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Helena's finals > breast > Flashcards

breast Flashcards

1
Q

Mx. mastitis

A

mastitis: encourage breast feeding from other unaffected breast, use analgesia, antibiotics usually not needed
Antibiotics: flucloxacillin (lactational) with metronidazole (non-lactational)
breast abscess: US guided FNA or surgical incision/drainage

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2
Q

breast screening:

A

mammography 47-73 y/o every 3 years

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3
Q

most common breast cancer

A

invasive ductal carcinoma

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4
Q

concerned about familial breast cancer. when to refer

A

first degree/ second degree relative and one of:

  • age of diagnosis < 40
  • bilateral breast cancer
  • male breast cancer
  • ovarian cancer
  • Jewish ancestory
  • family history of multiple cancers at a young age
  • two or more relatives on the father’s side
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5
Q

symptoms of fibroadenosis

A 
aka. fibrocystic disease
middle aged women
lumpy breasts
\+/- pain
symptoms worsen prior to menstruation
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6
Q

Breast hormonal therapy options

A

ER+ cancer
tamoxifen ER antagonist blocks oestrogen effect – pre/peri menopausal

post menopausal
aromatase inhibitors eg. letrozole, anastrozole
reduce conversion of testosterones into oestrogens

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7
Q

HER2+ breast cancer

A

HER2+ cancer

trastuzumab (herceptin)

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8
Q

plan for lymph nodes in breast cancer

A

no lymphadenopathy:
do a pre-op USS and if positive do a sentinel node biopsy

present with lymphadenopathy:
axillary node clearance

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9
Q

consequences of axillary lymph node clearance

A

arm lymphoedema

functional arm impairment

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10
Q

surgical options for breast cancer

A

wide local excision
masectomy
followed by breast reconstruction for cosmesis if the patient wants - either at the initial operation or at a later date

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11
Q

DCIS size cut off for wide local excision vs masectomy

A

4cm
below = wide local excision
above 4cm = masectomy

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12
Q

masectomy indications

A

multifocal tumour (several lobes)
central tumour
large lesion in small breast
DCIS>4cm

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13
Q

wide local excision

A

solitary lesion
peripheral tumour
small lesion in large breast
DCIS<4cm

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14
Q

adjuvant radiotherapy indications breast cancer

A

following wide local excision

following masectomy for T3/4 tumours, >4 positive axillary nodes

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15
Q

side effects of tamoxifen (selective oestrogen receptor modulator SERM)

A

menstrual disturbance: bleeding/ amenorrhoea
menopausal symptoms
endometrial cancer
venous thromboembolism

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16
Q

broad management options for breast cancer

A

hormone therapy - ER antagonists eg. tamoxifen, aromatase inhibitors eg. anastrazole, letrozole
biologics eg. herceptin (trastuzumab) in HER2+ cancer

chemo prior or after surgery

surgery: wide local excision or masectomy, with breast reconstruction

radiotherapy after

17
Q

when to start abx in breast feeding mastitis

A

symptoms do not improve after 12-24 hours of effective milk removal

nipple fissure

systemically unwell

culture indicates infection

  • continue breast feeding with abx (fluclox 14 days)
18
Q

receptors to check for on breast cancer biopsy

A

oestrogen
progesterone
HER-2

19
Q

when can you surgically excise fibroadenoma

A

> 3cm + causing discomfort

20
Q

prognostication in breast cancer

A

nottingham prognostic index
score based on tumour size, number of lymph nodes, grade
the score matches to a percentage 5 year survival

21
Q

signs of inflammatory breast cancer

A

rapidly progressive

obstruction of lymph drainage –> erythema, oedema of the breast

22
Q

major side effect of aromatase inhibitors

A

osteoporosis
so need to check bone mineral density prior and during treatment

hot flush, arthralgia, myalgia

23
Q

duct ectasia mx

A

self limiting
stop smoking
total duct excision for severe symptoms

24
Q

BRCA gene mutations inheritance pattern

A

people are usually heterozygous
autosomal dominant

so having a parent with the mutation gives child a 50% chance of getting it

25
Q

lifetime risk of getting breast or ovarian cancer with BRCA1 or 2

A

40%

26
Q

risk factors for breast cancer

A 
early menarche, late menopause
COCP
not breastfeeding
nulliparity
having children after 30 doubles the risk 
past breast cancer 
obesity 
smoking
27
Q

what is the first line treatment for breast cancer

A

surgery (routinely followed by radiotherapy to reduce recurrence)

28
Q

axillary radiotherapy vs surgical axillary node clearance

A

AMAROS trial found axillary radiotherapy = axillary node clearance with fewer side effects in radiotherapy

29
Q

snowstorm sign on USS axillary lymph nodes

A

extracapsular breast implant rupture

the silicone drains via the lymphatics giving a snowstorn appearance in the breast and lymph nodes

30
Q

periductal mastitis

A

recurrent infections
smokers
Mx. co-amoxiclav

31
Q

intraductal papilloma mammography findings

A

no findings on mammography

so do a USS +/- galactogram

Helena's finals (22 decks)

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