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Reproduction Y3 JC > Breast > Flashcards

Breast Flashcards

1
Q

What is cytopatholgoy?

A

When you take a sample to show cells of change

E.g fluid, nipple discharge, needle scrape, fine needle aspiration

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2
Q

Classifying breast FNA, what category would implying malignancy?

A

C5 is malignant

C1 unsatisfactory
C2 benign
C3 atypical probs benign
C4 suspicious malignant
C5 malignant
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3
Q

What is histopathology?

A

Biopsy of a specimen

E.g needle core biopsy, vacuum assisted biopsy, skin biopsy, incisional biopsy of mass

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4
Q

What classification of needle core biopsy would define a malignant lesion?

A

B5 is malignant

B1 unsatisfactory/normal
B2 benign
B3 atypical probs benign
B4 suspicious malignancy
B5 malignant (b5a carcinoma insitu, b5b invasive carcinoma)
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5
Q

What is the significance in treatment approaches between B5a and B5b for needle core biopsy?

A

B5a carcinoma insitu so can leave axillary nodes alone

B5b invasive carcinoma so need a sentinal node biopsy as likely lymphatic spread

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6
Q

Who is most likely to get gynaecomastia?

A

Those who were exposed to exogenous or endoenous hormones in pregnancy
Cannabis users
Liver disease

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7
Q

What is fibrocystic change

A

Where multiple blue domed cysts with pale fluid accumulate in the breast tissue. With intervening fibrosis

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8
Q

Who is most likely to get fibrocystic change?

A

People with anovulatory cycles (long oestrogen stim)
Women 40-50
Early menarche
Late menopause

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9
Q

What is the treatment option for a fibroadenoma?

A

Surgical excision and reassurance as not malignant

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10
Q

What genetic mutations predispose you to getting a breast carcinoma?

A

BRCA1
BRCA2
HER2

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11
Q

Which precursor to breast carcinoma is most likely to progress to malignancy?

A

Ductal carcinoma in situ (DCIS)

Lobular in situ neoplasia

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12
Q

What risk does having atypical ductal hyperplasia give you to progress to breast carcinoma vs general population

A

4x population risk

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13
Q

What would the treatment for ductal carcinoma insitu be?

A

Surgery

Adjuvant radiotherapy

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14
Q

What does carcinoma in situ mean?

A

Malignancy is confined by the basement membrane so it is not yet invasive

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15
Q

What stain can you use to identify lobular in situ neoplasia

A

E-cadherin stain immunohistochemistry

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16
Q

What factors confer a high risk to developing breast cancer?

A

NON PARITY (childless)

Anything that increases your exposure to oestrogen

Obesity, early menarche, late menopause, not breast feeding

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17
Q

What are some of the symptoms of malignant breast cancer?

A 
Dimpled or depressed skin
Visible lump
Nipple change (inversion)
Bloody discharge
Texture change
Colour change
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18
Q

What is pagets disease of the nipple?

A

Where DCIS reaches the nipple epidermis but it is still an in situ carcinoma

Presenting with eczema of the breast and potentially discharge

19
Q

Where does breast cancer metastasis to?

A 
Liver
Bone
Brain
Lungs
Abdo viscera
Female genital tract
Local invasion
20
Q

Breast cancer is oestrogen receptor positive what can you do to shrink it without physically removing the tumour?

A

Tamoxifen
Oophrectomy
Aromatase inhibitors (letrozole)
GnRH antagonists like goserilin

21
Q

Breast cancer is HER2 receptor positive what can you do to shrink it without physically removing the tumour?

A

Trastuzamab (herceptin) which is a monoclonal antibody

22
Q

What is the treatment for a fibroadenoma?

A

Reassurance not going to cause you any harm

Can remove if you want

23
Q

Describe the physiology behind lactation

A

Mechanoreceptors stimulated from child sucking, goes to hypothalamus stimulates release of prolactin from anterior pituitary which causes milk secretion. Also stimulates oxytocin to be released from the posterior pituitary to cause smooth muscle contration and ejection of milk.

24
Q

What are the benefits of breast feeding for the child?

A 
Better growth
Preventitive against childhood obesity
Less diarrhoea, vomiting, constipation
Less type 2 diabetes
Less eczema
25
Q

What are the benefits of breast feeding to the mom

A

Protective against breast cancer
Bonding
Saves money

26
Q

Mom is pregnant and develops breast cancer. Can you operate?

A

Yes but will wait to do reconstruction at a later date

27
Q

Can you breast feed during chemo?

A

No

28
Q

After having breast cancer what advice would you give them regarding contraception?

A

Avoid hormonal pills

Take copper coil and condoms

29
Q

What would be a common mammographic feature of DCIS?

A

Calcifications

30
Q

What would be a typical mammographic feature of invasive cancer?

A

Speculation (stellate ish)

31
Q

On shear wave elastography (ultrasound) are cancers described as soft or stiff?

A

Stiff (dense)

32
Q

Women 25 presents with a lump what is this likely to be?

A

Fibroadenoma

<30s think fibroadenoma and shows grey on ultrasond

33
Q

Women 40 presents with a lump what is this likely to be?

A

Cyst

30-50yrs think cyst, not in post menopausal as require oestrogen, show black on ultrasound

34
Q

Women 70 presents with a lump what is this likely to be?

A

Breast cancer

> 50yrs then likely cancer utlrasound shows different densitiies and ragged edges

35
Q

What is the name of the structures that carry the milk to the nipple?

A

The tubuoacinar ducts

36
Q

Describe some of the changes that occur in the breast during pregnancy each trimester

A

1st tri; proliferation of epitheilal n and myoepithelial cells, elongation and branching of the smaller ducts
2nd tri; glandular tissue continue developing
3rd tri; secretory alvoli mature with differentiated myoepithelial cells

37
Q

Where does the lymph from the breast drain to?

A

Most goes to the axillary nodes then anterior or pectoral nodes. Then to the left lymphatic trunk

38
Q

Describe the physiology of lactation

A

Mechanoreceptors respond to stimulation, hypothalamus from this releases oxytocin from posterior pituitary causing smooth muscle contraction and ejection of milk, prolactin increases in the anterior pituitary to then cause milk secretion

39
Q

What are the biochemistry that should be checked in breast tumours

A

Oestrogen receptors
Progesterone receptors
HER2 receptors

40
Q

What are some of the risk factors for developing breast cancwr?

A 
Depo injections
Early menarche
Hormone replacement therapy
Smoking 
Diabetes
Family history of breast cancer
41
Q

How would you treat mastitis

A

Antibiotics and percutaneous drainage or incision and drain

42
Q

What breast tumour is oestrogen receptor positive and has E-cadherin stain immunohistochemistry

A

Lobular in situ neoplasia

43
Q

Give an example of anti-oestrogen thearpy

A

Tamoxifen
Oophorectomy
Aromatase inhibitors (letrozole)
GnGH antagonists (goserilin)

44
Q

What medical therapy would you give to a patient who has a HER2 positive breast cancer

A

Trastuzamab (herceptin)

Reproduction Y3 JC (9 decks)

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