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breast Flashcards

1
Q

risk factors for breast cancer (higher and lower risk)

A

higher risk:

  • age
  • alcohol
  • smoking (as a teenager)
  • oestrogen-progesterone pill + HRT
  • Xray and gamma radiation
  • obesity
  • easy menarche/late menopause
  • dense breasts

lower risk

  • longer duration of breastfeeding
  • early age at first child
  • increasing parity
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2
Q

what genes involved with breast cancer

A

BRCA1, BRCA2, p53

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3
Q

breast cancer symptoms/signs

A
  • lump
  • pain
  • skin changes (rash, nipple eczema, dimples, skin tethering, redness)
  • nipple discharge
  • inverted nipple
  • lymph node swelling
  • systemic symptoms
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4
Q

with breast lump, what investigations to do

A
  • if < 35 and P1-P3: ultrasound
  • if < 35 and P4-P5: ultrasound + mammography
  • if > 35: mammography, ultrasound and biopsy
  • if micro calcification on mammography: core biopsy
  • if lymph node involvement: ultrasound + biopsy + CT abode/thorax/pelvis (if >4 lymph nodes/big lump/specific symptoms
  • MR if no concordance
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5
Q

areas of metastasis of breast cancer

A

Bs and Ls:

bone, brain, liver ,lung

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6
Q

tool for prognosis?

worse and better prognosis of breast cancer

A

tool: PREDICT
worse prognosis: triple negative , HER2 pos, grade 3; Nodal/metastasis
- better prognosis: ER pos, low grade, primary cancer

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7
Q

meaning of primary/secondary breast cancer

A

primary: originates in breast, not spread
secondary: originates in breast and spread

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8
Q

what features determine the grade of breast cancer

A
  • differentiation
  • pleomorphism
  • mitotic activity
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9
Q

which biomarkers in breast cancer

A

ER
PR
HER2

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10
Q

treatment of breast cancer

A
  • if ER pos: tamoxifen + adjacent chemo
  • if HER2 pos: herceptin + chemo
  • surgical: wide excision + radiotherapy OR mastectomy (multifocal, local recurrence, DIS or invasion)
  • chemo: adjacent/neoadjuven, triple neg cancers, HER2 pos, node/metastasis
  • aromatase inhibitors (postmenopausal women)
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11
Q

morbidity of treatment of breast cancer

A

lymphedema

disfiguring surgery

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12
Q

what treatment to give for bone metastasis

A

denosumab

bisphosphonates (for prevention)

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13
Q

classification of breast pain

A

cyclical (linked to hormones)

non cyclical

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14
Q

investigations for breast pain

A

mammography

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15
Q

management of breast pain

A
  • reassurance
  • well fitted bra
  • diet and lifestyle changes (alcohol, caffeine, less fat/more fibre)
  • NSAIDs (topical)
  • change contraceptive pill
  • if severe and prolonged: hormone suppressing drugs (tamoxifen or danazol)
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16
Q

mastitis risk factors

A
  • tight bra
  • nulliparity
  • baby not attaching well to the breast
  • use of dummy/bottle
  • smoking
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17
Q

general symptoms/signs of mastitis

A

painful breast
fever/general malaise
tender, red, swollen and hard area of the great, in a wedge shaped distribution
greenish discharge

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18
Q

different types of mastitis

A

periductal
granulomatous
lactational

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19
Q

lactational mastitis features

A
  • inflam condition
  • milk statis due to overproduction or insufficient removal of milk
  • may be infective or non infective
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20
Q

management of lactational mastitis

A
  • analgesia and warm water
  • keep breastfeeding
  • ultrasound of breast to look for abscess
  • breast milk MS&C (if indicated)
  • if infective: prescribe flucloxacillin
  • urgent referral to secondary care if breast abscess (ultrasound guided drainage)
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21
Q

features suspicious of infection in mastitis

A
  • nipple fissure that looks infective
  • purulent discharge
  • influenza-like symptoms and pyrexia > 24h
  • considerable breast discomfort
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22
Q

differentials of mastitis

A
  • breast cancer
  • duct ectasia
  • cellulitis
  • fibroadenosis
  • blocked duct
  • galactocoele
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23
Q

signs and symptoms of implant rupture

A
  • lumpiness/swelling in and around the breast
  • change in shape of breast
  • redness
  • pain and tenderness
  • burning sensation
  • enlarged lymph nodes in the armpit
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24
Q

which type of implant is most likely to rupture

A

PIP

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25
what is a fibroadenoma
benign breast tumour
26
how does fibroadenoma present on triple assessment
- P2 - U2 (pushing, not infiltrating margins and no shadowing behind the mass) - core biopsy (only if > 25yo)
27
management of fibroadenoma
- if diagnosis has been made through triple assessment, does not need treatment - if > 4cm, growing or patient requests it, can be excised
28
prognosis of fibroadenoma
- generally stays the same size, can get bigger or smaller | - does not increase risk of developing cancer
29
def of breast cysts
benign fluid filled lobules
30
epidemiology of breast cysts
women 35 yo- menopause
31
cause of breast cyst
change in oestrogen levels
32
treatment of breast cysts
- no need for treatment | - if large or uncomfortable: fine needle aspiration (if blood stained: send for cytology)
33
prognosis of breast cysts
does not increase risk of cancer
34
when do women undergo breast screening
between 47-73 years old | every 3 years
35
what tool(s) do you use for screening
mammography
36
when can you start screening and why tools can you access if you have a high risk of breast cancer
can start earlier (from 20y if gene involvement) | - annual MR and mammography
37
disadvantages of breast screening
- mammography is uncomfortable and involves small amount of radiation (few months-years of background radiation) - false pos results (unnecessary anxiety) - occasionally miss cancer - breast cancer may occur between screening appointments - screening may diagnose a cancer which never needed treating
38
explain process of breast screening
- mammography every 3 years between age 47-73 - prep: undress from waist down, do not wear talcum powder or deodorant , need to know about previous breast cancer Hx, HRT, FH - mammography done by female mamographer, need to compress breast - interpretation: read by two trained film readers (radiologists, breast physician or radiographers) - results: by post within 2 weeks - may have recall (one in 4 women) and do magnification view
39
def ductal carcinoma in situ
cancer cells have formed within the milk ducts but have not invaded through the basement membrane to surrounding breast tissue
40
symptoms of DCIS
breast mass nipple discharge paget's disease
41
how does DCIS appear on mammography
pattern of micro calcification following a linear branching pattern of milk ducts
42
management of DCIS
- wide local excision and radiotherapy - mastectomy - post surgical hormonal treatment (if pos) - annual mammogram and clinical examination for 5 years
43
def familial breast cancer
occurs more frequently in a family than would be expected in the general population
44
who do you refer to secondary care for breast cancer (FH wise)
- one 1st degree relative < 40 - two 1st/2nd degree relatives at any age or FH of: - bilateral breast cancer - male breast cancer - ovarian cancer - jewish ancestry - complicated cancer in young relatives - 2+ cancers on father's side
45
how do you manage familial breast cancer
- screening from a young age (MRI and mammograms annually) - prophylaxis mastectomy - prophylaxis oophorectomy - chemoprevention (tamoxifen and raloxifene)
46
doctor confidentiality with familial breast cancer genetic testing
- doctor cannot tell anyone without your consent - can share with family members that have undergone genetic testing to understand their risk (but should discuss this with you first) look up more
47
tripple assessment components
- clinical assessment (history and examination) - imaging (mammography/ultrasound) - needle biopsy (FNA/core biopsy)
48
triple assessment scoring (1-5)
1. normal 2. benign 3. indeterminate/probably benign 4. suspicious 5. malignant ``` P: palpation U: ultrasound M: mammography B: biopsy C: cytology ```
49
different views of a mammogram
- mediolateral oblique (MLO) view (to include axillary tail) | - craniocaudal (CC) view
50
why compress breast in mammogram
- spreads our glandular tissue (reduce overlap) - decreases risk of blurring - helps thin breast: avoids over/underexposure of certain parts - reduces radiation dose
51
how do you describe a mammography in terms of parts
R/L breast lower/upper inner/outer mass
52
findings on ultrasound for malignancy
- irregular borders - star shaped, spiked finger like projection - enlarged ducts - unusual tissue structures - invasion through tissue plane - dense shadowing behind it
53
benign findings on ultrasound
- round or oval shaped - well defined borders that are easily distinguished from surrounding tissue - tissue plane pushed away (but not invaded)
54
appearance of fluid, soft and dense tissue on ultrasound
fluid appears black soft tissue is varying shade of grey dense tissue appears white
55
advantages of FNA over core biopsy
- FNA quick and easy to perform - processing times are rapid (FNA: 30 mins, core biopsy, several days) - low cost procedure - few complications
56
disadvantages of FNA over core biopsy
- FNA interpretation requires highly trained and experienced pathologist - difficult to classify malignant lesions as evasive or non invasive - cytology prep does not require as much tissue in core biopsy - cytology preps cannot ascertain receptor status of a cancer
57
differentials for breast erythema
infection trauma underlying breast pathology (inflammatory)
58
cause of puckering of the breast
associated with invasion of suspensory ligaments of the breast underlying malignancy
59
cause of peau d'orange
- dimpling of skin due to cutaneous lymphatic oedema - tethering of swollen skin ti hair follicles and sweat glands - typically associated with inflammatory breast cancer
60
difference between skin tethering and skin fixation
skin tethering: lump is attached to the skin but can be moved in an arc without moving the skin. if moved outside arc, skin indents skin fixation: lump cannot be moved without moving the skin
61
paget's disease
eczematoid change in nipple associated with underlying breast malignancy differs from eczema of nipple as mainly involve nipple and then laterally spreads to alveolar
62
nipple eczema
nipple and or areolar associated with erythema and pruritus
63
differentials of lump presentation through the ages
20s: benign modularity or fibroadenoma 30s: benign modularity 40s: benign modularity or increasing risk of cyst (or cancer) 50s: cysts, benign nodular or cancer 60s: cancer
64
differentials of microcalcifications
- fibroadenomas - cysts - response to trauma or surgery - DCIS

Year 4 (13 decks)

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