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MED-Y3 > Breast disease > Flashcards

Breast disease Flashcards

1
Q

What is a fibroadenoma ?

A

A benign tumour of fibrous and epithelial tissue that arises from globules. Comes from the stroma of the breast lobule.

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2
Q

What are the clinical features of a fibroadenoma ?

A
  • Young age of presentation
  • Firm, non tender mass
  • Rounded with smooth edges
  • Highly mobile.
  • Normally dont grow beyond 3cm.
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3
Q

Do patients with fibroadenoma undergo triple assessment ?

A

Yes

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4
Q

How is fibroadenoma managed ?

A

Can be managed with surgical excision but may regress after menopause.

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5
Q

What is mastitis and what are some of the symptoms ?

A

Infection of the breast, commonly caused by bacteria entering the duct usually due to a break in the nipple of the skin.

Usually associated with breast changes, mastalgia, malaise and fever.

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6
Q

What is intraductal papilloma ?

A

Benign papillary tumour that commonly presents with bloody discharge from the nipple. There is usually no palpable mass.

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7
Q

What is fat necrosis ?

A

Inflammatory reaction to adipose tissue damage and can present with a painless breast pass or skin thickening. Commonly caused by physical trauma to the breast, surgery or radiotheapy.

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8
Q

What is mammary duct ectasia ?

A

Palpable, peri areolar breast mass caused by inflammation and dilation of the large breast ducts. Usually presents with thick yellow, green or brown nipple discharge bilaterally and can mimic cancer.

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9
Q

What are the potential risk factors for breast cancer ?

A
  • Increased hormone exposure (like late first pregnancy, HRT, oral contraceptives)
  • BRCA
  • Caucasian ethnicity
  • Advancing age
  • Obesity
  • Alcohol and tobacco use.
  • History of breast cancer
  • Previous radiotherapy treatment
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10
Q

When is breast screening offered ?

A
  • 3 Yearly mammogram in all women aged 50-70
  • Women over 70 can self refer for screening every 3 years if they wish
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11
Q

When is a 2ww indicated in suspected breast cancer ?

A
  • They are over 30 with an unexplained breast mass (regardless of pain)
  • They are 50 or older with nipple discharge, retraction or other concerning symptoms.
    -Consider if skin changes suggestive of breast cancer or if the patient is 30 years or older with an unexplained mass in the axilla.
  • Non urgent referral in patients under 30 years old with an unexplained breast mass.
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12
Q

What is a Ductal carcinoma ?

A
  • Most common form of breast cancer
  • Caused by abnormal proliferation of ductal cells.
  • DCIS if the BM is not breached
  • Higher grad = ductal cells loose acinar structure and become abnormally large.
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13
Q

What is lobular carcinoma ?

A
  • 15 percent of all breast cancers.
  • Frequently impalpable and or not found as a discrete lump.
  • LCIS if the BM is not breached
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14
Q

What is medullary carcinoma and what groups is it more common in (gene mutation) ?

A

Most common in younger patients and those with BRCA1 gene mutation.
Usually significant lymphatic infiltration and has a better prognosis than ductal tumours.

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15
Q

What are the malignancy associations with the BRCA1 gene ?

A

40 percent increased risk of ovarian cancer as well as increased risk of pancreatic, colon and prostate cancer.

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16
Q

What malignancy associations are linked with BRAC2 mutation ?

A
  • 15 percent risk of ovarian cancer
  • Breast cancer.
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17
Q

What are all breast samples tested for ?

A
  • Oestrogen (ER)
    -Progesterone (PR)
  • HER2
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18
Q

What are oestrogen (ER) positive tumours treated with ?

A
  • Tamoxifen (pre-menopausal)
  • Anastrozole (post-menopausal)
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19
Q

What are HER2 positive tumours treated with ?

A

Trastuzumab

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20
Q

What are pre menopausal, oestrogen positive tumours treated with and when ?

A

Tamoxifen - 5 years post surgery

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21
Q

What are post menopausal, oestrogen positive tumours treated with and when ?

A

Anastrozole - 5 years post surgery

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22
Q

What are some of the surgical management options in breast surgery ?

A
  • Wide local excision (used in smaller more solitary lesions that are peripherally located)
  • Sentinel node biopsy’s in invasive cancers
  • Axillary node clearance in positive nodes)
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23
Q

When is radiotherapy indicated in breast cancer ?

A
  • In all patients with a wide local excision in order to reduce risk of recurrency. Also offered to mastectomy patients in higher cancer stages (T3/T4)
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24
Q

When is chemotherapy indicated in breast cancer ?

A
  • HER2 tumours
  • Can be used to downstage tumours before surgery
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25
Q

What biological therapy can be given to HER2 positive patients ?

A

Trastuzumab (Herceptin) and can be given to downstage tumours.
Is given with chemotherapy or 3 weeks following surgery.

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26
Q

What are the side effects of Herceptin (trastuzumab) - used in the treatment of HER2 tumours ?

A

Cardiac dysfunction and teratogenicity

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27
Q

What are the side effects of Tamoxifen ( ER tumours pre menopausal) ?

A
  • Hot flushes
  • Nausea and weight gain
  • Vaginal bleeding and discharge
  • Increased risk of DVT/PE and endometrial cancer
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28
Q

What are the side effects of Anastrozole (ER post menopausal women) ?

A

Hypo - oestrogenism (hot flushes, fatigue and osteoprosis)

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29
Q

What is cyclical mastalgia ?

A

Breast tenderness that arises pre menstrual in patients. Usually associated with periods and subsides after a period.

30
Q

Why cab cyclical mastalgia (painful breasts associated with periods) present to a GP ?

A

Sometimes there can be fibrocystic changes to the breast presenting as breast lumpiness.

31
Q

What are the clinical features of fat necrosis of the breast ?

A
  • Firm round lump -> hard irregular lump
  • Usually previous trauma to the breast
  • Overlying skin inflammation/ bruising

MAKE sure to always send the patient for triple assessment to rule out cancer.

32
Q

What is fibrocystic disease of the breast ?

A

The most common benign breast disease and occurs commonly in the 20-50 year old age group. Due to the effect of cyclical hormones such as oestrogen and progesterone which can lead to chronic changes in the breast including small cysts and proliferate changes

33
Q

What are the clinical features of fibrocystic disease of the breast ?

A
  • Bilateral lumpy breasts - most commonly in the upper outer quadrant.
  • Breast pain
  • Symptoms which can worsen with the menstrual cycle.
34
Q

How is fibrocystic disease of the breast managed ?

A
  • Treatment is supportive - soft, well fitting bra and analgesia
  • Most cases will resolve after menopause.
35
Q

What is a lactational breast abscess ?

A
  • Infectious mastitis may cause an accumulation of pus of which may lead to the development of a lactational breast abscess.
36
Q

What is the most common causative organism of lactational breast abscess ?

A

Staphylococcus aureus that usually enters via a crack in the nipple skin or through a milk duct.

37
Q

What are the clinical features of lactational breast abscesses ?

A
  • Fevers or rigors
  • Malaise
  • Pain and erythema over an area of the breast
  • May be a mass - not always palpable
  • Hx of recent or current mastitis
38
Q

How is lactational breast abscesses managed ?

A
  • Incision and drainage or needle aspiration
  • Oral or IV antibiotics dependent on local protocol.
39
Q

What is a malignant phyllodes tumour ?

A

Breast cancer of fibroepithelial origin which commonly presents in women in their 40s/50s.

40
Q

What are the clinical features of malignant phyllodes tumours ?

A
  • Smooth, hard, palpable breast mass that can sometimes be seen as a smooth bulge under the skin of the breast
  • In advanced cancer - may ulcer
  • Can be agressive and grow quickly.
41
Q

How are malignant phyllodes tumours similar to a fibroadenoma ?

A
  • Can present similarly to fibroadenoma
  • Fibroadenomas typically present in younger women and are not fast growing.
42
Q

How are malignant phylodes tumours diagnosed ?

A
  • May appear as a round breast lesion with well defined edges on mammography
  • Biopsy will distinguish between malignant and benign
43
Q

What is mastitis ?

A

Inflammation of the breast, with or without infection.

44
Q

What is perpetual mastitis ?

A

Inflammation of the breast associated with lactation in postpartum women.

45
Q

What are the symptoms of mastitis (inflammation of the breast usually caused by infection) ?

A
  • Localised symptoms - Painful, tender, red and hot breast.
  • Systemic symptoms - fever, rigors, myalgia, fatigue, nausea and headache.
  • Normally unilateral and presents 1 week postpartum.
  • Some cases there may be development of a breast abscess (fluctant, tender mass with overlying erythema)
  • In cases where there is a suspected abscess, there should be early refferal to secondary care.
46
Q

What is it important to advise women with mastitis ?

A
  • Breastfeeding women can continue to breastfeed.
  • Advise in methods to facilitate milk removal like manual expression
47
Q

How is mastitis managed ?

A
  • Analgesia
  • Course of oral antibiotics according to local protocol.
  • If the condition does not improve, the patient may require IV antibiotics or surgical management.
48
Q

What is pagets disease of the nipple ?

A

Rare disease of the nipple that is associated with underlying cancer

49
Q

What are the presenting symptoms of pagets disease of the nipple ?

A

Commonly affects the nipple first before spreading to the areola and the rest of the breast.

  • Eczema like rash on the skin of the nipple and the areola. Can be itchy, red,crusty and inflamed
  • Nipple discharge that may be bloody
  • Burning sensation, increased sensitivity or pain.
  • Nipple changes like nipple retraction or inversion.
  • In some cases there may be a palpable breast lump.
  • May be a skin ulcer that does not heal.
50
Q

What features are highly suspicious for invasive breast cancer ?

A

Fixed position when putting hands on hips and hard irregular lump.

51
Q

What is the definitive management of a breast lump ?

A

Incision and drainage

52
Q

What is a risk factor for fat necrosis of the breast ?

A

Obesity

53
Q

What are some of the potential risks of axillary node clearance surgery ?

A

Lymphoedema (swelling of the arm), damage to the brachial plexus and axillary artery/vein injury.

54
Q

What are some of the risks of breast surgery (anesthetic and surgical) ?

A

Anaesthetic risks - Stroke, VTE, MI and aspiration

Surgical - Pain, bleeding, infection, seroma (fluid under the scar site) and poor cosmetic outcomes

55
Q

What is the most common causative organism of perpetual mastitis ?

A

Staphylococcus aureus

56
Q

How should a patient over 30 with a new, unexplained breast mass be reffered ?

A

urgent 2ww

57
Q

How should a patient under 30 with a new, unexplained breast mass be reffered ?

A

Non urgent refferal

58
Q

What antibiotics can staph aureus infections be treated with ?

A

flucoxacillin and co amoxiclav.

59
Q

On drainage of a breast cyst, what colour of fluid would be concerning ?

A

Straw red colour can indicate malignancy.

60
Q

What is a common sign of DCIS ?

A

Bloody discharge from the nipple.

61
Q

What is mammary duct ectasia ?

A

Benign condition where there is dilation of the large ducts in the breast. There is also inflammation of the ducts and hence causes intermittent discharge from the nipple.

Commonly presents in perimenopausal women

62
Q

How will discharge look in mammary duct ectasia ?

A

May be white, green or grey

63
Q

What is a significant risk factor for mammary duct ectasia ?

A

Smoking

64
Q

How does mammary duct ectasia present ?

A
  • Nipple discharge
  • Tenderness of pain
  • Nipple retraction or inversion
  • Breast lump that may produce discharge that may be brown or bkoody
  • Patient may be a smoker
65
Q

How is mammary duct ectasia diagnosed ?

A
  • Usually triple assessment in order to exclude breast cancerThere may be microcalcifications on mammogram, however these are not specific to mammary duct ectasia.
66
Q

How is mammary duct ectasia treated ?

A
  • May resolve without treatment
  • Reassurance that it is not cancer
  • Mastalgia symptomatic treatment.
  • Antibiotics if infection is suspected or present
  • Surgical excision of the affected duct may be required in problematic cases.
67
Q

What can a fibroadenoma develop into ?

A

If they continue, can develop into a phyllodes tumour. This can be malignant

68
Q

What is one of the more notable side effects of trastuzumab ?

A

HF and a tetarogenic

69
Q

What is one of the more notable side effects of tamoxifen ?

A

Hypo-orestrogenism - Hot flushes ect

70
Q

What is one of the more notable side effects of tamoxifen ?

A

Increased risk of endometrial cancer and increased risk of DVT/PE

MED-Y3 (24 decks)

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