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Cancer Care > Breast disease > Flashcards

Breast disease Flashcards

1
Q

What are the different types of breast malignancy

A 
Ductal Carcinoma in situ - most common 
Lobular Caarcinoma in situ - rarer
Ductal invasive carcinoma 
Lobular INvasive carcinoma 
Pagets 
Inflammatory
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2
Q

What is the screening programme for breast cancer?

A

Screening every 3 years for women 50-70 currently trialling 47-73
Mammogram
Patients with family hx of breast cancer/BRCA mutation –> screened every year after 40

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3
Q

why are mammograms not used in younger patients

A

Breast tissue is too dense so ultrasound is used

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4
Q

What are the risk factors for breast cancer

A 
Genetic: 
- BRCA genes and p53
- Family hx of breast cancer 
- Family hx of ovarian and prostate cancer 
- Ashkenazi Jewish descent 
Obs and Gynae hx 
- null parity or low parity 
- no breastfeeding 
- use of COCP
- use of combined HRT
- Early menarche and late menopause
other 
- increasing age 
- past hx of breast cancer or other malignancy 
- smoking 
- alcohol
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5
Q

How may breast malignancy present

A 
Painless lump in breast 
Nipple inversion 
Peau d'orange 
Nipple discharge
Change in size/shape of breast 
Overlying skin changes - rash 
Systemic symptoms - weight loss, night sweats, fatigue
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6
Q

How does Paget’s disease of the breast present

A 
Unilateral eczema of nipple that spreads beyond areola (a way to differentiate from eczema) 
Itching
Erythematous 
Scaling 
Erosions and ulceration
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7
Q

How is Pagets disease of the breast investigated

A

Skin scrapings –> paget cells will be found
Punch biopsy
Wedge biopsy - can help see if DCIS or invasive carcinoma underneath

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8
Q

How may you rule out eczema if suspected Pagets

A

Give course of oral steroids and see if it clears up

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9
Q

How is suspected breast cancer investigated

A

Triple assessment

  • examination (asymmetry, skin changes, axillary nodes, mobile or tethered lump, nipple inversion, discharge
  • USS/ Mammogram
  • ultrasound guided FNA or biopsy
Bloods 
- FBC, U+Es, LFTs, CRP (if suspecting infection or as baseline before treatment)
Imaging for staging 
- CT CAP 
CXR
Abdo USS
PET scan - for bony mets
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10
Q

What are the differentials for a breast lump

A 
Breast cyst 
Fibroadenoma 
Abscess
Mets - neuroendocrine or AML
Lymphoma of breast 
Traumatic fat necrosis 
Inflammatory carcinoma
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11
Q

How is breast malignancy treated?

A

Surgery

  • wide local exicision - solitary lesion, peripheral tumour
  • mastectomy - larger tumours, central tumour, DCIS >4 cm
  • Axillary clearance (after sentinel node biopsy)

Chemo

  • usually started after primary surgery
  • Oestrogen positive - tamoxifen in pre menopausal and aromatase inhibitors in post menopausal

Radiotherapy
- After breast conserving surgery

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12
Q

What is a sentinel node biopsy and what are the complications

A

Inject dye/radiolabelled dye into tumour and see which nodes it goes to
Seroma and lymphoedema –>will need draining

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13
Q

What are the three hormones breast cancer can be positive or negative for

A

Progesterone
Herceptin
Oestrogen

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14
Q

Which mutation has a strong association with HER2 positive Cancer

A

p53

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15
Q

Which mutation has a strong association with Oestrogen positive but HER 2 negative cancer

A

BRCA2

Also most common hormone receptor combo

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16
Q

Which mutation has a strong association with Oestrogen and HER2 negative cancer

A

BRCA1

17
Q

How may a cyst present

A

Fluid filled mass
May be pain - compression on other structures
most common in over 50s

18
Q

How is a cyst investigated and treated

A

Mammogram/USS - presents similarly to malignancy

FNA under ultrasound

19
Q

What is a fibroadenoma

A

Smooth, mobile, rubbery, firm, benign tumour of breast
Most common in younger age group 15-35
Less common in post menopausal women due to hormones

20
Q

How is a fibroadenoma treated

A

usually left in situ with follow up

removed if >3cm or patient preference

21
Q

How does duct ectasia present

A

Yellow/green discharge
Slit like nipple inversion
palpable mass
More likely in menopausal women

22
Q

What is duct ectasia

A

Dilating and shortening of the major lactiferous ducts

Mammogram shows dilated calcified ducts

23
Q

How is duct ectasia managed

A

Conservatively

total or subtotal exicision if unremitting nipple discharge

24
Q

How does mastitis present

A

Skin inflammation and thickening
Cracks in nipple
Can be lactational or non-lactational (tobacco smoking)

25
Q

What is the pathophysiology of mastitis

A

Ducts become blocked and engorged with milk

Cracks form in nipple and bacteria gets in causing inflammation

26
Q

How is mastitis treated

A

Flucloxacillin for 10 days

27
Q

Which organism commonly causes mastitis

A

staph aureus

28
Q

How does fat necrosis of the breast present

A

Firm lump usually painless

normally history of trauma or breast feeding but there may not be

29
Q

What is fat necrosis of the breast

A

Damage to the fatty tissue due to trauma

30
Q

How is fat necrosis treated

A

Its not

It resolves spontaneously

31
Q

How does intraductal papilloma present

A

Bloody discharge from nipple normally unilateral

Typically in sub areolar region

32
Q

What can intraductal papilloma present similarly to

A

Ductal carcinoma

however no increased risk of malignancy

Cancer Care (2 decks)

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