Breast disease

Question 1

Recent breast surgery or trauma to the chest can cause a benign mass. What is this known as?

Answer 1

Fat necrosis

• usually disappears after 2-3 months

Question 2

Mastitis

Answer 2

Inflammation caused by milk stasis in a lactating woman

Unilateral breast discomfort, swelling

Question 3

Treatment of mastitis

Answer 3

ABX

Continue breastfeeding

Question 4

Acute mastitis is usually caused by which pathogen?

Answer 4

Staph aureus -> can lead to abscess

Question 5

What is the most common benign breast condition?

Answer 5

Fibroadenoma

• Common in women under the age of 30 years
• THINK breast mice! Discrete, non-tender, highly mobile lumps

Question 6

The size of fibroadenomas varies with _______ levels

Answer 6

Oestrogen

Question 7

Staghorn cell arrangement of cells on histology seen in..

Answer 7

Fibroadenomas

Question 8

What is the main symptom of intraductal papilloma

Answer 8

Clear/bloody nipple discharge

Local areas of epithelial proliferation in large mammary ducts

Question 9

Phyllodes tumour

Answer 9

Rare breast tumours (most are benign but some are malignant)

More common in women with fibroadenomas

Question 10

Dilatation of the large breast ducts =

Answer 10

Mammary duct ectasia

Common around the menopause
Tender lump and can cause green nipple discharge

Question 11

Breast abscess is common in..

Answer 11

lactating woman

Red/hot/tender swelling
Commonly follows mastitis

Question 12

What is the most common type of breast cancer

Answer 12

IDC Invasive ductal carcinoma

Question 13

If there is no BM penetration (no metastases) what kind of breast cancer is it more likely to be?

Answer 13

DCIS or LCIS

Question 14

Breast abscess treatment

Answer 14

Aspirate or incision and drain, remove dead skin and irrigation of pus

Question 15

If you treat suspected mastitis with ABX twice and still no improvement consider that it could be something…

Answer 15

more sinister/malignancy

Inflammatory breast cancer

Question 16

Granulomas in breast usually caused by..

Answer 16

Sarcoidosis

TB

Question 17

Galactocoele =

Answer 17

Milk filled cyst

Seen in pregnant/breast feeding women
When duct gets blocked

Question 18

When do you commonly see green/ brown nipple discharge

Answer 18

Duct ectasia

Question 19

When do you commonly see green/ brown nipple discharge

Answer 19

Duct ectasia

Common in post-menopausal women

Question 20

Which carcinoma in-situ will have calcifications

Answer 20

DCIS

Question 21

Cannonball lung lesions commonly seen with

Answer 21

IDC

Question 22

Paget’s disease of the breast =

Answer 22

Scaly/Eczema-like changes to the skin of the nipple and areola

Sign of underlying breast cancer (usually DCIS)

Question 23

How to tell the difference between eczema and Paget’s disease

Answer 23

Eczema is itchy and Paget’s is not itchy

Eczema is bilateral, Paget’s is unilateral

Eczema usually presents with history of atopy

Question 24

Triple assessment for early/rapid detection of breast cancer =

Answer 24

1) History and examination
2) Radiological imaging (Mammograph or US)
3) Histology (biopsy of suspision mass)

Question 25

Triple assessment for early/rapid detection of breast cancer =

Answer 25

1) History and examination 2) Radiological imaging (Mammograph or US) 3) Histology (biopsy of suspicious mass)

Question 26

Punch biopsy is done when..

Answer 26

there is a change to the skin of the breast or nipple

Question 27

The NHS Breast Screening Programme

Answer 27

Women aged 50-70 invited every 3 years

Question 28

Breast cancer management

Answer 28

Wide local excision or mastectomy

Question 29

Breast cancer management

Answer 29

Surgery = Wide local excision or mastectomy Radiotherapy = Usually after surgery Chemo = used neoadjuvantly or for node +ve cancer Hormonal therapy = If ER positive = anostrazole or tamoxifen Biological therapies = if HER2 receptor positive = trastuzumab/herceptin

Question 30

What does it mean if cancer is triple-negative

Answer 30

Cancer does not have receptors for either HER2 or hormones oestrogen and progesterone

Question 31

Signs of inflammatory breast cancer

Answer 31

Progressive, erythema and oedema of the breast in the absence signs of infection (such as fever, discharge or elevated WCC/CRP)

Question 32

Tumour marker in breast cancer

Answer 32

CA 15-3

Question 33

Which hormonal breast cancer therapy is used in pre-menopausal women

Answer 33

Tamoxifen Anastrozole is used in post-menopausal women

Question 34

Why isn't tamoxifen used in post-menopausal women with ER-positive breast Ca?

Answer 34

Increased risk of endometrial cancer

Question 35

BRCA1/BRCA2 gene mutation increase your risk of breast/ovarian cancer by __%

Answer 35

40%

Question 36

The 'snowstorm' sign on ultrasound of breast for someone with breast implants indicates

Answer 36

breast implant rupture