Breast Flashcards
what points would you want to clarify on a ?breats cancer referral
(red flags)
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
what are indications for mammography
clinically suspicious lump
residual lump after cyst aspiration
red flags
why is mammorgraphy in those under 40 less acurate
less visibility as breast tissue is glandular and dense rather than fatty
what is the screening process for mammography
ages 47-53y = every 3y
unless high family risk then:
40-50y
what imaging is usually used in those under 25y with clinically suspicious lump
us
what comprimises of a triple assessment
- clinical assessment
- radiological (US/XRAY/MRI)
- histological/cytological testing
when would you use MRI (breast)
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
what us a fine needle aspiration cytology
a small needle is passed through lump and theres suction
then sample analysed by cytologist in lab
what are pros of fine needle aspiration cytology
quick
cheap
low false positive
what are cons of fine needle aspiration cytology
low sensitivity and specificity
what is a core biopsy
under local anaesthesia, small incision ande and biopsy taken with biopsy gun
gives histological diagnosis
what are pros of core biopsy
accurate diagnosis of benign lesions and differentiation of invasive cancers vs ductal in situ
what is a vaccum assisted biopsy
removal of small lesion using vaccume suction and rotating blade
when is vaccum assisted biopsy used
when theres diagnostic uncertainty
what is an open biopsy
surgical removal of lesion either whole or in part
when is open biopsy used
pagets disease of the nipple
what are the types of breast cancer
ductal (70%)
lobar
other
grades of breast cancer
grade 1 = well differentiated
G2
G3= undifferentiated with high mitotic rate
what are tumour receptor statuses
oestrogen receptor
progesterone receptor
none
is a breast cancer is oestrogen receptor +ve what does this mean
cancer driven by oestrogen, marker of good prognosis
what is the HER 2 receptor
a receptor for epidermal growth factor and indicates aggressive proliferation
what is Ki67
a proliferation marker indicating aggression of cancer
what is multigene breast cancer
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
what cancer type is linked to BRCA
triple negative
what treatements are great for oestrogen/progesterone receptor +ve breast cancers
antioestrogen therapy
what is the drug used for HER +ve breast cancers
herceptin aka transtuzamab
what are the treatements for the different kinds of breast cancer
what does it mean if mets are present in breast cancer
terminal
when would you treat w wide local excision
20% of breast tissue (or over 4cm)
what is a mastecomy
removal of all breast tissue leaving pectoral muscles + sentinel node biopsy
when would you do total axillary node clearence
known nodal disease
what are indications for mastectomy
subareolar tumour
cantraindicated radiotherapy
BRCA1
pateint choice
when is tamoxifen used
pre menopausal women
for OR+ve
what are SE of tamoxifen
GI disturbances
Hot flushes
Headaches and rashes
Visual disturbances
Thrombotic state
what is a severe complication of radiotherapy (breast)
can develop angiosarcoma
what do aromitase inhibitors do
prevent periferal conversion of androgens to testosterone
but only effective in post menopausal - as no affect on ovaries
(Letrozole)
what is a comlication of aromitase inhibitors
worsens osteoporosis so DEXA every 2 y and vit D suppliment sneeded + bisphosphonates
describe TNM staging
what is the nottingham prognostic index
what are complications of axillary node clearence
seroma formation
parasthesia under arm
winging of scapula
lymphoedema
what is the management of a non cancerous women with high risk fam hx
genetic screeening
then risk assessed:
- low
- reassurence
- medium
- annual screening from 40-50 + tamoxifen
- High
- MRI+ other testing annually, tamoxifen, mastectomy, oophorectomy
what is the gene linked to male breast cancer
brca2
what is li-fraumeni syndrome
rare germ line mutation causing mutation in tumour suppression gener
predisposes to childhood and adult cancers
mri ages 20-70y
profylactic mastectomy
what is significant nipple discharge
persitent
unilateral/unifocal
spontaneous
bloody/clear
what is duct ectasia
dilated and full of debris ducts prone to secondary infection
yellowish / bloody discharge
what is a papilloma
benign worty growth w bloody/clear discharge
what are the two types of breast infection
lactational = peripheral
non lactational = central and associated w duct ectasia)
what Abx are used in lactational infections
erythromicy or flucloxacillin
what Abx are used in non lactational infections
metronidazole and flucloxacllin
what can be given to manage cyclical mastalgia
Danazol inhibits LH and FSH
Tamoxifen - side effects and inc risk of endometral cancer
Goserelin - unlicensed
