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Yr4 - Cancer Care > Breast > Flashcards

Breast Flashcards

1
Q

Define fibroadenoma

A

Arise from terminal duct lobular unit
Aberrations of normal breast development
Mixture of connective tissue and epithelium
Very low malignant potential

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2
Q

Clinical features of fibroadenoma

A

Affected by hormones - change in size during cycle
Extremely mobile, discrete, rubbery mass
- breast mice
Common in younger women
- make up 60% of palpable masses in women aged 20

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3
Q

Mx of fibroadenoma

A 
Core biopsy to confirm diagnosis
If < 3cm
- reassure and discharge
- if symptomatic - excise
If > 3 cm
- excise
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4
Q

Features of breast cyst

A 
Epithelial lined fluid-filled cavities 
Formed when lobules become distended due to blockage
Simple
- 1 chamber
Complex 
- multiple cysts in 1 area of inoculated
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5
Q

Clinical features of breast cyst

A

Most common in perimenopausal women
Smooth discrete breast masses
- can be firm due to increased pressure

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6
Q

Ix for breast cyst

A

USS
- halo - due to solid capsule
Aspiration

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7
Q

Mx of breast cyst

A 
If simple and asymptomatic
- reassure and discharge
If large, symptomatic or complex
- aspirate to dryness
- if blood stained fluid send for cytology
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8
Q

Features of Phyllodes tumour

A

Clinically similar to fibroadenoma
Rare fibroepithelial tumours
Malignant potential and 10% benign will recur after excision

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9
Q

Features of adenoma

A

Benign glandular tumour
Older female population
Nodular - easily mimic malignancy

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10
Q

Clinical features of Phyllodes tumours

A

Rapid growing

Occur in older age group

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11
Q

Mx of Phyllodes tumour

A

Widely excised

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12
Q

Features of papilloma

A

Intraductal papillomas are benign breast lesions

Occur in females 40-50 years

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13
Q

Clinical features of papilloma

A

Typically occur in subareolar region

Bloody or clear nipple discharge

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14
Q

Mx of papilloma

A

Appear similar to ductal carcinomas on imaging
Require biopsy
Some excised to ensure no atypical cells or neoplasia present
Breast cancer risk only increased with multi-ductal papilloma - treated with microdoecotmy

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15
Q

Clinical features of lipoma

A

Soft and mobile
Low malignant potential
Only removed if significantly enlarging or causing symptomatic compressive or aesthetic issues

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16
Q

Define mastitis

A

Inflammation of the breast tissue
Commonly caused by infection
- S.Aureus

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17
Q

Types of mastitis

A

Lactational mastitis
- up to 1/3 of breast feeding women
- presents during first 3 months or during weening
- associated with cracked nipples and milk stasis
Non-lactational mastitis
- occur with other conditions such as duct ectasia
- tobacco smoking risk factor - causes damage to sub-areolar duct walls predisposing to infection

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18
Q

Clinical features of mastitis

A

Tenderness
Swelling
Erythema

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19
Q

Mx of mastitis

A

Systematic abx therapy
Simple analgesics
For lactational mastitis continue milk drainage or feeding

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20
Q

Define breast abscess

A

Collection of pus within breast lined with granulation tissue
- commonly developing from acute mastitis

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21
Q

Clinical features of breast abscess

A

Tender fluctuant and erythematous masses
Fever and lethargy
Confirmed by USS

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22
Q

Mx of breast abscess

A

Empirical abx and US guided needle therapeutic aspiration

More advanced abscesses may require incision and drainage under local anaesthetic

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23
Q

Define duct ectasia

A

Dilation and shortening of major lactiferous ducts

Common presentation in peri-menopausal women

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24
Q

Clinical features of duct ectasia

A

Coloured yellow/green nipple discharge
Palpable mass
Nipple retraction

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25
Q

Ix for duct ectasia

A

Mammography
- dilated calcified ducts
If biopsied mass
- multiple plasma cells

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26
Q

Mx of duct ectasia

A

Conservatively

Duct excision for unremitting nipple discharge

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27
Q

Define fat necrosis

A

Common condition caused by acute inflammatory response in the breast
Ischaemic necrosis of fat lobules
Associated with trauma, previous surgical or radiological intervention

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28
Q

Clinical features of fat necrosis

A

Usually asymptomatic or presenting as a lump

Acute inflammatory response can persist causing chronic fibrotic change - solid irregular lump

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29
Q

Ix for fat necrosis

A

Hyperechoic mass on USS

30
Q

Mx of fat necrosis

A

Self-limiting

Analgesia and reassurance

31
Q

Clinical features of nipple eczema

A

Itching
Dryness
Erythema
Areola affected first

32
Q

Mx of nipple eczema

A 
May need punch biopsy if unsure of diagnosis
Reduce exposure to allergens
- simple soap
- hypoallergenic laundry soap
Short course high conc steriod cream
33
Q

Define mastectomy

A

Complete removal of the breast

Aesthetic outcomes are important

34
Q

Indications for mastectomy

A

Mx of large or multifocal cancers

Risk reduction - those with BRCA1/2

35
Q

Advantages of immediate reconstruction

A

Minimal time without breast mound
Preservation of skin envelope
Natural shape
Reduced need for symmetrising surgery

36
Q

Disadvantages of immediate reconstruction

A

Prolonged operating time
Complications may result in delay to adjuvant treatment
Radiotherapy can cause poor cosmesis

37
Q

Advantages of delayed reconstruction

A

Longer time for decision making
Psychological adjustment after diagnosis
Radiotherapy before reconstruction
Improved patient satisfaction

38
Q

Disadvantages of delayed reconstruction

A

Replacement of larger amount of skin

Second operation, hospital stay and recovery

39
Q

Features of autologous tissue flap reconstruction

A

Natural texture and appearance
Aesthetic result improves over time
Multiple options for donor sites
Can be used after failed implant reconstruction

40
Q

Features of non-autologous implant reconstruction

A

Good for small-moderate sized breasts
Shorter stay and recovery period
No donor site so no extra scar
Need healthy mastectomy skin flaps
Radiotherapy can lead to poor cosmesis and increased complications
Risk of breast-implant associated large cell lymphoma

41
Q

Features of latissimus dorsi flap (LD)

A

Thoracodorsal artery
LD muscle + some overlying skin rotated 180 degrees on pedicle
Skin de-epithelialised with skin island in centre

42
Q

Features of deep inferior epigastric perforator flap (DIEP)

A

Deep inferior epigastric perforating artery and vein
Anastomosed to perforating internal mammary artery and vein
Skin de-epithelialised with skin island in centre

43
Q

Features of breast conserving surgery

A 
Partial removal of breast tissue
Complete removal of local disease
Ideal for
- high breast:tumour ratio
- likely poor outcome with mastectomy
44
Q

Symmetrising in breast conserving surgery

A 
Volume displacement
- parenchymal advancement
- round block
- therapeutic mastopexy
- therapeutic reduction mammoplasty
Volume replacement
- lateral intercoastal artery perforator flap (LICAP)
- mini latissimus dorsi flap (LD)
- free flap
45
Q

Features of sentinel lymph node biopsy

A 
Evaluate microscopic lymph node involvement
Radioactive colloid agent
Blue dye
Dissection and removal of up to 4 nodes
Can lead to lymphoedema in up to 5%
46
Q

Features of axillary node clearance

A

Confirmed axillary node involvement
Levels defined by location relative to pec major
- level I: below the lower edge of the pectoralis minor muscle
- level II: underneath/posterior the pectoralis minor muscle
- level III: above/medial the pectoralis minor muscle
Aim to remove all lymph nodes

47
Q

Complications of axillary node clearance

A

Lymphoedema - 15%
Damage to long thoracic nerve
Poor mobility of shoulder and arm
Chronic pain

48
Q

Views on mammogram

A

CC - craniocaudal

MLO - medial bilateral oblique

49
Q

Features of normal mammogram

A

Shadow pec major
Blood vessels
Fluffy post-menopausal
Milk ducts leading to nipple

50
Q

Wires on mammogram

A

Wire inserted if impalpable cancer found on screening to mark location

51
Q

Development of breasts

A

Breast buds develop in both sexes 6-9th week of foetal life

At puberty female breast develops under influence of oestrogen and progesterone

52
Q

Anatomy of breasts

A

2-6th rib
Sternal edge to anterior axillary line
15-20 lobes
Supported by Cooper’s suspensory ligaments

53
Q

Arterial supply to the breast

A

External mammary artery
Internal mammary arteries
Intercostal arteries

54
Q

Suspicious features on mammography

A

Irregular, spiculated, radiopaque mass

Microcalcification

55
Q

Features of calcification on mammography

A

May be benign or malignant
Needs histological assessment
- stereotactic core biopsy

56
Q

When is an MRI used for breast cancer

A

Dense breasts
Lobular carcinomas
Exclude multifocal disease
To screen <40s at high risk patients

57
Q

Features of FNA

A 
Fine Needle Aspiration
Quick
Less uncomfortable
Lower morbidity
Cytological assessment only
58
Q

Features of core biopsy

A

Removes small amount of tissue
Higher morbidity and pain
Takes longer
Can determine receptor status and grade of tumour

59
Q

Mx of axilla in breast cancer

A

If normal axillary USS - dye directed SLNB
If suspicious node perform USS guided FNA
- If malignant perform axillary clearance
- If benign perform dye directed SLNB

60
Q

Features of oestrogen antagonists

A

Tamoxifen
Blocks ER
Can be used in both pre and post menopausal women

61
Q

Disadvantages of oestrogen antagonists

A

Increased risk of DVT

Increased risk of endometrial Ca

62
Q

Advantages of oestrogen antagonists

A

Protects bones from osteoporosis

63
Q

Features of aromatase inhibitors

A

Armidex, Letrozole
Blocks enzyme aromatase
Prevents oestrogen production in post menopausal women
- cannot be used pre-menopausal as ovaries still releasing oestrogen

64
Q

Disadvantages of aromatase inhibtors

A

Increased risk of osteoporosis

65
Q

Whos invited to UK breast screening

A

Women 47-73
3 yearly intervals
2 view mammography

66
Q

Breast cancer receptor status

A 
Oestrogen receptor (ER)
- 75%
Progesterone receptor (PR)
- most ER positive are PR positive
- cannot be targeted
Human epidermal growth factor 2 (HER2)
- can be treated with monoclonal antibody trastuzumab (Herceptin)
67
Q

Breast cancer grading

A

Based on differentiation - well, moderately or poorly
Graded on nuclear pleomorphism, mitotic rate and tubule formation
Two scores combined to give grade 1, 2 or 3

68
Q

Define Paget’s disease of the nipple

A

Roughening, reddening and slight ulceration of the nipple

Vast majority have underlying malignancy

69
Q

Presentation of Paget’s disease of the nipple

A

Itching or redness in nipple or areola
Flaking and thickened skin
Painful and sensitive
Involves the nipple then areola - eczema will spare the nipple

70
Q

Ix for Paget’s disease of the nipple

A

Biopsy

Mammogram

71
Q

Features of carcinoma in situ

A

Malignancies contained in basement membranes

Typically found on imaging as rarely symptomatic

Yr4 - Cancer Care (12 decks)

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