Breast Flashcards
What is the first line management of an isolated breast cancer <4cm wide?
WLE
What is the involvement of the LNs in pre op assessment and procedure optimisation?
Women with no palpable axillary LNopathy should have pre-op USS before primary surgery. If positive, they should have a sentinel node biopsy to assess nodal burden
Patients presenting with palpable LNopathy should receive axillary node clearance at primary surgery
What factors can help determine whether mastectomy or WLE is the best option?
Multifocal mastectomy, solitary WLE
Central mastectomy, peripheral WLE
Large lesion in small breast mastectomy, small lesion in large breast WLE
DCIS >4cm mastectomy, DCIS <4cm WLE
What should be offered to women post WLE?
Breast reconstruction AND
Whole breast radiotherapy as this reduces risk of recurrence by 2/3rds
What patient population are aromatase inhibitors particularly used in?
Post menopausal women with ER+ve Ca
What is the most commonly used biological therapy, and what is a contraindication to its use?
Trastuzumab (Herceptin) - used in HER2 positive tumours
Cannot be used if history of heart disorders
What chemotherapy regimen is commonly used for breast cancer?
FEC
Fluorouracil
Epirubicin
Cyclophosphamide
What are the features of duct ectasia?
A thick greenish/cheesy nipple discharge with a peri-areolar lump, commonly presenting around the time of the menopause with ‘slit like’ nipple retraction
What is the discharge like in a ductal papilloma?
Bloodstained
What should occur after breast conserving surgery?
Radiotherapy as standard
What endocrine therapy is most commonly used in elderly patients even if they are ER+ and why?
Aromatase inhibitors such as Letrozole, as this is how oestrogen is made in post menopausal patients
What should be prescribed for patients with grade 3 tumour and axillary nodal involvement?
Cycotoxic chemo +- Herceptin (trastuzumab)
Pagets disease of the nipple is most commonly associated with which underlying breast pathology?
Invasive ductal carcinoma
What is the difference between Paget’s disease and eczema?
Pagets starts at the nipple and spreads to the areola, whereas eczema progresses opposite to this
A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.
Fibroadenoma - non tender, discrete and highly mobile
A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.
Fibroadenosis/fibrocystic breast disease/benign mammary dysplasia
What is the inheritance of BRCA1/2?
AD
What breast lesion would show the halo sign on mammography?
Breast cyst
What would a ‘snowstorm sign’ on mammography indicate?
Ruptured breast implant which may track to the axillae
Which patients should be referred using TWW for ?breast cancer?
ANY women >30 with an unexplained breast lump
OR
Age>50 with any of the following unilateral signs:
discharge
retraction
other changes of concern
Periductal mastitis is common in which patient population?
Smokers
What is the use of neo-adjuvant chemotherapy?
It downsizes the tumour before surgery allowing for breast conservation surgery as opposed to mastectomy
How do you T stage a breast cancer?
T1 <2cm T2 2-5cm T3 5+cm T4a invades chest wall T4b invades skin T4c invades chest wall and skin T4d inflammatory breast cancer
Cause of lump in an obese patient with skin tethering?
Fat necrosis
When might you excise a fibroadenoma?
If >3cm and causing moderate discomfort
Can family members be chaperones?
No
What type of breast cancer have a grey gelatinous surface?
Mucinous carcinoma
When would you see comedo necrosis on core biopsy?
High grade DCIS
What can be done with nodal involvement should the patient not consent for surgery?
Axillary radiotherapy
