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Breast diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

Non-cancerous breast lump

  1. Fibroadenoma - histology
  2. Description
  3. Excision indication
  4. Fibroadenosis - symptoms
  5. Relate to what
  6. Management options
  7. Breast cyst - description
  8. Fat necrosis - description
    9 Associations
  9. Lipoma - description
  10. Phyllodes tumour - MAYBE MALIGNANT (25%)
A
  1. From stromal/epithelial breast duct tissue
  2. Discrete, non-tender, smooth, well circumscribed, firm, highly mobile (‘breast mice’), 3cm, women <30,
    Smaller after menopause (hormone dependent)
  3. If >3cm
  4. Bilateral lumps/pain/tenderness, size fluctuates
  5. Menstruation (start 10 days before, resolve after)
  6. Stop hormonal contraception, NSAIDs, weight loss
  7. Fluid filled, smooth, well circumscribed, mobile, possibly fluctuant (size/location), occur aged 30-60 yo. ‘Halo sign’ on mammogram
  8. Firm, round/irregular, fixed, dimpling, nipple inversion
  9. Local trauma/surgery; oil cyst (contains emulsified fat), obese women, large breasts
  10. Fat collection, soft, painless, mobile, up to 20cm
  11. Large, fast growing periductal stromal cell, 40-50yo
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2
Q

Referrals

  1. 2ww - definite indications (3)
  2. Triple assessment comprises of
  3. 2ww - consider (2)
  4. Non-urgent
A
  1. 30+ and unexplained breast lump with/without pain
    50+ and unilateral nipple discharge/retraction
    Previous breast cancer with new suspicious symptoms
  2. Clinical Assessment
    Breast Imaging (ultrasound or mammography)
    Biopsy (fine needle aspiration or core biopsy)
  3. Skin changes suggestive of breast cancer
    30+ and unexplained axilla lump with/without pain
  4. <30 and unexplained breast lump with/without pain
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3
Q

Breast cancer

  1. Suspicious symptoms
  2. Associated genes
  3. Metastasis sites (2 Ls, 2 Bs)
A
  1. Hard, irregular, painless, fixed, skin/chest wall tethered, nipple retraction, skin dimpling/oedema (peau d’orange)
2. BRCA 1 (chromosome 17) - 60% breast, 40% ovarian
BRCA 2 (chromosome 13) - 40% breast, 15% ovarian
  1. Lung, liver, bone, brain
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4
Q

Breast screening

  1. When
  2. Benefits (2)
  3. Harm (6)
  4. Call back rate
A
  1. Every 3 years from 47-73 yo
  2. Earlier detection leading to:
    Reduction in mortality (biggest reduction aged 50-70) More breast-conserving treatment (less mastectomies)
  3. Over-diagnosis (so unnecessary treatment)
    False-positive mammograms (unnecessary further tests)
    False reassurance if missed cancer + incorrect diagnosis
    Mammography - pain/discomfort
    Psychological distress
    Radiation exposure (may increase breast cancer risk)
  4. 1 in 25 (and 1 in 4 of those have cancer)
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5
Q

Breast pain

  1. Management - conservative
  2. Medical
A
  1. Well fitting bra, diet, exercise

2. Topical NSAIDS, change OCP if pain is linked, consider hormone suppressing drugs if severe and prolonged

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6
Q

Mastitis

  1. Symptoms/signs
  2. How common in breastfeeding women
  3. 1st line management if uncomplicated
  4. Indications for ABX therapy
  5. Commonest organism if infective
  6. ABX management
  7. Complication + signs of this
A
  1. Tender, warm, erythematous, thickened tissue, pain/burning whilst breastfeeding
  2. 1 in 10
  3. Continue breastfeeding
  4. If systemically unwell / nipple fissure present / no improvement after 12-24 hours of effective milk removal / culture indicates infection
  5. Staph. aureus
  6. Flucloxacillin PO 10-14 days
  7. Abscess - fever, pus discharge, local erythema, pain, heat
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7
Q

Breast cancer - ductal carcinoma

  1. Commonest of all breast cancers
  2. Ductal carcinoma in situ (DCIS) - meaning
  3. Management options
A
  1. Invasive ductal carcinoma (‘No Special Type/NST’)
  2. Hasn’t spread beyond local tissue - ‘comedo necrosis not breaching basement membrane’
  3. Low risk - excise (1cm margins) and radiotherapy, middle/high/multifocal - mastectomy (lower recurrence)
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8
Q

Nipple discharge - benign differentials

  1. Mammary Duct Ectasia (MULTIPLE ducts) - discharge
  2. Other symptoms
  3. Major risk factor
  4. Management
  5. Complication
  6. Duct/Intraductal Papilloma - (ONE duct) - discharge
  7. Timing of presentation
  8. Investigation
  9. Management
  10. Breast abscess - presentation
A
  1. Thick green/brown, sometimes bloody
  2. Mastalgia (non-cyclical), nipple inversion/retraction, sometimes tender palpable subareolar mass
  3. Smoking, peri-menopausal
  4. Conservative (settles spontaneously), excision if persistent
  5. Rupture - inflamed - ‘plasma cell/periductal mastitis’
  6. Serous/bloody discharge
  7. Post-menopause
  8. Breast ductography (via contrast injection) shows small (2-3mm wart-like lesion within duct)
  9. Excision and vigilant breast screening (can increase risk of breast cancer as hyperplastic)
  10. Fever, pus discharge, local erythema, pain, heat
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9
Q

Galactorrhoea (lactation)

  1. Occurs due to what, released from what, stopped by what
  2. Timing related to pregnancy
  3. Idiopathic - cause, management
  4. Prolactinoma (pituitary gland tumuor) - symptoms
  5. Management
  6. Drug causes
  7. Endocrine causes (4)
  8. Other causes (2)
A
  1. Prolactin from anterior pituitary (dopamine suppresses this)
  2. 2nd trimester to 2 years post-birth
  3. Prolactin high but no mass, give bromocriptine (dopamine agonist)
  4. 20-40 yo, gynaecomastia, impotence, amenorrhoea, infertility, bitemporal hemianopia
  5. Bromocriptine / surgery
  6. Dopamine antagonists (antipsychotics, domperidone, metoclopramide), female contraceptives, SSRIs, methyldopa, b-blockers, digoxin, spironolactone
  7. Hypothyroid, acromegaly, Cushing’s, PCOS
  8. Liver failure, CKD
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10
Q

Breast cancers - other

  1. Lobular carcinoma in situ (LCIS) = aka
  2. Occurs in who
  3. Symptoms
  4. Management
  5. 30% progress to, + problem with this
  6. Inflammatory - presentation
  7. Prognosis compared to other cancers
  8. Paget’s disease of nipple - presentation
  9. May represent
A
  1. Lobular neoplasia
  2. Pre-menopausal
  3. Asymptomatic, diagnosed incidentally on breast biopsy
  4. 6 monthly examination, yearly mammograms
  5. Invasive lobular carcinoma - not always visible on mammograms
  6. Similar to mastitis / breast abscess but does not respond to ABX - swollen, warm, tender breast with pitting skin (peau d’orange)
  7. Worse
  8. Starts on nipple and spreads to areola - unilateral erythematous, scaly rash, bloody discharge, underlying lump - 2ww
  9. Invasive ductal carcinoma (90%) / DCIS (10%)
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11
Q

Triple assessment

  1. Clinical - suspicious symptoms
  2. Imaging - type if <30 + advantages of this
  3. Type if >30 and advantages of this
  4. Finding in extracapsular ruptured implant
  5. Lump biopsy - assesses for what
  6. Lymph node - if none abnormal found on assessment, do what
  7. Triple negative meaning
A
  1. Hard, irregular, painless, fixed, skin/chest wall tethered, nipple retraction, skin dimpling/oedema (peau d’orange)
  2. USS, distinguishes solid lumps (e.g. fibroadenoma / cancer) from cystic lumps
  3. Mammography, picks up calcifications missed by ultrasound
  4. ‘Snowstorm’ sign on USS of axilliary lymph nodes
  5. ER and HER2 status
  6. Pre-surgery axilliary USS, then sentinel node biopsy
  7. No HER, ER, PR receptors
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12
Q

Breast cancer - management

  1. Wide local excision - indications
  2. Mastectomy - indications
  3. Axilliary clearance - when, side effect
  4. Radiotherapy (3-5 weeks) - type if WLE
  5. Indication if post-mastectomy
  6. ER+ - hormonal therapy
  7. Tamoxifen SEs - higher risk of what (3)
  8. HER2+ - management + contraindication
  9. Side effects of HER2+ management
  10. Chemotherapy - indication
  11. Imaging if neo-adjuvant
  12. Follow-up
A
  1. Solitary, peripheral, small in large breast, DCIS <4cm
  2. Multifocality, local recurrence, DCIS / invasion >4cm
  3. If disease in nodes; risk of chronic lymphoedema
    NOT if isolated tumour cell / ‘micrometastases’
  4. Whole breast - may reduce recurrence by 2/3
  5. T3-T4 tumours / 4+ positive axilliary nodes
  6. Tamoxifen unless post-menopause (then anastrozole, exemestane or letrozole)
  7. Endometrial cancer, VTE, menopausal symptoms
  8. Herceptin (trastuzumab) - not if heart disease
  9. Diarrhoea, tumour pain, headaches
  10. To downstage a primary lesion, or post-surgery if axilliary node disease (FEC-D chemotherapy if hormone negative but node positive)
  11. MRI (before, during, after)
  12. No screening if total mastectomy, yearly for 5 years otherwise, then tailor accordingly
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Medical School (28 decks)

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