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Gynae > Breast > Flashcards

Breast Flashcards

1
Q

RFs for breast cancer?

A
  • obesity
  • smoking
  • FH in 1st degree relative
  • oestrogen exposure
    • increased no of ovulations
  • female
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2
Q

outline screening for breast cancer

A
  • mammogram every 3 years from 50-70
  • if BRCA gene: MRI every year from 20-49, then mammogram thereafter
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3
Q

outline risks of BRCA gene

A
  • BRCA 1- chromosome 17
    • 50-85% risk of breast cancer
    • 40-60% ovarian cancer
  • BRCA2- chromosome 13
    • same risk as above for breast
    • 15% risk ovarian cancer
    • increased risk for male breast cancer & prostate cancer
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4
Q

Outline benign breast lumps

A
  • cysts
  • fibroadenoma
  • lipoma
  • fat necrosis
  • abscess
  • phyllodes tumour
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5
Q

outline benign conditions that present w nipple discharge

A

duct ectasia

intraductal papilloma

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6
Q

Mx of benign breast lumps?

A

treat conservatively or local excision

apart from cyst / abscess & phyllodes tumour

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7
Q

describe breast cysts + Mx

A
  • benign
  • well circumscribed, mobile, fluctuant lump
  • Mx: needle aspiration or local excision
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8
Q

describe fibroadenomas + Mx

A
  • most common breast pathology
  • epi: 15-35years
  • well circumscribed, firm, highly mobile
  • 10% disappear every year- excision based on pt preference
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9
Q

describe fat necrosis

A
  • lump formed by degeneration/scarring of fat
  • aetiology: often post breast surgery/trauma
  • firm, irregular, fixed lump
  • radiologically similar appearance to breast cancer
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10
Q

describe lipoma

A
  • benign fat lump
  • soft, painless, mobile lump >20cm
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11
Q

mx of abscess?

A

may require incision and drainage surgically

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12
Q

describe phyllodes tumour and mX

A
  • benign but has potential to become malignant
  • Mx: wide local excision/mastectomy if large
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13
Q

describe duct ectasia

A
  • smoking major RF
  • nipple discharge that may be blood stained
  • nipple inversion/retraction
  • may be assoc w subareolar mass
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14
Q

describe intraductal papilloma + Ix

A
  • benign but increased risk of cancer
  • subareolar region
  • blood stained/sticky nipple discharge
  • Ix: ductography
  • Mx: excision and vigilant breast screening
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15
Q

what is gynaecomastia?

A

benign enlargement of male breast

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16
Q

aetiology of gynaecomastia?

A
  • obesity
  • anabolic steroids
  • cannabis
  • prostate/pituitary/testicular cancer
  • liver cirrhosis
  • medications
17
Q

what medications may cause gynaecomastia?

A
  • spironolactone
  • 5 alpha reductase inhibitors
  • PPI
  • ACEI
  • amiodarone
18
Q

Mx of gynaecomastia?

A
  • stop precipitating cause
  • SERM
  • surgery
19
Q

outline categories of malignant breast lumps

A
  • In-Situ carcinoma: pre-invasive, not detected clinically (on X-Ray)
    • ductal
    • lobular
  • Invasive carcinoma
    • ductal - 80%
    • lobular - 15%
  • Pagets disease
  • Inflammatory breast cancer
20
Q

describe pagets disease

A
  • malignant cells infiltrate into epidermis
  • cell proliferation–> skin thickening
  • causes a red, eczematous rash on nipple
  • discharge & inversion are possible
21
Q

describe inflammatory breast cancer

A
  • presents as red, swollen, warm, itchy and inflamed breast
  • caused by blockage of lymphatic vessels
  • increased breast size
22
Q

epidemiology of breast cancer?

A

1/8 women in their lifetime will have breast cancer

23
Q

macroscopic signs of breast cancer

A
  • firm lump
  • fixed mass
  • tethering/dimpling of skin
24
Q

what does triple assessment involve? and when does this get done?

A

w 2ww cancer referral & suspicious lump

  • Clinical
    • history&examination
  • Imaging
    • US<35
    • Mammogram >35
  • Histology
    • FNAC
    • Core biopsy
25
Q

mets of breast ca?

A

2b’s + 2L’s

bone

brain

liver

lung

26
Q

staging?

A

TNM

27
Q

what is the most important prognostic indicator?

A

node status

28
Q

Medical Mx of breast cancer?

A
  • hormonal therapy
    • ER+ve (80%)
      • pre menopausal: tamoxifen (SERM)
      • post menopausal: aromatase inhibitors
    • PR+ve
    • Her-2+ve (assoc w worse prognosis)
      • herceptin
  • bisphosphonate
    • reduced risk of recurrence in post-menopausal women
29
Q

how long is hormonal therapy indicated for?

A

increasing evidence for 10 years, esp node positive women

30
Q

surgical Mx of breast cancer?

A
  • Wide local excision
    • if tumour <4cm
  • Mastectomy
  • Sentinel LN biopsy
    • if clear –> no further treatment required
    • if +ve –> removal of all nodes surgically or w radiotherapy to all nodes
31
Q

complications of surgical Mx?

A
  • lymphedema
  • nerve injury- long thoracic nerve –> winging of scapula
32
Q

who is chemo indicated for?

A
  • advanced hormone receptor negative cancer
  • aggressive disease
33
Q

outline the follow-up to breast cancer treatment

A

triple assessment once yearly for 5 years after

Gynae (42 decks)

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