breast diseases Flashcards
‘prickly’ skin changes on the breast not involving the nipple. What is it caused by? What is it associated with?
peau d’orange
blocked lymphatic drainage
breat cancer
hard, mobile lump on breast following trauma
fat necrosis
smooth, mobile lump in lobule (deep)
fibroadenoma
fluid filled lump in lobule (deep)
breast cyst
breastmilk filled lobular lump (deep)
galactocele
soft mobile lump just under skin
loipoma
nipple changes that show ulcerated nipple. What is it associated with?
pagets disease of the nipple
breast cancer
1st line for oestrogen-receptive positive breast cancer in
1. premenopausal women
2. postmenopausal women
- premenopausal women: tamoxifen
- postmenopausal women: aromatase inhibitors
‘halo’ appearance on mammography is associated with
breast cysts
what is duct ectasia?
As women progress through the menopause the breast ducts shorten and dilate. In some women this may cause a green nipple discharge and slit like retraction of the nipple. No specific treatment is required.
Adversre effects of tamoxifen
- menstrual disturbance: vaginal bleeding, amenorrhoea
- hot flushes
- VTEs
- endometrial cancer
examples of aromatase inhibitors + SEs
anastrozole, letrozole
they work by reducing peripheral oestrogen synthesis
osteoporosis, hot flushes, arthralgia, myalgia, insomnia
[benign breast lesions] how to differentiate and treat
1. fibroandenoma
2. breast cyst
3. fat necrosis
4. duct papilloma
- fibroandenoma: mobile, firm lump, excise if >3cm
- breast cyst: mooth, discrete, fluctuant lump, aspirate. If bloody aspirate then biopsy and excise.
- fat necrosis: imaging and core biopsy
- duct papilloma: nipple discharge, microdochectomy
biological therapy for breast cancer
trastuzumab (Herceptin) in HER2 positive tumours
breast cancer screening - who is it offered to? how often?
women 50-70
every 3 years
‘lumpy’, painful breast which is worse before menstruation
Fibroadenosis
blood-stained nipple discharge with no lump =
duct papilloma
more common in lactating women, present with red, hot tender swelling
breast abscess
young female patient with breast inflammation, smoking and breast abscess
Periductal mastitis
‘snow storm’ appearance on US of axillary lymph nodes is suggestive of what?
Extracapsular breast implant rupture
How should breast cancer women be managed before surgery?
If no palpable lymph nodes: pre axillary US scan -> if negative -> sentinel node biopsy
If lymphadenopathy is present -> axillary node clearance is needed at surgery
What side effect is common with axillary lymph node clearance?
Arm lymphedema and functional arm impairment
What is the mechanism of action of tamoxifen?
Oestrogen receptor selective antagonism
How should suspected Pages be managed?
Needs referral to breast clinic
Discharge from multiple ducts?
Duct ectasia
Single duct discharge which has small amounts of blood on testing?
Intraductal papilloma
Microdochectomy can be used as a treatment for duct ectasia in who?
Young women
Most common type of breast cancer?
Invasive ductal carcinoma
Erythematous, oedematous breast with no signs of infection?
Think inflammatory breast cancer
What marker may be raised with inflammatory breast cancer?
CA 15-3
Which dermatome is the nipple?
T4
Acute side effects of radiotherapy?
- Fatigue
- Hair loss
- Sore throat
- Pain at site
- Skin changes
What are long term complications of radiotherapy?
- Lymphoedema
- Delayed healing
- Chronic skin changes
- Osteoporosis
- Neuro signs
Management of patients who have had wide local excision?
Whole breast radiotherapy
What is the inheritance of someone with BRCA?
50% chance of children inheriting
Duct like structure with regular columnar cells and fibrous tissue?
Fibroadenoma
How often should women with BRCA11 be screened?
Annually with MRI
What should be done before starting someone on Herceptin?
Echo -> can cause cardiomyopathy
Which breast cancer medication can cause heart failure?
Trastuzumab
