breast cancer?

A

Neoadjuvant - shrink tumour

adjuvant therapy - after surgery to reduce recurrence

For treatment control of metastatic disease

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16
Q

What are the pros and cons of breast implants?

A

Pro’s:

  • minimal scars
  • reasonable appearance

Con’s:

  • cold
  • don’t feel natural
  • Long term effects - hardening, leakage, shape change
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17
Q

What is a con of Transverse rectus abdominal/ TRAM flap:

A

Abdominal Hernias

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18
Q

When working out the best management for patients with breast cancer, what type of meeting is there?

A

MDT

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19
Q

When is Adjuvant radiotherapy offered?

A

After WLE

After mastectomy if:
- positive margins
- >5cm tumour
>4 positive lymph nodes

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20
Q

What is a common side effect of adjuvant radiotherapy?

A

Cardiomyopathy

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21
Q

Invasive Ductal carcinoma can be further divided into what types?

A

Tubular, cribriform, medullary, mucinous, papillary

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22
Q

What is the single most important prognostic factor for breast cancer?

A

Lymph nodal status

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23
Q

What does the nottingham prognostic index take into account?

A

Size
Nodal status
Grade

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24
Q

How is DCIS managed?

A

WLE

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25
Q

Generally what is meant by grade and stage?

A

Grade refers to the amount of nuclear abnormalities and cellular changes.

Stage is the prognostic risk factors that reflect the likely hood of the patients outcomes, especially the involvement of metastasis - nodal status

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26
Q

Which types of invasive breast cancers show the best prognosis?

A

Tubular
Cribriform
Papillary

27
Q

Which type of breast cancer tends to have columns of cells stacked upon each other?

A

invasive lobular carcinoma

28
Q

What are the clinical symptoms of Paget’s disease?

A

Itchiness
Redness
Flaking/ thickened skin

29
Q

What are the differentials for Paget’s disease of the nipple?

A

Eczema

30
Q

If a patient comes in complaining of lumpy bumpy feeling in breast, which is associated with menstrual pain, what is the likely diagnosis? and what are characteristics of this change?

A

Fibrocystic changes

  • cysts
  • fibrosis
  • hyperplasia
31
Q

List some inflammatory conditions of the breast:

A

Acute Mastitis
- breast feeding

Fat necrosis

Granulomatous Mastitis

  • TB
  • Sarcoidosis

Mammary Duct ectasia

  • greenish brown discharge
  • can cause nipple retraction
32
Q

What is another name for fibrocystic changes?

A

Fibroadenosis

33
Q

On a mammogram which breast condition is likely to produce a halo sign?

A

Breast cyst

34
Q

Can a family member or friend be used a sa chaperone?

A

No it has a to an impartial individual

35
Q

What is the screening times for breast?

A

50- 70

- every 3 years

36
Q

What pre-operative assessment can be done of the lymph nodes?

A

Ultrasound

37
Q

When can a fibroadenoma be removed?

A

> 3cm

38
Q

Where does breast cancer spread to?

A

Lymphatic spread

Bones
Brain
Liver
Lungs

39
Q

When imaging for breast cancer, who gets what type of imaging?

A

<35 years old: Ultrasound

> 35 years old: mammogram

40
Q

What blood tests do you want to do into breast cancer?

A

FBC
Bone profile
LFTs
ESR

41
Q

Describe how the sentinel node is analysed:

A

It is cut out when Identified on surgery.
It is then sent for frozen section.

If positive then axillary clearance occurs or radiotherapy

42
Q

What are some of the complications of breast surgery?

A

Damage to long thoracic nerve
- winging of scapula

Lymphoedema

Frozen shoulder

Haematoma

43
Q

What is the histology grade of the tumour based upon?

A

Bloom richardson system

44
Q

When is radiotherapy used post surgery?

A

WLE

Positive nodal status

Large tumour resection

Bone metastasis

45
Q

What are the stages of breast cancer?

A

Stage 1: confined to breast

Stage 2: 1 node

Stage 3: Fixation to muscle, usually large amount of skin involvement

Stage 4: Fixation to chest wall. Metastasis

46
Q

What are the symptoms of duct ectasia?

A

Peri-arelormass

Nipple discharge
- white
- green
Calcification on mammogram

47
Q

When should surgery for a fibroadenoma be offered?

A

> 3cm
Family history of Ca
Patient choice

48
Q

How should LCIS be managed?

A

Bilateral mastectomy
or
Close surveillance - usually need MRI for lesions

49
Q

What are some causes of breast pain:

A

Menstrual cycle pain

Inflammatory

  • Mastitis
  • Duct ectasia

Trauma
- fat necrosis

Fibrocystic changes

50
Q

What are some causes of nipple discharge?

A

Physiological - pregnancy

Duct ectasia

Intraductal papilloma

Paget’s disease

Galactorrhea

51
Q

If the asymmetry or lump on the breast is not clear on physical examination, how can it be made more clear?

A

Ask patient to put hands on head.

To put hands on hips and lean forward

52
Q

If there is tethering, what ligament is involved?

A

Ligament of cooper/ Suspensory ligament

53
Q

Compare and contrast Paget’s disease and eczema:

A 
Presence of lump 
Clear markings in paget's
Nipple destroyed 
Occurs post menopause
Unilateral, eczema is often bilateral
54
Q

What investigations for staging should be done?

A

CT chest/ abdo/ pelvis

Technetium Bone scan

Head CT

55
Q

What are the two views of the mammogram?

A

Cranial caudal

Oblique view

56
Q

On US what would be suggestive of malignancy?

A

Vertical growth appearance

Irregular mass

Hypoechoic

57
Q

Disadvantages of FNCA?

A

NO architecture
- so can’t see if it is invasive

Can’t get ER/ PR/ HER status

58
Q

What is the aim of neoadjuvant therapy?

A

to down stage the cancer to allow for less invasive surgery

- WLE

59
Q

If NPI is >5 what is the 5 year survival?

A

50%

60
Q

What is the indications for neoadjuvant therapy?

A

Downstage for breast conservation

Downstage to make breast cancer operable if previously not operable

Inflammatory breast cancer

Improve cosmetics

61
Q

What advise should be given to females post breast cancer?

A

Monthly self examination

Mammogram every year for 5 years

62
Q

How much resection needs to be done in a WLE?

A

5cm

63
Q

What is a major side effect of letrazole? (aromotase inhibitor)

A

Osteoporosis

Phase 4 (49 decks)

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