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Breast Conditions Flashcards

1
Q

How common is breast cancer?

A

Most common cancer in women = most common type is ductal (80%)

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2
Q

What are the clinical risk factors for breast cancer?

A

Female gender, older age, gene mutations, atypical ductal/lobular hyperplasia, lobular carcinoma in-situ, atypical epithelial hyperplasia

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3
Q

What are the epidemiological risk factors for breast cancer?

A

Birth of first child > age 30, alcohol >1-2x daily, early menarche, family history, previous breast cancer, nulliparity, postmenopausal obesity

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4
Q

What are the protective factors against breast cancer?

A

Routine vigorous exercise, maintaining healthy weight

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5
Q

What are the symptoms of breast cancer?

A

Dimpled/depressed skin, visible lump, nipple change, bloody discharge, texture change, colour change

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6
Q

What is the presentation of breast cancer?

A

Stellate solid mass or pleomorphic casting microcalcifications, may be circular and calcification may be non-casting

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7
Q

When is US useful for diagnosing breast cancer?

A

Young women or those with mammographically dense breasts = not useful for evaluating calcifications

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8
Q

How is breast cancer diagnosed definitively?

A

Image guided tissue core needle biopsy

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9
Q

How is ductal carcinoma in-situ detected?

A

Detected by screening mammography as non-palpable

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10
Q

How is ductal carcinoma in-situ definitively diagnosed?

A

Stereotactic vacuum-assisted core biopsy

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11
Q

How are invasive lobular carcinomas diagnosed?

A

Not apparent by palpation or imaging until advanced

Lobular carcinoma in-situ can be used as tumour marker

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12
Q

How do invasive lobular carcinomas spread?

A

Spread diffusely with typical Indian file pattern

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13
Q

What is the preferred treatment for breast cancer?

A

Breast conserving surgery = may be wide local excision +/- oncoplastic procedure to shape breast

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14
Q

What is an essential component of breast conserving surgery for breast cancer?

A

Irradiation = usually performed in oncologic radiation therapy centre

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15
Q

How is irradiation delivered during breast conserving surgery for breast cancer treatment?

A

Total dose of 4500-5000 centigrays administered in fractions using opposed tangential fields = usually given 5 days per week for 3-6 weeks

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16
Q

What is a modified radical mastectomy?

A

Removal of entire breast including overlying skin and axillary lymph nodes

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17
Q

Why is the pectoralis major preserved during a modified radical mastectomy?

A

Facilitates improved wound healing and potentially allows reconstruction

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18
Q

Which women are candidates for breast reconstruction?

A

Most women who undergo mastectomy are candidates for reconstruction

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19
Q

What are the types of breast reconstruction?

A

Prosthetic and autologous = both can be performed immediately or be delayed until later

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20
Q

What are some features of breast reconstruction following non-skin sparing mastectomies?

A

Often results in prominent scars on new breast and paddle of skin that is different from rest of breast

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21
Q

What are some features of breast reconstruction after a skin sparing mastectomy?

A

Has better aesthetic outcomes as most of overlying skin preserved

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22
Q

What are the methods of breast reconstruction?

A

Breast prosthesis
Latissimus dorsi myocutaneous flap
Deep inferior epigastric perforator free flap
Rectus abdominis myocutaneous flap
Superior/inferior gluteal artery perforator free flap

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23
Q

What are the indications for radiation therapy to treat breast cancer?

A

Involvement >3 nodes, tumour >5cm, positive surgical margins

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24
Q

When can partial breast irradiation for breast cancer be given?

A

Intra or post-operatively through special catheter following breast conserving surgery

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25
Q

What are some adjuvant therapies for breast cancer?

A

Chemotherapy = individualised therapy, may offer clinical trials if patient qualifies
Hormonal therapy = most commonly tamoxifen

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26
Q

What are some targeted therapies for breast cancer?

A 
Trastuzumab = targets HER2, effective as adjuvant
Bevacizumab = targets vascular endothelial growth factor, 1st line for metastatic disease
Lapatinib = dual inhibitor of EGFR and HER2
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27
Q

What are the indications for using lapatinib to treat breast cancer?

A

Use alongside capecitabine = advanced/metastatic disease whose tumours overexpress HER2

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28
Q

What must a breast cancer patient have previously been treated with in order to qualify for lapatinib?

A

Must have been previously treated with an anthracycline, a taxane and herceptin

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29
Q

What is the most common benign tumour of the breast?

A

Fibroadenomas

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30
Q

How are fibroadenomas diagnosed?

A

Presence of palpable mass in young women and confirmed by US

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31
Q

What are the features of fibroadenomas?

A

Rubbery or firm, mobile, non-tender and smooth with distinct borders

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32
Q

How do fibroadenomas change around menopause?

A

Tend to remain unchanged or shrink approaching menopause and become non-palpable after menopause

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33
Q

How are fibroadenomas managed?

A

Usually don’t need removal but can be done electively = open lumpectomy or percutaneous vacuum-assisted core biopsy

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34
Q

What do Phyllodes tumours resemble?

A

Resemble fibroadenomas clinically and cytologically

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35
Q

How do Phyllodes tumours differ from fibroadenomas?

A

Often larger = 3-6cm
Occur in older women aged 35-45
Tend to increase in size and require histologic verification

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36
Q

What are the histological types of Phyllodes tumours?

A

Benign, indeterminate or malignant

37
Q

How are Phyllodes tumours managed?

A

Excise with 1cm clear margins and carefully follow up

38
Q

What are the types of mastalgia?

A

Cyclic and non-cyclic

39
Q

What are the features of cyclic mastalgia?

A

More common = diffuse and most intense during intermediate premenstrual phase, tends to be bilateral

40
Q

What are the features of non-cyclic mastalgia?

A

Localised and persistent, less responsive to treatment

41
Q

Is mastalgia a feature of breast malignancy?

A

Rarely = more common if it is associated with a palpable breast mass

42
Q

What are some causes of anterior chest wall pain that don’t originate from the breast?

A

Achalasia, angina, cervical radiculitis, cholecystitis, cholelithiasis, coronary artery disease, costochondritis, fibromyositis, hiatal hernia, myalgia, neuralgia, osteomalacia, phantom pain, pluerisy, PE, rib fracture, sickle cell disease, TB

43
Q

What is the cause of most cyclic mastalgia?

A

Intense variant of physiological breast changes that occur during menstrual cycle

44
Q

What women with mastalgia should be investigated for cancer?

A

Those over 35 = need evaluation and mammogram

45
Q

What are some management options for mastalgia?

A

Well fitting firm bra and regular exercise

Evening primrose oil, tamoxifen and topical NSAIDs

46
Q

When do palpable cysts tend to occur?

A

During the late reproductive years

47
Q

What are the features of cysts?

A

Palpable, clearly defined, soft, mobile, smooth with distinct borders, multiple and/or bilateral

48
Q

When may cysts become tender?

A

Before menstruation

49
Q

How are cysts diagnosed?

A

Fine needle aspiration = only grossly bloody fluid should be sent for cytological evaluation

50
Q

What must be done following fine needle aspiration of a cyst?

A

Palpate the area of the cyst to ensure there is no residual fluid

51
Q

What is a papilloma?

A

Benign intracystic papillary proliferation = often associated with blood cyst fluid

52
Q

When should you suspect a papilloma of being an intracystic carcinoma?

A

If fluid is grossly bloody or there is residual mass after aspiration

53
Q

How are papillomas diagnosed histologically?

A

US-guided core biopsy

54
Q

What is the appearance of physiological nipple discharge?

A

Clear, yellow and watery

55
Q

What is the most common cause of nipple discharge?

A

Intraductal papilloma

56
Q

Should bloody nipple discharge be investigated?

A

Yes = always pathologic, especially when from single duct

57
Q

Is nipple discharge a sign of malignancy?

A

Rarely = more common if associated with palpable mass

58
Q

What is the management for all intraductal lesions?

A

Should be excised and evaluated

59
Q

What investigations are done for nipple discharge?

A

Mammography, US, surgical excision

60
Q

What is Paget’s disease of the nipple?

A

Variant of ductal carcinoma = intraductal and/or invasive

61
Q

What is the usual presentation of Paget’s disease of the nipple?

A

Dry and scaly erythematous lesion = often underlying palpable mass or radiological abnormality

62
Q

Why can Paget’s disease of the nipple be mistaken for nipple discharge?

A

Can present as erythematous weeping lesion on nipple surface and areola

63
Q

How is Paget’s disease of the nipple diagnosed?

A

Incisional or punch biopsy

64
Q

What is puerperal mastitis related to?

A

Pregnancy or lactation = common and usually responds quickly

65
Q

What are the signs of puerperal mastitis?

A

Fever, erythema, induration, tenderness, swelling

66
Q

What organism most commonly causes puerperal mastitis?

A

Staph aureus

67
Q

How is puerperal mastitis treated?

A

Flucloxacillin 500mg orally every 6hrs or augmentin 625mg every 8hrs for 7 days

68
Q

What is the management of puerperal mastitis?

A

Examine patient every 3 days and change antibiotic if no response to treatment
No need for cultures = not rewarding
Continue breastfeeding until infection clears

69
Q

Is non-puerperal mastitis common ?

A

No = uncommon and rare in postmenopausal women

70
Q

What organisms cause non-puerperal mastitis?

A

Staph aureus, peptostreptococcus magnus, bacteroides fragilis

71
Q

What is the treatment of non-puerperal mastitis?

A

1st line = augmentin 625mg orally every 8hrs for 7 days

2nd line = cephalexin 500mg orally every 6hrs for 7 days

72
Q

What are some features of chronic mastitis?

A

Uncommon = may be associated with subareolar abscess

73
Q

What can chronic mastitis lead to?

A

Periareolar fistulae = surgically excise when inflammation is quiescent

74
Q

When should you consider inflammatory carcinoma as a cause of chronic mastitis?

A

When mastitis is unresponsive to treatment and spreads over entire breast

75
Q

How do breast abscesses present?

A

Flocculent, sometimes bulging, mass usually located in central area of mastitis

76
Q

How are breast abscesses diagnosed?

A

Focused US can verify pus-filled centre
Aspiration with 18-gauge needle using local anaesthetic is diagnostic
Microbiological analysis of aspirate

77
Q

How are breast abscesses treated?

A

Aspiration may be therapeutic if all pus aspirated

May need to repeat aspiration every 3 days = especially if >10ml of pus is initially aspirated

78
Q

How are breast abscesses that haven’t cleared by repeated aspiration treated?

A

Open surgical drainage under general anaesthesia

Continue antibiotics until all evidence of inflammation has cleared

79
Q

What are some features of adenolipomas?

A

Presents as smooth palpable mass

Has characteristic mammographic pattern

80
Q

Where is apocrine metaplasia of epithelial cells found?

A

Histologically noted in lining of cysts = cells enlarge and are eosinophilic

81
Q

What is ductal hyperplasia?

A

Benign histologic process

82
Q

What is atypical ductal hyperplasia associated with?

A

Increased risk of carcinoma = beginning of transformation to ductal carcinoma in-situ and eventually invasive ductal carcinoma

83
Q

What can fat necrosis mimic?

A

Cancer

84
Q

What are some features of fat necrosis?

A

Has distinct mammographic appearance
Often secondary to breast trauma
Usually resolves spontaneously but may leave residual mammographic lesion

85
Q

What is a galactocele?

A

Palpable milk filled cyst = commonly associated with pregnancy or lactation, diagnoses and drained by FNA

86
Q

What are some features of lipomas?

A

Thin smooth border on mammography, may be palpable, reveals only adipose cells on biopsy

87
Q

What is Mondor’s disease?

A

Phlebitis and subsequent clot formation in superficial veins of breast = usually resolves spontaneously in 8-12 weeks

88
Q

How does Mondor’s disease present?

A

Firm, vertical cord-like structure = usually associated with history or trauma to breast

Reproduction (62 decks)

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