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Breast disease > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

What are the indications for performing mastectomy?

A 
multifocal disease
if mass can't be reduced by radiotherapy
Size of mass
BRCA1/2 gene
If radiotherapy is contradindicated
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2
Q

Name three options for breast reconstructive surgery

A
  1. Latissimus dorsi flap
  2. Free flap (from epigastric perforator, same tissue for tummy tuck)
  3. Implants
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3
Q

Which nerves do surgeons need to avoid when performing breast surgery?

A

long thoracic nerve in axilla region (damage causes winged scapula) and thoracodorsal nerve

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4
Q

List three modes of diagnosing breast cancer

A

symptomatic
screening
surveillance (PMH, FH)
incidental

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5
Q

List five risk factors for breast cancer

A 
smoking
HRT
oral contraceptives
breastfeeding
age
FMH
early menarche and late menopause
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6
Q

Why is tamoxifen termed modulator rather than antagonist?

A

it has antagonistic properties in the breast but agonistic properties in the endometrium, therefore small risk of endometrial cancer

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7
Q

What are the components of triple assessment?

A

history/exam

imaging: mammography/ultrasound
biopsy: excision/core biopsy

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8
Q

What is peau d’orange a sign of?

A

inflammatory breast cancer

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9
Q

List three nipple changes indicative of breast cancer

A

nipple inversion
nipple discharge
paget’s disease of the nipple- eczematous changes

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10
Q

How to describe breast lump?

A 
site in breast (upper/outer quadrant)
discrete lump or generalised lumpiness
size in cm
hard/soft, smooth/irregular
mobile/fixed
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11
Q

What are the indications for mammography?

A

used for a new breast symptom over the age of 35, performed in both breasts

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12
Q

What are the indications for ultrasound of the breast?

A

to look at specific areas of clinical abnormality e.g. discrete lump. Distinguishes between cystic and solid lumps

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13
Q

What are the three methods of performing breast biopsy?

A

FNA- cytological diagnosis but difficult to get specimen
Core biopsy- histological diagnosis but takes time for result
Excision biopsy- requires surgery

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14
Q

What is the breast screening programme?

A

From 50, invited every 3 years until 71

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15
Q

How is breast cancer staged?

A

CXR
CT abdo/chest/pelvis
MRI scan
Bone scan

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16
Q

What are the two surgical approaches to treating breast cancer

A
  1. mastectomy +- breast reconstruction

2. wide local excision (breast conservation)

17
Q

Aside from surgery, what are the other treatment options?

A

radiotherapy
chemotherapy
hormonal
monoclonal antibodies

18
Q

What is the indication for tamoxifen?

A

oestrogen receptor positive patients (around 80%)

19
Q

What is the MOA of herceptin/trastuzamab

A

Her-2 receptor blocker (growth factor) which are associated with higher risk of disease

20
Q

What are the components of a triple negative breast cancer?

A

negative oestrogen, progesteron,e HER2 protein

21
Q

What is the prognosis of triple negative breast cancers?

A

more aggressive and poorer prognosis

22
Q

Name a breast pre-cancerous condition

A

DCIS/LCIS (in-situ)

23
Q

Which is the most common breast cancer?

A

invasive ductal carcinoma

24
Q

Name two sites of metastasis and state one associated symptom

A

Bones- bone pain
Lungs- dyspnoea, pleural effusion
Liver- abdo pain, hepatic impairment
Brain- headache, seizure

25
Q

Two differentials for breast cancer?

A

cysts
fibroadenomas
DCIS
duct ectasia

26
Q

MDT for breast cancer patient?

A 
oncologist
breast surgeon
radiologist
histopathologist
breast cancer nurse
27
Q

Two specific complications of breast surgery?

A
  • Haematoma, seroma
  • Frozen shoulder
  • Long-thoracic nerve palsy
  • Lymphoedema
  • Upper inner arm numbness
28
Q

Name the prognostic scoring tool used in breast cancer

A

Nottingham prognostic index

29
Q

MOA of tamoxifen?

A

selective estrogen receptor modulator

30
Q

Two side effects of tamoxifen?

A

endometrial cancer
menopausal symptoms
stroke
pulmonary embolism

31
Q

MOA of trastuzumab?

A

(anti-Her2) is used if Her2+ve

32
Q

Name one chemotherapy drug used in the management of breast cancer

A

trastuzumab/herceptin (tamoxifen= endocrine)

Breast disease (2 decks)

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