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#Phase 2.1: Peri Op > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are the risk factors for breast cancer? (11 things)

A
  1. family history
  2. age
  3. uninterrupted oestrogen exposure
  4. 1st pregnancy after 30yrs old
  5. early menarche
  6. late menopause
  7. HRT
  8. obesity
  9. BRCA genes
  10. not breastfeeding
  11. past breast cancer
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2
Q

What is the Triple Assessment method for breast cancer?

A
  1. History n examination
  2. Imaging
  3. Biopsy
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3
Q

If a patient presents with a breast LUMP, what questions should you ask? (12 questions)

A
  1. Previous lumps
  2. Family history
  3. Pain
  4. Nipple discharge
  5. Nipple inversion
  6. Skin changes
  7. Change in size related to menstrual cycle
  8. First/last/latest period
  9. Number of pregnancies
  10. Postnatal
  11. Breast feeding
  12. Drugs (eg HRT)
  13. Consider metastatic disease (weight loss, breathlessness, back pain, abdominal mass?)
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4
Q

If a patient presents with a breast PAIN, what questions should you ask? (6 questions)

A
  1. SQITARS
  2. Bilateral / unilateral
  3. Rule out cardiac chest pain (radiates to shoulders or arms / relieved by rest / dyspnoea / central crushing pain / sharp pain)
  4. History of trauma
  5. Any mass
  6. Related to menstrual cycle
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5
Q

If a patient presents with a NIPPLE DISCHARGE, what questions should you ask? (6 questions)

A
  1. Amount
  2. Colour
  3. Consistency
  4. Any blood?
  5. Unilateral / bilateral ?
  6. Smoking? (ductal ectasia)
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6
Q

What are the causes of nipple discharge? (3 things)

A
  1. Duct ectasia
  2. Intraductal papilloma/adenoma/carcinoma
  3. Lactation
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7
Q

What is the discharge like in Duct Ectasia? (3 things)

A
  1. Green / brown / red discharge
  2. From multiple ducts
  3. Bilateral
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8
Q

What is the discharge like in Intraductal papilloma / adenoma / carcinoma? (2 things)

A
  1. Bloody discharge
  2. From one duct
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9
Q

What is the management of duct ectasia? (3 things)

A
  1. Diagnose cause (mammogram / US / ductogram)
  2. Treat appropriately
  3. Cessation of smoking = reduces duct ectasia discharge
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10
Q

When asking about Past Medical History in breast cancer what should you ask? (2 things)

A
  1. Any previous lumps / malignancies?
  2. Previous mammograms / clinical examinations of breast / US / Fine needle aspiration / core biopsies
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11
Q

When asking about Drug History in breast cancer what should you ask? (2 things)

A
  1. HRT
  2. Pill

Both increase risk of breast cancer

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12
Q

What are the features of Stage 1 breast cancer? (2 things)

A
  1. Confined to breast
  2. Mobile
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13
Q

What are the features of Stage 2 breast cancer? (3 things)

A
  1. Growth confined to breast
  2. Mobile
  3. Lymph nodes in ipsilateral axilla
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14
Q

What are the features of Stage 3 breast cancer? (3 things)

A
  1. Tumour fixed to muscle (but not chest wall)
  2. Ipsilateral lymph nodes matted (fused ) + may be fixed
  3. Skin involvement
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15
Q

What are the features of Stage 4 breast cancer? (2 things)

A
  1. Complete fixation of tumour to chest wall
  2. Distant metastases
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16
Q

What are the features of TNM staging in breast cancer?

A 
T1 = \<2cm
T2 = 2–5cm
T3 = \>5cm
T4 = fixed to chest wall or peau d’orange (inflamm)

N1 = mobile ipsilateral nodes
N2 = fixed nodes

M1 = distant metastases

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17
Q

What are the surgical treatment options for breast cancer? (3 things)

A
  1. Wide Local Excision (WLE)
  2. Mastectomy
  3. Axillary surgery
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18
Q

What is the most common breast conserving treatment?

A

Wide Local Excision (WLE)

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19
Q

What is excised in Wide Local Excision (WLE)?

A

Tumour + 1cm margin of macroscopically normal tissue

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20
Q

What size tumours is Wide Local Excision only suitable for?

A

Focal smaller cancers

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21
Q

What is excised in Mastectomy?

A

All tissue from affected breast + some overlying skin

(amount of skin excised dependent on whether a reconstruction is planned)

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22
Q

Are the chest wall muscles touched in Mastecomy?

A

No they are left intact

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23
Q

What are the indications for Mastectomy? (4 things)

A
  1. Multifocal disease
  2. High tumour : breast tissue ratio
  3. Disease recurrence
  4. Patient choice
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24
Q

Why is Axillary surgery performed? (2 things)

A
  1. Assess nodal status
  2. Remove any nodal disease
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25
Which lymph nodes are removed in Sentinal node biopsy?
The FIRST lymph nodes into which tumour drains
26
How are the nodes identified in Sentinal node biopsy?
By injecting blue dye with associated radioisotope into peri-areolar skin Sentinal nodes identified by radioactivity detection / visual assessment (bc nodes become blue)
27
What happens after the nodes are removed in Sentinal node biopsy?
Nodes sent for histological analysis
28
What is Axillary node clearance?
Removal of all nodes in axilla
29
Why should you be careful when performing axillary node clearance?
To not damage important structures in axilla
30
What are the complications of Axillary node clearance? (3 things)
1. Paraesthesia (pins n needles) 2. Seroma formation (serous fluid accum) 3. Lymphedema in upper limb (swelling bc lymph accum)
31
What is the ANTERIOR border of the axilla made up of? (2 things)
Pectoralis Major + Minor
32
What is the LATERAL border of the axilla made up of?
Intertubecular groove of humerus
33
What is the MEDIAL border of the axilla made up of? (2 things)
1. Serratus anterior 2. Thoracic wall
34
What is the POSTERIOR border of the axilla made up of? (3 things)
1. Scapularis 2. Teres major 3. Latissimus dorsi
35
What are the contents of the axilla? (5 things)
1. Axillary artery 2. Axillary vein 3. Axillary lymph nodes 4. Brachial plexus 5. Biceps brachii (short head) + coracobrachialis
36
When is Radiotherapy recommended in breast cancer?
For all patients with invasive cancer after WLE
37
By how much does radiotherapy reduce the risk of recurrence in breast cancer?
10 yr recurrence risk reduced from 30% --\> 10%
38
When should chemotherapy be considered in breast cancer?
All patients except excellent prognosis patients
39
What is the aim of hormone treatment in breast cancer?
To reduce oestrogen activity
40
Which age group is Tamoxifen recommended for?
Pre menopausal patients
41
What is the general mechanism of action of Tamoxifen?
Blocks oestrogen receptors
42
What are the side fx of Tamoxifen (3 things)
1. Thromboembolism risk 2. Immobility 3. Uterine (endometrium) carcinoma (bc pro-oestrogenic effect on uterus) (warn patient to report vaginal bleeding)
43
What is an example of an Aromatase inhibitors?
Anastrazole / Letrozole (Amatu Sahar)
44
Which age group are Aromatase inhibitors recommended for?
Post menopausal patients
45
What is the general mechanism of action of Aromatase inhibitors? (4 things)
Block conversion of androgens (aka testosterone) to oestrogen in peripheral tissue (Aromatase is da converter) bc Widad said post menopausal womens main source of oestrogen aint der ovaries, its der androgens
46
Which patients is immunotherapy recommended for?
For patients whose cancers express specific growth factor receptors
47
What is an example of growth factor receptor in breast cancer?
HER2 (Human epidermal growth factor receptor)
48
What is the treatment for HER2 breast cancer?
Herceptin = monoclonal antibody that targets its activity
49
What is the side fx of immunotherapy in breast cancer?
Cardiotoxicity (so cardiac function monitored b4 + during treatment)
50
What are guide wires used for in breast surgery? Who is it inserted by?
To pinpoint exact place in breast where cancer is so surgeon can remove it Wire insertion done by radiologist
51
What are the benign breast diseases? (5 things)
1. Fibroadenoma 2. Breast cysts 3. Infective mastitis / breast abscesses 4. Duct ectasia 5. Fat necrosis FBI DF
52
What age do fibroadenomas usually present at?
Under 30 yrs old
53
What is a fibroadenoma?
Benign overgrowth of collagenous mesenchyme of 1 breast lobule
54
What are the characteristics of a fibroadenoma lump? (3 things)
1. Firm 2. Smooth 3. Mobile
55
Are fibroadenomas painful?
No
56
Can you have multiple fibroadenomas?
Yes
57
What proportion of fibroadenomas regress / stay same size / grow?
1/3 regress 1/3 stay same size 1/3 get bigger
58
What is the treatment for fibroadenomas? (2 things)
1. Just observe + reassure patient 2. Surgical excision if large
59
What age do breast cysts usually present at?
35+ yrs old
60
What are breast cysts?
Benign fluid filled round lump
61
Are breast cysts fixed to surrounding tissue?
No
62
Are breast cysts painful?
Sometimes
63
How can a breast cyst diagnosis be confirmed?
Aspiration
64
What are Infective mastitis / breast abscesses?
Mammary duct infection
65
What are Infective mastitis / breast abscesses sometimes associated with?
Lactation
66
What is the bacteria that causes Infective mastitis / breast abscesses?
Staph aureus
67
Are Infective mastitis / breast abscesses? painful?
Yes
68
How does Infective mastitis / breast abscesses present?
Hot swelling of breast segment
69
What is the treatment for Infective mastitis / breast abscesses? (2 things)
1. Abx 2. Open incision / percutaneous drainage if abscess
70
What age does Duct ectasia usually present at?
Around menopause
71
What happens to the ducts in Duct ectasia?
Ducts become blocked
72
What happens to secretions in Duct ectasia?
Secretions stagnate (don't flow)
73
What happens to the nipple in Duct ectasia? (2 things)
1. Nipple discharge 2. Nipple retraction + lump
74
What colour is the nipple discharge in Duct ectasia?
Green / brown / bloody
75
What should you advise patients with Duct ectasia?
Stop smoking
76
What is Fat necrosis of breast tissue?
Fibrosis + calcification after injury to breast tissue
77
In Fat necrosis of breast tissue what do the scars form?
Firm lump
78
What are the side fx of Aromatase inhibitors? (4 things)
1. Osteoporosis 2. Arthralgia / myalgia (joint / muscle pain) 3. Hot flushes 4. Insomnia
79
PM: What is a disadvantage of breast milk?
Breast milk has inadequate levels of vitamin K
80
PM: What is an advantage of breastfeeding for the woman herself?
Protective against breast + ovarian cancer (prevents ovulation)
81
What muscles does the breast lie over? (2 things)
1. Pectoralis major 2. Serratus anterior
82
What is the breast innervated by?
Branches of intercostal nerves from T4-T6
83
What is the arterial supply of the breast? (4 things)
1. Internal mammary (thoracic) artery 2. External mammary artery 3. Anterior intercostal arteries 4. Thoraco-acromial artery
84
What is the venous drainage from the breast?
Superficial venous plexus --\> subclavian + axillary + intercostal veins
85
Where is the majority of the lymphatic drainage of the breast to?
70% axillary nodes
86
What are the hormones involved in the Preparation of lactation? (3 things)
1. Oestrogen 2. Progesterone 3. Human placental lactogen
87
What is the function of Oestrogen in the hormonal Preparation of lactation?
Promotes duct development in high concentrations
88
What is the function of Progesterone in the hormonal Preparation of lactation?
High levels stimulate formation of lobules
89
What is the function of Human placental lactogen in the hormonal Preparation of lactation?
Prepares mammary glands for lactation
90
What are the hormones involved in the Stimulation of lactation? (2 things)
1. Prolactin 2. Oxytocin
91
What is the function of Prolactin in the hormonal Stimulation of lactation?
Causes milk secretion
92
What is the function of Oxytocin in the hormonal Stimulation of lactation?
Causes contraction of myoepithelial cells surrounding mammary alveoli --\> milk ejection from breast
93
What does suckling of baby stimulate in lactation?
Stimulates nipple mechanoreceptors --\> prolactin + oxytocin release from pit gland
94
Which part of the pituitary gland is Prolactin released from?
Ant pit
95
Which part of the pituitary gland is Oxytocin released from?
Post pit
96
Which artery provides the greatest contribution to the arterial supply of the breast?
Internal mammary (thoracic) artery (60%)
97
What is the most common organism causing Mastitis?
Staph aureus
98
What is the first-line management of mastitis?
Continue breastfeeding
99
What happens if mastitis is left untreated?
Develops into breast abcess (requires incision + drainage)
100
What are the typical pathological changes seen in invasive breast cancer? (8 things)
1. Coarse chromatin 2. Nuclear pleomorphism 3. Invasion of the basement membrane 4. Abnormal mitoses 5. Vascular invasion 6. Angiogenesis 7. Dystrophic calcification (may be seen on mammography) 8. Lymph node metastasis (from inside of nucleus outwards)
101
Which region of the breast do majority of breast cancers arise?
Upper lateral
102
What is the most common type of breast cancer?
Invasive ductal carcinoma

#Phase 2.1: Peri Op (24 decks)

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