Breast disease Flashcards
what is the triple assessment
clinical exam
mammogram/US
core needle biopsy
what do you see on mammogram in DCIS
micro-calcifications
staging method for breast cancer
TMN
Tumour (T0-T4 based on size)
Nodes (N0-N3 depending on how many and which lymph nodes it had migrated to)
Metastasis (M0-M1)
what requires an urgent referral to breast clinic
> 30 unexplained breast mass
50 nipple discharge, skin changes
what requires a non-urgent referral to breast clinic
<30 unexplained breast mass
Drug for ER+ pre menopausal
Tamoxifen
Drug for ER+ post-menopausal
Anastrazole
Drug for HER+ and main side effect
Trastuzumab, cardiotoxicity
presentation of fibroadenoma
firm, non-tender, highly mobile
what is fibrocystic disease of the breast?
cyclical pain and lumpiness of breasts bilaterally, associated with menstrual cycle
management of fibrocystic disease
supportive
soft bra, avoid caffeine
presentation of Phyllodes tumour
smooth, hard lump, grows rapidly
differentiating between phyllodes tumour and fibroadenoma
FA doesn’t grow as rapidly, FA occurs in younger women
presentation of Paget’s disease
eczema around nipple area
bloody/straw discharge
burning
inverted nipple
presentation of mastitis
unilateral inflammation of breast
painful + tender
associated with fever, myalgia, rigors
what is fat necrosis
happens secondary to trauma to the breast
lump w overlying bruising/inflammation
what is a complication of puerperal mastitis that causes symptoms of mastitis and erythema?
lactational breast abscess
accumulation of pus
caused by staph aureus
when is mammogram used instead of ultrasound
mammogram for age >35
common side effect of tamoxifen
hot flushes
changes in ,menstrual pattern
lateral part of the breast drains to..
axillary lymph nodes
medial part of the breast drains to…
internal thoracic/parasternal lymph nodes
what actually is pages disease
DCIS coming out of the nipple
it is neoplastic
differentiating mastitis and breast abscess
breast abscess may have a lump (tense, or fluctuant)
side effect of anastrazole
osteoporosis, myalgia and arthralgia
MOA of anastrazole
inhibits peripheral oestrogen synthesis
MOA of tamoxifen
complete oestrogen receptor antagonism
why can’t post menopausal women take tamoxifen
increased risk of endometrial bleeding and endometrial hyperplasia in post menopausal women
so aromatase inhibitors used instead
blood stained discharge coming from the nipple
duct papilloma
eczema around the nipple
pages disease of breast
difference in skin changes in Paget’s disease compared to nipple eczema
both start around the nipple
Pagets will spread to other areas of the breast as well
when to do WLE vs masctectomy
if tumour is <4cm do WLE
1st line course of Abx for mastitis
10 days flucox
what is duct ectasia and Mx?
dilatation and shortening of the terminal breast ducts
Px: creamy white discharge
Mx: reassurance or microdochectomy if its bothering them
periductal mastitis cause, Px, risk factors and Mx
ducts under the nipple become infected
pain, periareolar mass, discharge
Risk factors: young woman, smoker,
Mx: Abx
what is herceptin
trastuzumab
Mx of fibroadenoma depending on size
> 3cm = surgery
<3cm = reassurance
Breast cancer + no palpable lymphadenopathy
sentinel node biopsy
Breast cancer + palpable lymphadenopathy
axillary node clearance
If <3 lymph nodes are found on sentinel node biopsy
no further Mx to axilla
If 3 or > lymph nodes are found on sentinel node biopsy
lymph node dissection
