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Medicine - Finals > Breast > Flashcards

Breast Flashcards

1
Q

Give some differentials for breast lump?

A

Fibroadenoma (smooth, rubbery, mobile)

Cyst (rubbery, smooth, mobile - may be pain fluctuating with menstrual cycle)

Fat necrosis (firm, irregular mass - Hx trauma)

Intraductal papilloma (bloody nipple discharge)

Breast abscess (pain, fever, erythema)

Invasive breast cancer

Ductal carcinoma in situ (DCIS)

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2
Q

Give 3 genes associated with development of breast cancer?

A

BRCA1
BRCA2
TP53 (Li-Fraumeni syndrome)

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3
Q

Give 4 signs of breast cancer

A 
Painless lump (irregular, hard, fixed)
Skin tethering
Indrawn nipple
Nipple discharge
Peau d'orange (dimpled skin)
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4
Q

What makes up the ‘triple assessment’ of a breast lump?

A

1) Clinical examination
2) Imaging (USS <35, USS + mammogram >35)
3) Biopsy (FNA of core biopsy)

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5
Q

When is breast cancer screening offered?

A

Every 3 years for women 50-70yrs

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6
Q

What is the lifetime risk of breast cancer in women?

A

1 in 8

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7
Q

Why are mammograms a good screening tool?

A

Acceptable test
Early detection means disease can be found before metastatic spread
Important problem (1 in 8 women affected)
Reduces morbidity and mortality by up to 30%
Acceptable treatment for those screened +ve
Not compulsory

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8
Q

What are some controversies surrounding breast cancer screening?

A

?overdiagnosis

3 in 4 women that are called back will NOT have cancer - so can cause a lot of undue worry

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9
Q

Which lymph nodes to breast cancer spread to?

A

Axillary (40% have this at presentation)
Supraclavicular
Infraclavicular
Neck (always examine from behind)

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10
Q

What are some features of a benign mass on mammogram?

A

Rounded, smooth shape

Well-defined margins

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11
Q

What are some features of a suspicious mass on mammogram?

A

Rough edges

Poorly defined margins

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12
Q

Give 3 RFs for breast cancer

A 
FHx
Increasing age
Obesity
BRCA genes
Not breastfeeding
Uninterrupted oestrogen exposure - nulliparity, early menarche, late menopause, HRT, OCP
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13
Q

Give 3 protective factors against breast cancer

A

Breastfeeding
Multiparity
Late menarche
Early menopause

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14
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

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15
Q

Which is the type of breast cancer that can look like eczema?

A

Paget’s disease of the breast

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16
Q

What are the different stages of breast cancer?

A

1 - confined to breast, mobile
2 - confined to breast + nodes in ipsilateral axilla
3 - fixed to muscle, ipsilat LNs, skin involvement
4 - fixed to chest wall, distant mets

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17
Q

What is the index used to predict survival?
How is it calculated?
Give 2 good prognostic factors

A

Nottingham prognostic index

Grade (1-3) + Nodes (1-3) + 0.2(size, cm)

ER+ve
Low grade, stage and size

18
Q

Give some differentials for breast pain

A 
Angina
Lung disease
Oestrogens/HRT
Cyclical breast pain
Thoracic outlet syndrome
Gallstones
Costochondritis
19
Q

Give 4 differentials for nipple discharge

A

Duct ectasia
Cancer
Lactation
Infection

20
Q

What are the 2 views taken of each breast in a mammogram?

A

Cranio-caudal

Mediolateral oblique

21
Q

What is the role of MRI in breast assessment?

A

Not routine - can help in difficult cases
Screening in high risk ladies
Assessment of implants

22
Q

What are the 2 surgical options for treating primary operable breast cancer?

A

Breast conservation

Mastectomy

23
Q

What are the indications for breast conservation surgery?

A

Small tumour relative to breast size (<25% vol)
Not underneath nipple
No prev. radio to breast
Pre-op chemo may allow breast conservation
Patient choice

24
Q

What are the indications for mastectomy?

A 
Large tumour relative to breast
Tumour underneath/in-drawing of nipple
>1 cancer in same breast
Immediate/delayed reconstruction
Patient choice
25
Q

What are the 2 types of axillary surgery involves in breast cancer treatment?

A

1) Full axillary clearance (S/E: arm stiffness, lymphedema, numbness)
2) Limited axillary clearance

26
Q

What is meant by a triple negative breast cancer?

A

No ER/PR, HER2 or Ki67 (proliferative marker)

27
Q

What medication can be used to treat ER+ breast cancer?

A

1) Tamoxifen (if PRE-menopausal) *think Tammy girl
2) Aromatase inhibitors (e.g. anastrozole) if POST-menopausal

(ER+ women should receive 5yrs of one of these)

28
Q

How does tamoxifen work?

A

Anti-oestrogen: blocks ER on surface of breast cancer

in pre-menopausal women

29
Q

How does anastrozole work?

A

Aromatase inhibitor: prevents peripheral oestrogen synthesis

30
Q

When should radiotherapy be used in breast cancer treatment?

A

1) Lumpectomy/WLE (wide local excision)
2) Aggressive disease (after mastectomy)
3) Some tumour subtypes

31
Q

When should chemotherapy be used?

A

1) Aggressive disease phenotypes (HER2+, ER-. grade 3, node positive)
2) Complex algorithms
3) Selective use in >70s

32
Q

Which medication should be used for HER2+ breast cancer?

A

Trastuzumab (herceptin)

- monoclonal antibody, given with chemo

33
Q

What treatment options need to be considered for the future in someone with breast cancer?

A

PARP inhibitors
TDM1 - multiple HER2 pathway blockade
Bisphosphonates (protection against bone disease)

34
Q

What are some side effects of tamoxifen?

A

Hot flushes
Nausea
Vaginal bleeding

Rare: thrombosis, endometrial Ca

35
Q

What are some side effects of anastrozole (aromatase inhibitors)?

A

Hot flushes
Reduced bone mineral density

NO risk of DVT or endometrial Ca

36
Q

What are the 2 types of reconstruction surgery?

A

1) Primary
- skin preserved better, less psychological impact
- may delay chemo/radio if complications

2) Delayed
- does not risk delaying adjuvant Rx
- limited skin preservation, may take a long time to reconstruct

37
Q

Give some side effects of radiotherapy

A 
Skin viability risk (for reconstruction)
Loss of elasticity
Fat necrosis
Fibrosis
High rate of capsule formation with implants
38
Q

2 methods of breast mound recreation?

A

1) implant based - implant alone, implant augmented lat dorsi
2) autologous (use patent’s own tissue) - lat dorsi, TRAM flap

39
Q

Local complications of breast implants?

A

Capsule formation
Infection
Rupture
Shape changes with age and gravity

40
Q

Contraindications for lat dorsi flap?

A

Long term back pain
Physical job/hobby
Prev axillary surgery w/ evidence of pedicle damage

41
Q

What breast screening is done for women known to be BRCA1/2+?

A

30-40: annual MRI
40-50: annual mammogram + MRI
50-60: annual mammogram (+ MRI if dense breasts)
60-70: 3-yearly mammograms (MRI if dense breasts)

Medicine - Finals (13 decks)

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