Breast Conditions Flashcards
List clinically relevant risk factors for breast cancer
Increasing age Gene mutation Early menarche Late menopause Nulliparity Obesity Previous breast cancer
List the most common clinical features of breast cancer
Dimpled/depressed skin Visible lump Nipple change (inversion) Bloody discharge Colour change
What is the most common histological subtype of breast cancer?
Ductal carcinoma
What is the preferred treatment for breast cancer - mastectomy or breast-conserving therapy?
Breast-conserving therapy involving radiotherapy/chemotherapy and/or wide local excision
What is removed and left in modified radical mastectomy?
Whole breast, skin and axillary lymph nodes removed
Pectoralis major left
When can breast reconstruction be carried out?
Immediately (during mastectomy operation) or delayed until afterwards
What is a flap in breast reconstruction?
Taking skin from another part of the body with its blood supply and using it to reconstruct a breast
What flaps are typically used for breast reconstruction?
Latissimus dorsi
Deep inferior epigastric perforator (DIEP)
Transverse rectus abdominis myocutaneous (TRAM)
Superior/inferior gluteal artery perforator (SGAP/IGAP)
What are the indications for post-mastectomy radiotherapy?
Involvement of more than 3 nodes
Positive surgical margins
Tumours larger than 5cm
What is the most common hormonal therapy for breast cancer?
Tamoxifen
HER2 overexpression is implicated in some breast cancer - what treatment targets this specifically?
Trastuzumab (Herceptin)
What is the most common benign neoplasm of the breast?
Fibroadenoma
Fibroadenomas usually become non-palpable after the menopause. True/False?
True
What larger benign tumour can mimic fibroadenoma?
Phyllodes tumour
Mastalgia is usually unilateral. True/False?
False
Can be unilateral but usually bilateral
List conservative management that can improve mastalgia
Well-fitting firm bra
Regular exercise
Evening primrose oil
Tamoxifen
What is the most common aetiology of spontaneous nipple discharge?
Intraductal papilloma
How does Paget’s disease usually present on the nipple?
Dry, eczematous, scaly lesion
Can be erythematous and weeping
What antibiotic should be administered as soon as mastitis is suspected?
Flucloxacillin or any Staph aureus sensitive antibiotic
Breastfeeding should be continued even if there is mastitis. True/False?
True
What is the screening schedule for breast cancer?
Mammogram every 3 years for women aged 50-70
What is carried out in the “one-stop” clinic?
Clinical (history and examination)
Imaging (mammogram, ultrasound)
Pathology (biopsy)
When is adjuvant radiotherapy following breast-conserving therapy done on the breast alone?
Negative sentinel node biopsy
Nodes containing micrometastases (less than 2mm)
Less than 4 nodes involved in axillary clearance
When is adjuvant radiotherapy following mastectomy done?
Tumour size greater than 5cm
4 or more involved nodes
T4 disease
What adjuvant systemic treatment options are there for breast cancer?
HRT (tamoxifen, letrozole)
Trastuzumab (if HER2 positive)
Letrozole can only be used in postmenopausal women. True/False?
True
