breast disease Flashcards
what factors make a person high risk for breast cancer ( Give 4 )
- breast cancer in a first degree male relative of any age
- breast cancer in a first degree relative under the age of 40
- bilateral breast cancer in a first degree relative under 50
-breast cancer in 2 first degree relatives
give 4 symptoms of fibroadenomas
-firm non tender breast mass
-rounded and smooth edges
-mobile upon palpation, often referred to as having a ‘’ rubbery’’ consistency
- 3 cm at max
which type of breast cancer presents with a thickened area of breast tissue alongside nipple changes
invasive lobular carcinoma
which is the most common type of breast cancer ?
Invasive ductal carcinoma
which condition presents with eczema like changes ?
Paget’s disease of the breast
what are the main differentials for Paget’s disease of the breast ?
Atopic dermatitis
contact dermatitis
intraductal papilloma
mastitis
psoriasis
which breast condition is characterised by ‘’ lumpy’’ breasts
Fibrocystic disease of the breast / fibroadenosis
what is the management of fibrocystic disease of the breast ?
soft + well fitting bra
analgesia
avoid caffiene
what is the management of lactational breast abscess
-drainage of abscess via needle aspiration or surgical drainage
- antibiotics
should you continue breastfeeding in lactational abscess ? why ?
continue breast feeding as milk stasiscan and promote development of abscesses
how do you distinguish between ductal carcinoma in situ vs invasive ductal carcinoma ?
In situ - basement membrane intact
invasive - basement membrane breached
what type of therapy is recommended for estrogen positive, HER2 negative breast cancer ?
Endocrine therapy - including tamoxifen, an aromatase inhibitor or combination of both
what is TNBC
triple negative breast cancer
lacking estrogen receptors, progesterone receptors and does not have an excess of the HER2 protein on the cancer cell surfaces.
More aggressive and fewer targeted treatments.
what is a side effect of letrozole? what needs to be monitored ?
osteoporosis, monitor bone mineral density
what is the management of triple negative breast cancer with axillary involvement ?
Neoadjuvant chemotherapy followed by surgery and adjuvant therapy
what is the management of fat necrosis of the breast
conservative management
what is triple assessment
clinical examination
imaging - mammography and / or ultrasound
tissue sampling - fine needle aspiration cytology or core biopsy
what is puerperal mastitis ? How does it present ?
Inflammation of the breast tissue, associated with breastfeeding due to obstruction in the ducts / infection.
presents with a painful tender and hot breast along with systemic symptoms such as fevers, rigors, myalgia, fatigue, nausea and headaches.
which type of breast cancer presents as a rapidly enlarging, smooth hard palpable breast mass
Malignant Phyllodes tumour
which type of cancer may be visible as a smooth bulge under the breast skin
Malignant Phyllodes tumour
which condition presents with an accumulation of pus in the breast tissue
Infectious mastitis
how are symptomatic breast cysts managed
aspiration
management of breast cancer patients who are -
node +ve
node -ve
FEC-D : node positive
FEC : node negative
when is a wide local excision preferred
solitary lesion
peripheral tumour
small lesion in large breast
DCIS < 4 cm
when is a mastectomy preferred
multifocal , central tumour
large lesion in small breast
DCIS > 4cm
when is radiotherapy recommended in breast cancer
after wide local excision, T3,T4 tumours for women who have had a mastectomy
fat necrosis
obese women with large breasts following trauma , may develop into hard irregular lump
mucinous carcinoma
grey gelatinous surface
ductal carcinoma situ
has not breached basement membrane and can present with comedo necrosis
what index can be used to give an indication of survival
Nottingham prognostic index
duct ectasia
menopause
cheese like nipple discharge
slit like retraction of the nipple
breast cysts
perimenopausal females
soft fluctuant swellings
hallo appearance on mammography
what does snowstorm sign on ultrasound of axillary lymph nodes indicate
snowstorm sign on ultrasound indication extracapsular breast implant rupture
intraductal papilloma
growth of papilloma in a single duct - tumour of fibrovascular tissue within the lactic ducts
clear or blood stained discharged
bilateral breast discharge in adolescent
hormonal changes
nature of inheritance of the BRCA1 gene
autosomal dominant
mammary duct ectasia vs duct papilloma
tender lump around areola + green nipple discharge - mammary duct ectasia
ductal papilloma - blood stained discharge
when are the following recommended -
radiotherapy
chemotherapy
after wide local excision , 4/more positive lymph nodes and t3/t4 tumours that have undergone mastectomy
chemotherapy is recommended either to downstage a lesion or afterwards if there is axillary node disease
