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Year 3 Surgery > Breast Disease > Flashcards

Breast Disease Flashcards

1
Q

Epidemiology of breast cancer

A

Second most common cause of death from cancer in the uk

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2
Q

Risk factors for breast cancer

A 
Increased hormone exposure (early menarche, late menopause, nuliparity or late first pregnancy, oral contraceptives)
Susceptibility,it’s gene mutations (most commonly BRCA1 or 2
Advancing age. 
Caucasia
Obesity 
Alcohol and tobacco use
Past history of breast cancer 
Previous radiotherapy
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3
Q

Who gets screened for breast cancer

A

All women aged 50-70
Every 3 years
Invited for mammogram and results may lead to triple therapy

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4
Q

Benefits of breast sceeening

A

Early detection of cancers
Reduction in relative risk of death
Referral for triple assessment

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5
Q

Risks of breast screening

A

Mammograms are painful and felt to be undignified

False negatives and positives

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6
Q

Indications for urgent referrals for triple assessment

A

Over 30 with an unexplained mass regardless of pain or not
Older than 50 with nipple discharge, retraction or other concerning symptoms
Mass in Axilla, 30 years or older and skin changes suggestive of cancer

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7
Q

Presentation of breast in breast cancer

A 
New lump or mass
Swelling of the affected breast 
Peau d orange 
Breast or nipple pain
Nipple retraction 
Dry red flaking or thickening around area
Nipple discharge 
Swollen lymph nodes
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8
Q

Histological subtypes of breast cancer

A

Ductal carcinoma
Lobular carcinoma
Medullary carcinoma
Phyllodes tumour

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9
Q

Ductal carcinoma features

A

Most common breast cancer
Ductal cells proliferate
Cells lose their acinar structure and arrange themselves into rows
If basement in tact then considered ductal carcinoma in situ

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10
Q

Lobular carcinoma presentation

A 
Make sup 15% of breast cancers
More likely to be bilateral and multi centric
Arrange themselves into single rows
Cells are small bland and uniform 
Sparse distribution so often impalpable
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11
Q

Medullary carcinoma features

A

More common in younger patients with BRCA1 mutation
Composed of solid sheets of anaplastic cells with large pleomorphic nuclei and frequent mitoses
Significant lymphocytic infiltration
Better prognosis

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12
Q

Phyllodes tumour features

A

Rare

Grows a leaf like pattern

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13
Q

Genetic pathophysiology

A

BRCA 1 and 2 are TSGs and their mutations can be inherited
BRCA 1 found on chromosome 17 and increases the rfx of breast ovarian colon pancreatic and prostate cancer. Autosomal dominant inheritance

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14
Q

BRCA2

A

Chromosome 13 same as before minus prostate and throw in stomach. Pr positive tumours

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15
Q

Which 3 receptor types are checked for in breast. Cancer

A

Oestrogen ER
PROGESTERONE PR
HER 2 (human epidermal growth factor)
Absence of ER or PR is a bad prognostic indicator
Triple negative is associated with younger age and poorest outcome

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16
Q

In terms of hormonal therapy how is ER positive cancer treated if the patient is premenopausal? (-55)

A

Tamoxifen (oestrogenreceptor antagonist)

17
Q

In terms of hormonal therapy how is ER positive cancer treated if the patient is postmenopausal? (55+)

A

Anastrazole (aromatase inhibitor)

18
Q

SE of tamoxifen

A 
Hot flushes
Nausea
Weight gain
Increased risk of DVT
Tetragenic (danger to foetus)
19
Q

Trustumumab (herceptin) indication in breast cancer

A

Hormone therapy in HER2 receptor positive cancers

20
Q

What is a mastectomy and why would you do one?

A

Multi focal tumours or central tumours, diameter of incision greater than 4cm

21
Q

What is a WLE and why do one

A

Take less than 4cm with the diameter of incision , depends on there being enough breast left for aesthetic appearance after
So,Italy tumours
Peripherally located

22
Q

Radiotherapy

A

Almost all patients with a WLE should be offered adjuvant radiotherapy as it reduces reoccurrance
Mastectomy shahid be offered to patients with higher cancer stages

23
Q

How are breast cancers staged

A

TNM

24
Q

Which treatment could you give to a 70 year old who is her2 negative, er positive and pr negative

A

Anastrazole

25
Q

Which treatment to a 49 year old her 2 negative er positive and pr negative woman

A

Tamoxifen

26
Q

Fat necrosis of the breast

A

Benign and common in obese patients
Can be a fi4m round lump or soft and uneven
Usually found following trauma to the breast
Overlying coin changes show bruising and inflam

27
Q

Puerperal mastitis

A

Inflammation of the breast associated with lactation in postpartum women

Clinical diagnosis based on the following-
Localised symptoms- painful, tender, red hot breast
Systemic symptoms- fevers, rigours, myalgia, fatigue, nausea and headache

Year 3 Surgery (2 decks)

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