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Phase 3a > Breast > Flashcards

Breast Flashcards

1
Q

what points would you want to clarify on a ?breats cancer referral

(red flags)

A

is the lump painless

is there skin distortion

is there nipple discharge/bloody discharge

recent onset nipple inversion

is there axillary lymphadenopathy

is there ulceration

is there pagets disease of the nipple

family Hx of breast cancer

HRT use

menopausal status

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2
Q

what are indications for mammography

A

clinically suspicious lump

residual lump after cyst aspiration

red flags

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3
Q

why is mammorgraphy in those under 40 less acurate

A

less visibility as breast tissue is glandular and dense rather than fatty

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4
Q

what is the screening process for mammography

A

ages 47-53y = every 3y

unless high family risk then:

40-50y

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5
Q

what imaging is usually used in those under 25y with clinically suspicious lump

A

us

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6
Q

what comprimises of a triple assessment

A
  1. clinical assessment
  2. radiological (US/XRAY/MRI)
  3. histological/cytological testing
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7
Q

when would you use MRI (breast)

A

patients aged 30-50y with high risk family history have annual screening

or

in ?recurrent breast cancer after breast conversion therapy + mammorgraphy+US

or

?axillary recurrence

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8
Q

what us a fine needle aspiration cytology

A

a small needle is passed through lump and theres suction

then sample analysed by cytologist in lab

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9
Q

what are pros of fine needle aspiration cytology

A

quick

cheap

low false positive

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10
Q

what are cons of fine needle aspiration cytology

A

low sensitivity and specificity

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11
Q

what is a core biopsy

A

under local anaesthesia, small incision ande and biopsy taken with biopsy gun

gives histological diagnosis

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12
Q

what are pros of core biopsy

A

accurate diagnosis of benign lesions and differentiation of invasive cancers vs ductal in situ

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13
Q

what is a vaccum assisted biopsy

A

removal of small lesion using vaccume suction and rotating blade

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14
Q

when is vaccum assisted biopsy used

A

when theres diagnostic uncertainty

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15
Q

what is an open biopsy

A

surgical removal of lesion either whole or in part

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16
Q

when is open biopsy used

A

pagets disease of the nipple

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17
Q

what are the types of breast cancer

A

ductal (70%)

lobar

other

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18
Q

grades of breast cancer

A

grade 1 = well differentiated

G2

G3= undifferentiated with high mitotic rate

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19
Q

what are tumour receptor statuses

A

oestrogen receptor

progesterone receptor

none

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20
Q

is a breast cancer is oestrogen receptor +ve what does this mean

A

cancer driven by oestrogen, marker of good prognosis

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21
Q

what is the HER 2 receptor

A

a receptor for epidermal growth factor and indicates aggressive proliferation

22
Q

what is Ki67

A

a proliferation marker indicating aggression of cancer

23
Q

what is multigene breast cancer

A

a gene signature with histological markers = good prognostic score

can be Luminal A/B and can have oestrogen/progestoerone +ve markers but never ER markers

24
Q

what cancer type is linked to BRCA

A

triple negative

25
Q

what treatements are great for oestrogen/progesterone receptor +ve breast cancers

A

antioestrogen therapy

26
Q

what is the drug used for HER +ve breast cancers

A

herceptin aka transtuzamab

27
Q

what are the treatements for the different kinds of breast cancer

A

28
Q

what does it mean if mets are present in breast cancer

A

terminal

29
Q

when would you treat w wide local excision

A

20% of breast tissue (or over 4cm)

30
Q

what is a mastecomy

A

removal of all breast tissue leaving pectoral muscles + sentinel node biopsy

31
Q

when would you do total axillary node clearence

A

known nodal disease

32
Q

what are indications for mastectomy

A

subareolar tumour

cantraindicated radiotherapy

BRCA1

pateint choice

33
Q

when is tamoxifen used

A

pre menopausal women

for OR+ve

34
Q

what are SE of tamoxifen

A

GI disturbances

Hot flushes

Headaches and rashes

Visual disturbances

Thrombotic state

35
Q

what is a severe complication of radiotherapy (breast)

A

can develop angiosarcoma

36
Q

what do aromitase inhibitors do

A

prevent periferal conversion of androgens to testosterone

but only effective in post menopausal - as no affect on ovaries

(Letrozole)

37
Q

what is a comlication of aromitase inhibitors

A

worsens osteoporosis so DEXA every 2 y and vit D suppliment sneeded + bisphosphonates

38
Q

describe TNM staging

A
39
Q

what is the nottingham prognostic index

A
40
Q

what are complications of axillary node clearence

A

seroma formation

parasthesia under arm

winging of scapula

lymphoedema

41
Q

what is the management of a non cancerous women with high risk fam hx

A

genetic screeening

then risk assessed:

  • low
    • reassurence
  • medium
    • annual screening from 40-50 + tamoxifen
  • High
    • MRI+ other testing annually, tamoxifen, mastectomy, oophorectomy
42
Q

what is the gene linked to male breast cancer

A

brca2

43
Q

what is li-fraumeni syndrome

A

rare germ line mutation causing mutation in tumour suppression gener

predisposes to childhood and adult cancers

mri ages 20-70y

profylactic mastectomy

44
Q

what is significant nipple discharge

A

persitent

unilateral/unifocal

spontaneous

bloody/clear

45
Q

what is duct ectasia

A

dilated and full of debris ducts prone to secondary infection

yellowish / bloody discharge

46
Q

what is a papilloma

A

benign worty growth w bloody/clear discharge

47
Q

what are the two types of breast infection

A

lactational = peripheral

non lactational = central and associated w duct ectasia)

48
Q

what Abx are used in lactational infections

A

erythromicy or flucloxacillin

49
Q

what Abx are used in non lactational infections

A

metronidazole and flucloxacllin

50
Q

what can be given to manage cyclical mastalgia

A

Danazol inhibits LH and FSH

Tamoxifen - side effects and inc risk of endometral cancer

Goserelin - unlicensed

51
Q
A

Phase 3a (22 decks)

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