Breast Cancer and other such lumps Flashcards
Who gets a two week referral for breast cancer?
unexplained mass > 30s
Unilateral nipple changes >50s
Consider if
Skin changes raising suspicion
Unexplained mass in axilla <30s
Who should get non-urgent referral for breast cancer?
Unexplained breast mass for u30s
Who should be screened for breast cancer and how frequently?
Caudal-cranial and oblique view mammograms
50-70s
Every 3 years
Who gets genetic screening for breast cancer
One relative that is…
- 1st degree with breast Ca before 40yrs
- 1st degree with bilateral breast cancer <50 yrs
- Male with breast Ca at any age
Two relatives (both 1st or one 1st, one 2nd)…
- Both breast cancer at any age
- One breast one ovarian
Three relatives (first/second)
Breast cancer at any age
As they are both firm, how can cancer be distinguished from fibroadenoma?
Cancer: Irregular, not mobile. Can have skin changes and discharge
Fibroadenoma: Smooth, mobile
As both can have nipple inversion, how can breast cancer be distinguished from fat necrosis?
Breast can have unilateral, bloody discharge
Fat necrosis has history of local trauma
What investigations should be performed in suspected breast cancer?
- Clinical examination
- Imaging: US <30yrs< mammogram
- Biopsy
What pre-op assessment guides surgical management of breast cancer?
if nodes non-palpable: Axillary ultrasound
+ve: Sentinel node biopsy to check
Palpable nodes: Axillary node clearance
In terms of breast and associated cancers, what counselling points must be addressed for
BRCA1
BRCA2
BRCA1
65-85% lifetime breast cancer risk
Increased ovarian, pancreatic, colon and prostate cancer
BRCA2
40-85% lifetime breast risk
Increased prostate, pancreas, biliary tract and stomach cancer
How do you determine by size and focality if mastetomy or WLE would be needed?
Mastectomy for larger, multifocal and central tumours
WLE for smaller, solitary and peripheral tumours
Who gets radiotherapy for breast cancer?
Post WLEs
Reduces recurrence by 2/3s
How does menopausal status affect hormonal therapy in breast cancer?
Pre/perimenopausal women get tamoxifen
Post-menopausal get anastrozole
How does being HER2 +ve breast cancer sway therapy? who is the exception?
Trastuzumab is given
Dont give if heart disorders
When is FEC-D chemotherapy given?
Axillary node disease
Patient presents with an eczematous breast, what are you worried about?
DCIS/invasive breast cancer
Which breast cancer is
The most common
Has pleomorphic nuclei, prominent nucleoli and frequent mitoses
Consists of ‘leaf-like’ epithelial and stroma tissue
Ductal
Lobular
Phyllodes
What meds and lifestyle increase breast cancer risk?
Consumption of alcohol/cigarrettes
Conception: Late or none
Contraception:COC/HRT
Couch potato
What size of fibroadenoma would you excise?
>3cm
Clinically differentiate mammary duct ectasia and breast mastitis/absces
Both non mobile and painful
Ectasia: areolar lump, green discharge, >50yrs
Mastitis: no lump, no discharge, lactating women
How do you treat mastitis/breast abscess?
Continue breast feeding
Flucloxicillin 14 days if systemic unwell, nipple fissure or non-improvement 12-24 hours after milk removal
How do you manage mammary duct ectasia?
Conservative
Microdochectomy/duct excision if problematic
Bilateral breast lumps that fluctuate with menstrual cycle and are sometimes painful indicates what? How do you treat it?
Fibrocystic changes
Sports bra + NSAIDs
Stop caffeine
What is the treatment for mastitis?
Co-amoxiclav
