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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
Ix for duct ectasia
Mammography - dilated calcified ducts If biopsied mass - multiple plasma cells
26
Mx of duct ectasia
Conservatively | Duct excision for unremitting nipple discharge
27
Define fat necrosis
Common condition caused by acute inflammatory response in the breast Ischaemic necrosis of fat lobules Associated with trauma, previous surgical or radiological intervention
28
Clinical features of fat necrosis
Usually asymptomatic or presenting as a lump | Acute inflammatory response can persist causing chronic fibrotic change - solid irregular lump
29
Ix for fat necrosis
Hyperechoic mass on USS
30
Mx of fat necrosis
Self-limiting | Analgesia and reassurance
31
Clinical features of nipple eczema
Itching Dryness Erythema Areola affected first
32
Mx of nipple eczema
``` May need punch biopsy if unsure of diagnosis Reduce exposure to allergens - simple soap - hypoallergenic laundry soap Short course high conc steriod cream ```
33
Define mastectomy
Complete removal of the breast | Aesthetic outcomes are important
34
Indications for mastectomy
Mx of large or multifocal cancers | Risk reduction - those with BRCA1/2
35
Advantages of immediate reconstruction
Minimal time without breast mound Preservation of skin envelope Natural shape Reduced need for symmetrising surgery
36
Disadvantages of immediate reconstruction
Prolonged operating time Complications may result in delay to adjuvant treatment Radiotherapy can cause poor cosmesis
37
Advantages of delayed reconstruction
Longer time for decision making Psychological adjustment after diagnosis Radiotherapy before reconstruction Improved patient satisfaction
38
Disadvantages of delayed reconstruction
Replacement of larger amount of skin | Second operation, hospital stay and recovery
39
Features of autologous tissue flap reconstruction
Natural texture and appearance Aesthetic result improves over time Multiple options for donor sites Can be used after failed implant reconstruction
40
Features of non-autologous implant reconstruction
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
Features of latissimus dorsi flap (LD)
Thoracodorsal artery LD muscle + some overlying skin rotated 180 degrees on pedicle Skin de-epithelialised with skin island in centre
42
Features of deep inferior epigastric perforator flap (DIEP)
Deep inferior epigastric perforating artery and vein Anastomosed to perforating internal mammary artery and vein Skin de-epithelialised with skin island in centre
43
Features of breast conserving surgery
``` Partial removal of breast tissue Complete removal of local disease Ideal for - high breast:tumour ratio - likely poor outcome with mastectomy ```
44
Symmetrising in breast conserving surgery
``` 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
Features of sentinel lymph node biopsy
``` 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
Features of axillary node clearance
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
Complications of axillary node clearance
Lymphoedema - 15% Damage to long thoracic nerve Poor mobility of shoulder and arm Chronic pain
48
Views on mammogram
CC - craniocaudal | MLO - medial bilateral oblique
49
Features of normal mammogram
Shadow pec major Blood vessels Fluffy post-menopausal Milk ducts leading to nipple
50
Wires on mammogram
Wire inserted if impalpable cancer found on screening to mark location
51
Development of breasts
Breast buds develop in both sexes 6-9th week of foetal life | At puberty female breast develops under influence of oestrogen and progesterone
52
Anatomy of breasts
2-6th rib Sternal edge to anterior axillary line 15-20 lobes Supported by Cooper's suspensory ligaments
53
Arterial supply to the breast
External mammary artery Internal mammary arteries Intercostal arteries
54
Suspicious features on mammography
Irregular, spiculated, radiopaque mass | Microcalcification
55
Features of calcification on mammography
May be benign or malignant Needs histological assessment - stereotactic core biopsy
56
When is an MRI used for breast cancer
Dense breasts Lobular carcinomas Exclude multifocal disease To screen <40s at high risk patients
57
Features of FNA
``` Fine Needle Aspiration Quick Less uncomfortable Lower morbidity Cytological assessment only ```
58
Features of core biopsy
Removes small amount of tissue Higher morbidity and pain Takes longer Can determine receptor status and grade of tumour
59
Mx of axilla in breast cancer
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
Features of oestrogen antagonists
Tamoxifen Blocks ER Can be used in both pre and post menopausal women
61
Disadvantages of oestrogen antagonists
Increased risk of DVT | Increased risk of endometrial Ca
62
Advantages of oestrogen antagonists
Protects bones from osteoporosis
63
Features of aromatase inhibitors
Armidex, Letrozole Blocks enzyme aromatase Prevents oestrogen production in post menopausal women - cannot be used pre-menopausal as ovaries still releasing oestrogen
64
Disadvantages of aromatase inhibtors
Increased risk of osteoporosis
65
Whos invited to UK breast screening
Women 47-73 3 yearly intervals 2 view mammography
66
Breast cancer receptor status
``` 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
Breast cancer grading
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
Define Paget's disease of the nipple
Roughening, reddening and slight ulceration of the nipple | Vast majority have underlying malignancy
69
Presentation of Paget's disease of the nipple
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
Ix for Paget's disease of the nipple
Biopsy | Mammogram
71
Features of carcinoma in situ
Malignancies contained in basement membranes | Typically found on imaging as rarely symptomatic

Yr4 - Cancer Care (12 decks)

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