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My Final Year 4 Revision > Breast disease > Flashcards

Breast disease Flashcards

1
Q

What is concluded in the triple assessment?

A

Clinical assessment
Imaging
Needle biopsy

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2
Q

In the triple assessment each compenent is scored from 1-5. What do each of the numbers indicate?

A 
1 - normal
2 - benign 
3 - uncertain/ likely benign 
4 - suspicious 
5 - malignant
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3
Q

What are the risk factors for s for developing breast cancer?

A 
Oestrogen exposer
Family history
Obesity 
Smoking 
Alcohol 
Dense (Fibroglandular) breasts
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4
Q

What are examples of oestrogen exposure which increase the risk of breast cancer in women?

A 
Early monarchy 
Late menopause 
HRT
OCP 
No breast feeding 
No children
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5
Q

When ultra sounding the breast what are the two views of the breast?

A

Mediolateral oblique

Cranial-cuadal

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6
Q

What aspect of the breast does the mediolateral oblique capture?

A

The tail of the breast and therefore capturing lymph nodes

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7
Q

Why is a breast compressed during the mamogram

A

Spread out tissue
Uniform thickness of the breast
Stabilise the tissue

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8
Q

When is mammography used on top of ultrasound?

A

When a patient is over the age of 40 years

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9
Q

Why are ultrasound used in women under the age of 40 years?

A

Reduce radiation exposer
Less likely to have cancer
More dense (fibroglandular) breasts

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10
Q

What is the tail of Spence?

A

Projection of the breast along to the axilla

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11
Q

Where does majority of the lymph from the breast drain to?

A

The axilla

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12
Q

What lymph node regions are assessed during the breast examination?

A

Axillary

Supra/Infra-clavicular nodes

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13
Q

What is involved in the histological terminal duct unit?

A

Extralobular terminal duct

Intralobular terminal duct

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14
Q

What causes breast development in females after puberty?

A

Oestrogen (and some progesterone)

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15
Q

After pregnancy what stimulates lactation.

A

Prolactin and oxytocin (released from suckling)

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16
Q

What is the meaning of the word mystalgia?

A

Breast pain

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17
Q

What is skin tethering?

A

Lump is attached to skin but doesn’t move with skin

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18
Q

Where do most breast cancers occur?

A

50% occur in the upper inner quadrant

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19
Q

What growth factors are assessed when evaluating treatment of breast cancer?

A

Oestrogen
Progesterone
Human epithelial growth factor 2

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20
Q

What is protective for breast cancer?

A 
Early age at first birth
increased parity (duration of breast feeding)
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21
Q

What is used for ER positive breast cancers?

A

Tamoxifen

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22
Q

What is used for HER2 breast cancers?

A

Transtuzumab (herceptin)

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23
Q

What is better a mastectomy or a wide local excision (with radiotherapy) ?

A

They have an equivalent prognosis

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24
Q

How does adjuvant chemotherapy (tamoxifen etc) reduce spread of disease?

A

Stops micrometastesis

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25
Q

When would a mastectomy be chosen over a local excision?

A

Tumour > 4cm
Multifocal
Poor cosmetic result with local excision

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26
Q

What features of breast pain are less concerning?

A

Bilateral
Self resolves
Associated with menstrual cycle

However recommend a mammogram anyway

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27
Q

How is breast pain treated?

A

NSIADs and Danzol

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28
Q

What is Colostrum?

A

First milk production after delivery, rich in antibodies

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29
Q

What factors are associated with breast abscess?

A

Smokers
Diabetics
Immunocompromised

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30
Q

What distinguishes a ductal carcinoma in situ to a invasive ductal carcinoma?

A

Histological the cancer has not broken the epithelial basement membrane

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31
Q

A young female patient notices a unilateral lump which movable and has no pain. NO breast or family history of significance. What is the likely diagnosis?

A

Fibroadenoma, stile for triple assessment

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32
Q

How can a cyst vs a mass be distinguished when detected via mammography?

A

Ultrasound, black hola on ultrasound

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33
Q

When is a cyst treated?

A

if symptomatic, fine needle aspiration

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34
Q

How do cysts look on mamography?

A

Multiple cysts with varying size, bilateral

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35
Q

When are core biopsies used?

A

solid tumour masses

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36
Q

When are fine needle aspirations used?

A

axillary nodes

cysts

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37
Q

What criteria in a family history would lead to a specialist referral (NICE guidelines).

A

1 first degree relative less than 40 years old
2 first or second degree relatives of any age

+ jewish, male BC, ovarian, bilateral history etc.

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38
Q

What ages do screening take place?

A

From 47-73 years, every 3 years

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39
Q

When there is a genetic predisposition like BRCA how often does breast cancer screening take place?

A

Annual MRI and mammograms

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40
Q

What factors are involved in an increased risk of breast cancer?

A

TP53 mutation
BRCA mutation
supradiaphrmatic irradiation for hodgkins lymphoma

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41
Q

What are the common sites of metastasis?

A

2 Ls and 2 Bs

Bone
Brain
Lung
Liver

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42
Q

Why is Anastrozole used over tamoxifen in postmenopausal women?

A

Aromatase is the main enzyme for oestrogen in peripherally, this is the main source of oestrogen in postmenopausal women

43
Q

What is a sentinel node biopsy?

A

Where the lymphatic drainage of the breast using a dye or radioactive marker indicates the first lymphatic node(s), and therefore which may have malignant cell.

44
Q

If a sentinel biopsy shows malignant cells what is the next course of action for a person with an excised breast cancer?

A

Total node clearence

45
Q

What are the side effects of tamoxifen

A

DVT
Endometrial thickening
Hot flushes and headaches

46
Q

What to ask in a history of breast cancer?

A

Ask about related breast symptoms (inc. red flags)
Risk factors
FH
Life style (smoking, alcohol, children things)
medication

47
Q

What to describe when describing a lump?

A 
Shape
Size 
Consistency 
Hardness
Tethering
48
Q

What are the red flags for breast cancer?

A

Eczema
Nipple changes and discharge
Dimpling and redness
Discharge

49
Q

What is fat necrosis?

A

Caused by trauma and neurosis. Can also cause oil cysts

50
Q

Describe what a lump in the breast feels like?

A 
Stony hard 
Irregular 
Fixed 
Nipple retraction 
Skin changes
51
Q

What is the pathophysiology of Peau d’orange?

A

lymphedema caused by cancer blocking lymph drainage, axillary clearance and radiotherapy

52
Q

What differentials for redness on the breast?

A

Immunocompromised
Diabetic
Smokers
Inflammatory breast cancer

53
Q

What does fungating in relation to breast cancer?

A

The cancer breaking through the epidermis out of the skin. Can smell. Can cause discharge.

54
Q

If metastatic breast cancer is suspected, what can be done in addition to the standard breast exam?

A

Auscultation of the lungs
Palpate liver
Consider bone mets

55
Q

When would an MRI of the breast be used?

A 
BRCA women 
Lobular carcinoma (breast cancer)
56
Q

What are the feature of lobular carcinoma which make is different from ductal carcinoma?

A

Multifocal
Bilateral
Not seen on a mammogram!

57
Q

Why can a patient only be given radiotherapy once?

A

Greater risk of angiosarcoma with subsequent radiotherapy

58
Q

Breast reconstruction may be indicated in patients with…

A

Increased BMI
PVD
Smoking
Diabetic

59
Q

What effect does tamoxifen have on fertility?

A

Not allowed OCP but increases fertility. Is teratogenic

60
Q

How can nipple eczema and Pagets disease be differentiated?

A

Bilateral

Normally active at another site on the skin

61
Q

How is lactational mastoiditis treated?

A

Carry on breast feeding
Ultrasound for abscess
antibiotics - flucloxacillin

62
Q

What complete pathological remission

A

When chemotherapy has completely eradicated all viable cancer from the breast and axilla

62
Q

What are the three components of a triple assessment?

A

clinical assessmentimaging assessmentneedle biopsy

63
Q

Lifetime risk of developing breast cancer

A

1 in 8

64
Q

Lower risk of developing breast cancer

A

longer duration of breastfeedingincreasing parityearlier age at first birth

65
Q

Higher risk of breast cancer

A

FHHRT useearlier menarche

66
Q

things marked 1-5 in triple assessment

A

Palpationultrasound/Mammographycytology

67
Q

Paget’s disease

A

looks like eczema or psoriasis but on one breast

68
Q

Swelling of arm after breast cancer

A

Axillary node clearance

69
Q

two angles of mammography

A

mediolateral obliquecraniocaudal

70
Q

Grade of breast cancer shows how…

A

aggressive the cancer is

71
Q

HER2 positive spread faster or slower?

A

faster

72
Q

invasive lobular carcinoma- what scan is nneded

A

MRI- identifies extent of cancer

73
Q

IF P4 but M0 and U0- what next

A

clinical (freehand) core biopsy

74
Q

if positive for cancer, where scan next?

A

axilla

75
Q

ER pos, HER2 neg. What treatment?

A

Tamoxifen

76
Q

HER2 pos- what treatment?

A

trastuzumab

77
Q

what is the aim of chemo?

A

to eradicate micrometastatic disease

78
Q

what three characteristics are used to determine stage?

A

tumour size, number of lymph nodes involved, presence of mets

79
Q

triple neg breast cancer means

A

no HER2, ER or PR receptors

80
Q

What tool can be used to estimate breast cancer survival

A

PREDICT

81
Q

Side effects of tamoxifen

A

endometrial thickening, DVT, menopausal symptoms, cataracts

82
Q

Small lumps on nipple.

A

Montgomery tubercles- can be normal but become more pronounced in pregnancy

83
Q

Cyclical breast pain

A

usually more in menstrual cyclesettles down by itself stops after menopause

84
Q

non cyclical breast pain

A

could be costochondritis, causes are often unclear and resolves itself

85
Q

patient report cyclical type breast pain. Next step

A

reassure, offer bilateral mammogram

86
Q

painful area in breast. red and tender. Beginning to feel tired and unwell. had baby 5 weeks ago

A

lactational mastitis- can be infectious or non infectious

87
Q

Lump in context of lactational mastitis

A

could be an abscess- ultrasound it.

88
Q

abscess present- what next

A

ultrasound guided drainage. send fluid to microbio. start fluclox

89
Q

red, swollen, hot breast. Not lactating

A

consider inflammatory breast cancer- can mimic mastitis and breast abscesses

90
Q

treatments to consider in pts with breast pain

A

NSAIDS, danazol

91
Q

do you stop breastfeeding in mastitis

A

no- feed on demand from both breasts unless too painful

92
Q

predisposing factors for breast abscess

A

immunocompromised, diabetes, nipple piercing, smoking

93
Q

Breast implant problems

A

could be PIP implants (wrong grade silicone)leaking implant

94
Q

Investigation with implant problems

A

UltrasoundMRI

95
Q

Young female with breast lump

A

fibroadenoma

96
Q

even if thinking fibroadenoma- what next

A

triple assess- palpate, image, biopsy (if over 25)

97
Q

imaging in woman over 40

A

mammogram and ultrasound

98
Q

blood stained cyst fluid- what next?

A

send for cytology

99
Q

what type of gene is BRCA

A

tumour suppressor protein

100
Q

inheritance of BRCA

A

autosomal dominant

101
Q

chromosomes with BRCA

A

13 and 17

102
Q

prophylactic mastectomy reduces risk of cancer by what percent

A

90

103
Q

herceptin

A

HER2 cancers

My Final Year 4 Revision (16 decks)

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