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Reproduction and Sexual Health > Breast Disease > Flashcards

Breast Disease Flashcards

1
Q

What is the most common cancer of all women?

A

Breast

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2
Q

What is the second most common cancer of women?

A

Ovarian

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3
Q

80% of breast cancers are the _______ type

A

Ductal

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4
Q

Outline the 5 year survival rates by extent of breast cancer at time of diagnosis.

A
  • All stages – 86%.
  • Localized cancer – 97%.
  • Cancer with regional involvement – 78%.
  • Metastatic cancer – 23%.
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5
Q

List risk factors for breast cancer.

A
  • Female.
  • Old age.
  • Gene mutations e.g BRCA
  • Atypical ductal or lobular hyperplasia.
  • Lobular carcinoma in situ.
  • Atypical epithelial hyperplasia.
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6
Q

List some epidemiological risk factors for breast cancer.

A
  • First child born after 30y/o.
  • Alcohol consumption one or more times per day.
  • Early menarche.
  • FHx of breast cancer.
  • Past history of breast cancer.
  • Nulliparity.
  • Postmenopausal obesity.
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7
Q

Having never had children is a risk factor for breast cancer

A

T

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8
Q

Having your first baby >30 years is a risk factor for breast cancer

A

T

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9
Q

Early menarche is a risk factor for breast cancer

A

T

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10
Q

Postmenopausal obesity is a risk factor for breast cancer.

A

T

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11
Q

List the common symptoms of breast cancer.

A
  • Dimpled or depressed skin
  • Visible lump
  • Nipple change - inversion
  • Bloody discharge
  • Textured change
  • Colour change
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12
Q

What is the most common histologic type of breast cancer, accounting for as many as 80% of breast malignancies?

A

Ductal carcinoma

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13
Q

What are the typical findings of a ductal carcinoma?

A

Stellate solid mass or pleomorphic casting microcalcifications

BUT, a malignant solid mass may be circular and the calcifications may be non-casting

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14
Q

Ultrasound can be helpful in defining a malignant solid mass

A

T

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15
Q

Who is US easier to detect breast cancer in?

A
  • Mammographically dense breasts

* Young women

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16
Q

The DEFINITIVE DIAGNOSIS is established by IMAGE-GUIDED TISSUE CORE-NEEDLE BIOPSY

A

T

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17
Q

How do we get a DEFINITE diagnosis of breast cancer in situ?

A

Image guided tissue core needle biopsy

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18
Q

Ductal carcinoma in-situ is commonly ____ __________

A

Non-palpable

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19
Q

How is a ductal carcinoma in situ easily seen?

A

On screening mammography as malignant calcifications, usually pleomorphic and of the casting type

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20
Q

How do we get a DEFINITE diagnosis of ductal carcinoma in situ?

A

By stereotactic vacuum-assisted core biopsy

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21
Q

How does an invasive lobular carcinoma spread?

A

Spreads diffusely, with a typical histologic Indian file pattern

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22
Q

How does an invasive lobular carcinoma usually present?

A

Invasive lobular carcinoma not being apparent, either by palpation or imaging, until the cancer is at an advanced stage

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23
Q

What is a tumour marker for invasive lobular carcinoma?

A

Lobular carcinoma in situ (LCIS).

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24
Q

What is LCIS associated with?

A

Associated with increased risk of eventual invasive carcinoma that usually is of the ductal type

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25
Q

Equivalent long-term breast cancer survival can be achieved by either breast-conserving therapy or mastectomy

A

T

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26
Q

What is the best tx for breast cancer?

A

Masectomy

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27
Q

Although mastectomy is the best treatment for breast cancer, what is the PREFERRED treatment?

A

Breast conserving therapy

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28
Q

What is breast conserving therapy?

A

A wide local excision, with or without an oncoplastic procedure to shape the breast

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29
Q

What is the other essential component of breast conserving surgery?

A

Radiation therapy (irradiation).

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30
Q

Describe the radiotherapy used in breast cancer.

A

Total dose of 4500-5000 centigrays is administered in fractions, using opposed tangential fields.

Course is usually administered in daily fractions, 5 days per week for 3-6weeks.

A boost dose of irradiation to the tumour bed increases the target dosage to 6000-6500 centigrays.

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31
Q

What does a modified radical/total mastectomy do?

A

Removes the entire breast, including the overlying skin and the axillary lymph nodes

Entire breast, skin, nipple, and axilla are removed

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32
Q

In radical/total mastectomy, everything is removed except what?

A

Pectoralis major muscle …

  • Facilitates improved wound healing and, potentially, allows reconstruction
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33
Q

Breast reconstruction should be offered to all women

A

T

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34
Q

What are the 2 options for breast reconstruction, in terms of timing?

A
  • Immediate - at the same time as the masectomy

* Delayed - after mastectomy during another surgery

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35
Q

Skin sparing masectomy leads to a more aesthetically pleasing outcome

A

T

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36
Q

Outline the different options of breast reconstruction.

A
  • A breast prosthesis
  • The latissimus dorsi (LD) myocutaneous flap (usually plus a breast prosthesis)
  • Deep inferior epigastric perforator (DIEP) free flap
  • Transverse rectus abdominis myocutaneous (TRAM) flap
  • Superior/inferior gluteal artery perforator (S-GAP or I-GAP) free flaps
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37
Q

What is radiation an important feature of?

A

Breast conserving surgery

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38
Q

What are the 3 indications for post-masectomy radiotherapy?

A
  • Involvement of >3 nodes.
  • Positive surgical margins.
  • Tumours >5cm.
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39
Q

What new technique is a promising alternative to whole-breast RT?

A

Partial breast irradiation, given either intra- or post-operatively through special catheters.

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40
Q

What is the most commonly used hormonal therapy?

A

Tamoxifen

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41
Q

What is tamoxifen?

A

An anti-oestrogen

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42
Q

Overexpression of ____ _ is implicated in the pathogenesis of breast cancer

A

HER 2

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43
Q

What is a key marker for determining a pt’s outcome?

A

HER 2

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44
Q

What drug targets HER 2?

A

Herceptin (Trastuzumab) – a recombinant humanized monoclonal antibody

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45
Q

What is Bevacizumab?

A

A recombinant humanized monoclonal antibody against vascular endothelial growth factor

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46
Q

What is Bevacizumab 1st line in the treatment of?

A

Metastatic breast cancer

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47
Q

What is the 1st line treatment of metastatic breast cancer?

A

Bevacizumab

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48
Q

‘A dual inhibitor of epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) tyrosine kinases’ is referring to what drug?

A

Lapatinib

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49
Q

What is the indication for Lapatinib?

A

In combination with capecitabine for the treatment of

  • Patients with advanced breast cancer or metastatic breast cancer (MBC)
    +
  • Whose tumors overexpress HER-2 (ErbB2) and who have received previous treatment that included an anthracycline, a taxane, and herceptin
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50
Q

What is a fibroadenoma?

A

The most common benign neoplasm of the breast

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51
Q

What is the most common benign disease of the breast/

A

Fibroadenoma

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52
Q

How does a fibroadenoma present?

A

A palpable mass (e.g. 1-3mm) in the early reproductive years of a woman’s life

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53
Q

What women get fibroadenomas?

A

Women in early years of reproductive life

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54
Q

When do fibroadenomas usually occur?

A

In the early reproductive years, but can be diagnosed at any age

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55
Q

How is a fibroadenoma diagnosed?

A

With ultrasound core biopsy

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56
Q

Describe how a fibroadenoma feels on examination.

A
  • Rubbery to firm.
  • Mobile.
  • Smooth, with distinct border.
  • Usually NON-TENDER.
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57
Q

Fibroadenomas are pre-malignant

A

F

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58
Q

Is a fibroadenoma pre-malignant?

A

NO

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59
Q

Do fibroadenomas need to be removed?

A

No – because they tend to remain unchanged or decrease in size approaching the menopause, and usually become non-palpable after the menopause

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60
Q

When do fibroadenomas become non-palpable?

A

After menopause

61
Q

Some women would rather have their fibroadenomas removed even although this is not necessary. How is this done?

A

Electively, in the form of open lumpectomy, or percutaneous vacuum-assisted core biopsy as an outpatient procedure, under local anaesthesia.

62
Q

What resembles fibroadenomas in clinical presentation and cytology?

A

The uncommon phyllodes tumour

63
Q

How care phyllodes tumours different from fibroadenomas?

A
  • Larger – 3-6cm.
  • Tend to occur in older women – 35-45y/o.
  • Tend to increase in size.
64
Q

What does diagnosis of a phyllodes tumour need?

A

Histologic verification

65
Q

Phyllodes tumours can be …

A
  • Benign.
  • Intermediate.
  • Malignant.
66
Q

How is a phyllodes tumour managed?

A
  • With wide (1cm), clear surgical margins, and followed up carefully.
  • Metastasis, although rare, is possible.
67
Q

What is mastalgia?

A

Breast pain

68
Q

Mastalgia is usually _________

A

Cyclical (but can be non-cyclical)

69
Q

When is the pain of mastalgia more intense?

A

During the immediate premenstrual phase of the cycle

70
Q

The pain in mastalgia is diffuse

A

T

71
Q

Mastalgia is unilateral/bilateral

A

Usually bilateral, but can be unilateral

72
Q

In non-cyclical mastalgia, the pain is …

A

Localized, and often persistent

73
Q

Non-Cyclical mastalgia is LESS responsive to treatment than cyclical mastalgia

A

T

74
Q

Is mastalgia associated with malignancy?

A

No- unless there’s a palpable breast mass

75
Q

Clinically, it is imperative to be certain that pain in mastalgia is where?

A

Within the breast, and not of a non-breast aetiology, affecting the anterior chest wall

76
Q

What is cyclic mastalgia due to in most women?

A

The woman having an intense variant of physiologic breast changes that occur during the menstrual cycle.

77
Q

When can a woman with mastalgia be reassured that there is no evidence of cancer and that her sx are physiologic?

A

After complete evaluation and examination, including a mammogram for a woman aged 35 or older.

78
Q

When can mammograms start to be given?

A

> 35 years

79
Q

Give examples of therapies which have been shown to be effective in treating mastalgia.

A
  • Evening primrose oil.
  • Tamoxifen.
  • Topical NSAIDs.
80
Q

When do palpable breast cysts commonly occur?

A

During the late reproductive years of a woman’s life

81
Q

Describe how a breast cyst will feel on examination.

A
  • Palpable, clearly defined, soft, mobile and smooth.

* The borders are distinct.

82
Q

Are breast cysts tender?

A

YES !!!!

83
Q

When are breast cysts particularly sore?

A

Before menstruation

84
Q

Many cysts are multiple or bilateral

A

T

85
Q

What is an effective and efficient way of diagnosing and treating a cyst?

A

FNA

86
Q

During FNA in the management of a breast cyst, how much fluid should be removed?

A

As much as possible

87
Q

Should all cyst fluid be sent for cytologic evaluation?

A

No – only grossly bloody fluid should be cytologically evaluated

88
Q

What should be done after FNA of a ‘cyst’?

A

The area of the cyst must be palpated to be certain that there’s no residual mass

89
Q

Cysts are not usually/necessarily premalignant.

A

T

90
Q

What can occur within a cyst?

A

A benign intracystic papillary proliferation i.e PAPILLOMA

91
Q

What is often seen if a cyst has a benign intracystic papillary proliferation?

A

Bloody cyst fluid

92
Q

When should the rare intracystic carcinoma be clinically suspected?

A

When the fluid is grossly bloody, or there is a residual mass after aspiration

93
Q

What is needed for diagnosis of a intracystic carcinoma?

A

US-guided core biopsy of any intra-cystic solid lesion or irregular cystic wall

94
Q

Describe the physiologic discharge which can be elicited from the nipples of most women of reproductive age.

A

Clear, yellow, watery

95
Q

What type of discharge is pathologic, and requires evaluation?

A

Bloody nipple discharge, particularly from a single duct

96
Q

What is the most common aetiology of spontaneous nipple discharge?

A

An intraductal papilloma or papillomas – benign lesions

97
Q

Most common cause of nipple discharge is a benign intraductal papilloma

A

T

98
Q

Is nipple discharge a sign of malignancy?

A

Rarely – unlikely unless there is an associated palpable mass

99
Q

What should be done to all intraductal lesions?

A

They should be excised and histologically evaluated, to ensure that the rare intraductal carcinoma isn’t missed.

100
Q

What Ix’s are done in cases of pathological nipple discharge i.e bloody from a single duct?

A

Mammogram

101
Q

What is Paget’s disease of the nipple a variant of?

A

Ductal carcinoma, intraductal, +/or invasive.

102
Q

How CAN Paget’s disease of the nipple present?

How does Paget’s disease of the nipple USUALLY present?

A

CAN - red, weeping lesion on the surface of the nipple and areola

USUALLY - dry, scaly, eczematous lesion

103
Q

How is Paget’s disease of the nipple diagnosed?

A

By histologic tissue biopsy (incisional or punch).

104
Q

Palpable mass or radiological abnormality is often found underlying in Paget’s disease of the nipple

A

T

105
Q

What does puerperal mean?

A

The period from childbirth to 6 weeks after

106
Q

What is mastitis related to?

A

Pregnancy/lactation

107
Q

Is mastitis common?

A

YES !!!!

108
Q

How is mastitis treated?

A
  1. Flucloxacillin

2. Clarythromycin/clindamycin if penicillin allergic

109
Q

When should abx be given for mastitis?

A

As soon as clinical signs of mastitis …

  • Fever
  • Erythema
  • Induration
  • Tenderness
  • Swelling
110
Q

Once abx for mastitis is started, how often should the patient be examined?

A

Every 3 days – to be certain the infection is responding to therapy, and that there’s no evidence of abscess formation

111
Q

What non-drug treatment is good for mastitis?

A

Hot bath

112
Q

What should be done if there is a lack of response of pt with mastitis to abx?

A

Change abx

113
Q

Should cultures be done for mastitis?

A

NO

114
Q

What should be done regarding breast-feeding of someone with mastitis?

A

Breastfeeding should be continued if already begin +/or the infected breast can be pumped until to give the baby the breastmilk the mastitis clears.

Use a breast pump for the affected breast, you can give the baby this milk

115
Q

How does a breast abscess present?

A
  • A flocculent, sometimes-bulging mass.

This is usually located in the central area of the mastitis.

116
Q

If someone with mastitis develops a breast abscess, where will the abscess be seen?

A

At the centre of the area of mastitis

117
Q

How can you confirm a breast abscess?

A

Using focused ultrasound to show a fluid-filled (pus) centre.

118
Q

What Ix is diagnostic + therapeutic for a breast abscess?

A

Aspiration with a number 18-gauge needle using local anaesthesia.

119
Q

What happens to the aspirate from a breast abscess?

A

It is sent for microbiological analysis

120
Q

How often should aspiration of a breast abscess be done?

A

Every 3 days – especially if there is >10ml of pus initially aspirated.

121
Q

What is required if repeated aspirations are not effective in clearing a breast abscess?

A

Open surgical drainage under general anaesthesia.

122
Q

For how long should abx in an abscess be given?

A

Until all evidence of inflammation (cellulitis) has cleared.

123
Q

Non- puerperal mastitis is common/uncommon even in post-menopausal women

A

Uncommon

124
Q

What bacteria usually cause non-puerperal mastitis?

A
  • S. aureus.
  • Peptostreptococcus magnus.
  • Bacteroides fragilis.
125
Q

How should patients with non-puerperal mastitis be managed?

A
  • Re-examine every 3 days until infection clears.
  • Augmentin 625mg orally every 8 hours for 7 days as initial therapy.
  • Alternatively, cephalexin 500mg can be given orally every 6 hours for 7 days.
126
Q

Chronic mastitis is common/uncommon

A

Uncommon

127
Q

What is chronic mastitis associated with?

A

A subareolar abscess

128
Q

What can occur with a subareolar abscess from someone with chronic mastitis?

A

Periareolar fistulae

129
Q

How is a periareloar fistulae managed?

A

Surgically excise when the inflammation is quiescent.

130
Q

What should be suspected with a case of mastitis that is unresponsive to antibiotic therapy, particularly if it seems to spread over the entire breast?

A

Inflammatory carcinoma

131
Q

What does an adenolipoma usually present as?

A

A smooth palpable mass, with a characteristic mammographic pattern.

132
Q

An adenolipoma is a rare benign breast condition

A

T

133
Q

What are histologically noted in the lining of a cyst?

A

Apocrine metaplasia of the epithelial cells, which enlarge and are eosinophilic

134
Q

Ductal hyperplasia is a ______ histological process

A

Benign

135
Q

When can ductal hyperplasia be associated with an increased risk of malignancy?

A

When the hyperplasia is atypical

136
Q

What is ductal hyperplasia often the beginning of?

A

Transformation to ductal carcinoma in situ, and eventually invasive ductal carcinoma

137
Q

When can fat necrosis mimic carcinoma?

A

On examination

138
Q

How do we distinguish fat necrosis from carcinoma?

A

MAMMOGRAM - and the fact that it is often secondary to breast trauma.

139
Q

Give an example of a typical situation that results in fat necrosis.

A

Seat belt injury from a car crash

140
Q

What happens to fat necrosis as it progresses?

A

It usually subsides spontaneously, but may leave a residual mammographic lesion.

141
Q

What is a galactocele?

A

A palpable milk-filled cyst

142
Q

What are galactoceles associated with?

A

Pregnancy or lactation

143
Q

How is a galactocele diagnosed + managed?

A

FNA - also drains it

144
Q

Describe the appearance of the border of a lipoma on mammography.

A

Thin smooth border - can also be palpable

145
Q

What does a biopsy of a lipoma reveal?

A

ONLY adipose cells

146
Q

What is the ONLY cell type of a lipoma?

A

Fat cells

147
Q

What is Mondor’s disease?

A

Phlebitis and subsequent clot formation in the superficial (skin) veins of the breast.

148
Q

How does Mondor’s disease present?

A

As a firm, vertical, cord-like structure, usually associated with a history of trauma to the breast e.g. surgery

149
Q

What happens in Mondor’s disease

A

It usually resolves spontaneously in 8-12weeks

Reproduction and Sexual Health (51 decks)

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