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3a obs and gynae > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

List the modifiable risk factors for breast cancer

A 
obesity 
HRT >5 years 
COCP, HRT >5 years
alcohol 
nulliparity/ late childbirth
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2
Q

List the non modifiable risk factors for breast cancer

A

genetic - BRCA gene (50% chance of gene if first degree relative with it), family history
early menarche and late menopause
breast density

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3
Q

Which ages are offered the NHS breast screening programme?

A

47-73 y/o

offered mammogram every 3 years

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4
Q

What are the common types of breast cancer?

A

invasive ductal carcinoma **
invasive lobular carcinoma
ductal carcinoma in situ
lobular carcinoma in situ

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5
Q

How might a cancerous breast lump present?

A
  1. palpable lump - hard, craggy, irregular, fixed
  2. nipple discharge
  3. +/- pain or tenderness
  4. nipple in drawing
  5. skin tethering
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6
Q

When would you consider referring a patient presenting with a breast lump?

A 
previous breast cancer problems 
unexplained lump
tenderness or pain
nipple changes
abscess or mastitis 
family history
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7
Q

How are breast lumps assessed?

A

TRIPLE ASSESSMENT (score out of 15)

  1. CLINICAL SCORE - examination, history
  2. IMAGING SCORE- mammogram +/- ultrasound
    (mammogram not useful if <40 y/o as breast tissue too dense and not very useful) - distinguish between cystic and solid lesions
  3. BIOPSY/ PATHOLOGICAL SCORE - core biopsy with USS guidance - send for histology
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8
Q

What is first line therapy in breast cancer?

A

SURGERY !!!

  1. lumpectomy
  2. mastectomy
  3. breast reconstruction - immediately or delayed
  4. surgery to the axilla - full axillary clearance or limited axillary clearance (SE: lymphedema in the arms)
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9
Q

When is a lumpectomy considered?

A

lump <25% of breast tissue or <4cm
patient choice
small lesion in big breast
no previous radiotherapy

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10
Q

When is a mastectomy considered?

A 
central tumour
large density 
inflammatory cancers
previous breast surgery 
small breasts
patient choice
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11
Q

How is breast cancer staged?

A

TNM staging
T- size
N- nodes involved
M- metastases

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12
Q

When is chemotherapy considered for breast cancer?

A 
offered for high risk disease ....
young age 
HER2 +VE
grade 3 or more
node positive
ER -VE
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13
Q

What else should be offered alongside lumpectomy?

A

radiotherapy !

all women who undergo lumpectomy should have radiotherapy + mastectomy that are aggressive

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14
Q

How are oestrogen receptor (ER) positive women treated?

A

endocrine therapy for 5 years

premenopausal - tamoxifen
post menopausal - aromatase inhibitors e.g. anastrozole

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15
Q

What are the side effects of tamoxifen?

A

menopausal symptoms e.g. hot flushes, nausea, vaginal bleeding
increased risk of endometrial cancer
increased risk of VTE

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16
Q

How does tamoxifen work?

A

inhibit oestrogen receptor on breast cancer cells

17
Q

How does aromatase inhibitors work?

A

inhibit aromatase which converts androgens to oestrogen so less oestrogen
SE: hot flushes, reduced bone mineral density

18
Q

How are HER 2 +VE women treated?

A

trastuzumab (herceptin) and lapatinib for 1 year + chemotherapy

19
Q

What is the management plan for metastatic breast cancer?

A
  1. refer to palliative care team
  2. analgesia
  3. treat hypercalcaemia, dehydration or electrolyte imbalance
20
Q

which score if used for indication of survival?

A

Nottingham prognostic index

21
Q

When diagnosing breast cancer, what must also be checked for management?

A
  1. oestrogen receptor status
  2. HER2 status - detect by immunohistochemistry / FISH
  3. CT and PET for staging and check for mets
22
Q

List some differentials for breast lumps?

A
  1. breast cancer / pagets disease of breast
  2. fibroadenoma
  3. breast cyst
  4. sclerosis adenomas
  5. epithelial hyperplasia
  6. fat necrosis
  7. duct papilloma
  8. mammary duct ectasia
23
Q

Describe the features of a fibroadenoma

A

“breast mice” in <30 y/o

mobile firm non tender breast lumps

24
Q

How are fibroadenoma managed?

A

if >3cm = surgical excision

25
Q

Describe the features of breast cyst

A

smooth discrete lump (fluctuate)

26
Q

How are breast cysts managed?

A

aspiration + biopsy if blood stained or persistently refill

27
Q

Which benign breast conditions carry a risk for malignancy in the future?

A

breast cyst

epithelial hyperplasia *

28
Q

Describe the features of sclerosing adenosis

A

breast lump or breast pain

seen on mammogram changes that mimic carcinoma

29
Q

How is sclerosisng adenosis managed?

A

biopsy lesion

30
Q

How does epithelial hyperplasia present?

A

generalised lumpiness or discrete lumps +/- atypical symptoms

31
Q

Describe the features of fat necrosis

A

trauma**, common in obese women with large breasts

mass increasing in size, can mimic carcinoma, irregular lump

32
Q

Describe the features of duct papilloma

A

blood stained nipple discharge, mass

33
Q

Describe the features of fibroadenosis

A

“lumpy” painful breasts, worse before menstruation

34
Q

Describe the features of pagets disease of the breast

A

= intraductal carcinoma

reddening and thickening (eczema like changes) of nipple / areola

35
Q

Describe the features of mammaory duct ectasia

A

dilation of large breast ducts

tender lump around areola +/- green nipple discharge

36
Q

How to describe a lump

A

5 S’s

S- Site
S- Size
S- surface e.g. smooth, irregular
S- Shape e.g. round, oval
S- Surrounding structures e.g. skin (attached to skin is bad? has skin dimpled?), muscle (attached to muscle? get pt to tense and see if lump moves with it),

3a obs and gynae (5 decks)

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