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Breast Conditions Flashcards

1
Q

How many women are diagnosed with breast cancer at some point in their life?

A

1:9

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2
Q

How many women diagnosed each year with breast cancer are <50yo?

A

> 8000

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3
Q

What is the triple assessment?

A

Clinical- history and exam
Radiological- bilateral mammogram/US
Cyto-pathological- FNA (cells only), core biopsy

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4
Q

Why is mammography sensitivity reduced in young women?

A

Due to the presence of increased glandular tissue (<40yo)

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5
Q

When is breast US useful?

A

Assessment of breast lumps
Differentiating solid and cystic lesions
Guidance for FNA/CB
To assess tumour and size and response to therapy

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6
Q

What can core biopsy confirm that FNA can’t?

A

ER, PR, HER2 status

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7
Q

What is the most common invasive breast carcinoma?

A

Ductal carcinoma (80%)

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8
Q

What tests are used in breast cancer staging?

A

Bloods- FBC, U&Es, LFTs, Ca2+, PO2-
CXR
AUSS-if indicated
Bone scan- if indicated

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9
Q

In TNM staging for breast cancer, how is T assessed?

A 
T0 Non palpable
T1 <2cm
T2 2-5cm
T3 >5cm
T4 Invading skin/chest wall
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10
Q

In TNM staging for breast cancer, how is N assessed?

A

N0 Non palpable
N1 Mobile
N2 Fixed

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11
Q

In TNM staging for breast cancer, how is M assessed?

A

M0 No mets

M1 Mets

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12
Q

What are surgical options for breast carcinoma in the axilla?

A

Axillary Node Clearance (ANC)
Axillary Node Sampling (ANS)
Sentinel Lymph Node Biopsy (SNBx)

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13
Q

What will all patients get after WLE as adjuvant therapy?

A

Radiotherapy

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14
Q

What radiotherapy will post-WLE patients receive?

A

40-50Gy over 3 or 5 weeks

Boosts reduce local recurrence

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15
Q

What are the complications of radiotherapy post WLE/Mx?

A

Skin reaction- Skin telangiectasis
Radiation pneumonitis
Cutaneous Radio-/Osteonecrosis

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16
Q

When is radiotherapy given post Mx?

A

If there is local involvement

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17
Q

When is chemotherapy seen to be effective in women with breast carcinoma?

A

Greatest in younger women

Benefits increase with increasing adverse prognostic factor (LN +ve, ER -ve <35yo, HER2 +ve)

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18
Q

What are the traditional chemotherapies used in breast cancer?

A

CMF Combinations
Taxane Combinations
Anthracycline-containing Combinations using Doxorubicin or Epirubicin

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19
Q

What hormone therapy is carried out in breast cancer and when?

A

Oestrogen deprivation- only in ER +ve tumours

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20
Q

What non-invasive hormone therapy is carried out in breast cancer?

A

Tamoxifen

Aromatase inhibitors

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21
Q

What invasive hormone therapy is carried out in breast cancer?

A

Oophorectomy

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22
Q

Describe tamoxifen hormonal therapy in breast cancer

A 
20mg once daily over 5y
Blocks directly on receptor
Antagonist action in breast Ca
Effective in all age groups
Less effective in HER2+
More effective give after chemo
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23
Q

Describe aromatase inhibitor therapy in breast cancer

A

Inhibiting ER synthesis
Only effective in post menopausal women
Improve disease free survival
More effective in HER2+ women

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24
Q

What can aromatase inhibitors increase the risk of?

A

Osteoporosis

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25
Q

What is ANDI?

A

Aberration of Normal Development & Involution

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26
Q

What are some examples of ANDIs?

A

Fibroadenoma
Breast cysts
Duct papilloma

27
Q

Are fibroadenomas common?

A

Yes- esp in young women

13% of all palpable breast masses (60% in women aged <20y)

28
Q

Do fibroadenomas require excision?

A

Not if proven on US and FNA cytology

Only if unable to obtain pathological diagnosis, increasing in size or deforming

29
Q

What % of discrete breast masses are cysts?

A

15%

30
Q

How should breast cysts be managed?

A

Aspirate after US/mammography

If residual lump- investigate as lump

31
Q

How many patients with cysts have carcinomas?

A

1-3% patients, few are associated with the cyst

Negligible risk of developing cancer in patients with cysts

32
Q

Are duct papillomas common?

A

Yes- single or multiple

33
Q

What can duct papillomas cause?

A

Bloodstained nipple discharge

34
Q

How are duct papillomas managed?

A

Excision by microdochectomy (single duct excision) or total duct excision

35
Q

What malignancy potential do duct papillomas have?

A

Minimal

36
Q

What are some breast presentations of hormonal changes?

A

Mastalgia
Nipple discharge
Gynaecomastia

37
Q

What are the cyclical features of mastalgia?

A 
Premenopausal
Average age 34yo
Heightened awareness, discomfort, fullness, heaviness
Classically- outer half of each breast
Can be unilateral
38
Q

What are the non-cyclical features of mastalgia?

A

Older women- average 43yo
Pain can arise from chest wall, breast or outside breast
Continuous/random
Burning/drawing

39
Q

What are the possible causes of mastalgia?

A

Abnormal plasma fatty acid levels
Role of dietary factors such as caffeine and fats
Changes in hormonal levels

40
Q

How is mastalgia assessed?

A 
Hx
Exam
Imaging if necessary (e.g. unilateral)
Distinguish cyclical from non-cyclical
Exclude non breast causes
41
Q

How is mastalgia with mild/moderate symptoms treated?

A

Reassurance
Well fitting bra
Topical NSAIDs

42
Q

How is mastalgia with severe symptoms treated?

A 
Reassurance
Consideration of drug treatment: 
Evening primrose oil
Gamolenic acid (up to 1000mg/day for up to 6/12)
If no response, stop OCP
Danazol 100mg of
Bromocriptine
Tamoxifen
Not diuretics
43
Q

What are the S/E of danazol in mastalgia treatment?

A

Weight gain
Acne
Hirsutism
Occurs in 30%

44
Q

What are the S/E of gamolenic acid in mastalgia treatment?

A

Nausea
Slow response
Occurs in 4%

45
Q

What are the S/E of bromocriptine in mastalgia treatment?

A

Nausea
Dizziness
Occurs in 35%

46
Q

What are the clinical features of spontaneous nipple discharge?

A

Bloodstained/not bloodstained
Single/multiple duct
5-10% of patients with bloodstained discharge will have malignancy

47
Q

What are the clinical features of physiological nipple discharge?

A

Common
2/3 of pre-menopausal women can produce nipple secretion by cleansing nipple and applying suction
Colour- white/yellow/green/blue-black

48
Q

How is nipple discharge assessed?

A 
Hx
Exam
Imaging
If suspicious- duct excision
If bilateral milky discharge (galactorrhoea)- DHx, PL levels
49
Q

What are the causes of gynaecomastia?

A 
Puberty
Idiopathic
Drugs (cimetidine, digoxin, spironolactone, androgens, antioestrogens)
Cirrhosis/Malnutrition
Primary hypogonadism
Testicular tumours
Secondary hypogonadism
Hyperthyroidism
Renal disease
50
Q

Who does gynaecomastia effect?

A

30-60% boys aged 10-16yo

51
Q

Gynaecomastia resolves spontaneously within 2y in how many effected males aged 10-60yo?

A

80%

52
Q

If patients are embarrassed/condition if persistent, how can gynaecomastia be treated?

A

Surgery

53
Q

What is the most common cause of gynaecomastia in men 50-80yo?

A

Idiopathic

54
Q

How should gynaecomastia be investigated if suspicious?

A

Triple assessment

55
Q

How should gynaecomastia be treated?

A

If drug related- withdraw drug
Danazol or Tamoxifen can provide symptomatic improvement
Surgery- in rare cases

56
Q

What are some infective breast diseases?

A

Abscess
Periductal mastitis
Fat necrosis

57
Q

Who are breast abscesses common in?

A

Lactating post partum women

58
Q

What are the symptoms of breast abscess?

A

Pain
Swelling
Tenderness

59
Q

How is breast abscess investigated?

A

Cytology/bacteriology

60
Q

How is breast abscess treated?

A

Flucloxacillin +- aspiration
Co-amoxicillin
Persistent abscess- aspiration/incision & drainage
Persistent- investigation for underlying pathology

61
Q

What should be encouraged to continue in the presence of breast abscess?

A

Breast feeding

62
Q

Who is periductal mastitis +-abscess common in?

A

Female smokers

63
Q

How is periductal mastitis +- abscess managed?

A

Antibiotics
Aspiration
Incision and drainage
Ix of all persisting lesions

64
Q

How is fat necrosis managed?

A

Triple assessment

Most of the time spontaneously resolving

Reproduction (40 decks)

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