Breast key facts Flashcards by Tom Neild

What is triple assessment of a breast lump?

Clinical examination
Imaging (USS or mammography)
Histology (biopsy or fine needle aspiration)

How well did you know this?

Not at all

Perfectly

What is the criteria for a 2ww referral for breast cancer?

An unexplained breast lump in a patient over 30.
Unilateral nipple changes in patient aged 50 or above (including nipple discharge).

How well did you know this?

Not at all

Perfectly

When is a non-urgent referral warranted?

Under 30 with an unexplained breast lump.

How well did you know this?

Not at all

Perfectly

How does a fibroadenoma present?

Younger women (pre-menopause):
Painless
Smooth
Round
Well defined borders
Mobile

Not cancerous.

How well did you know this?

Not at all

Perfectly

How does fibrocystic breast changes present?

Generalised lumpiness to one or both breasts.
Cyclical breast pain.
Fluctuations in breast size.

How well did you know this?

Not at all

Perfectly

What is the management for fibrocystic breast changes?

Supportive bra
NSAIDs
Avoid caffeine.
Apply heat to the area.

How well did you know this?

Not at all

Perfectly

How do breast cysts present?

Individual fluid filled lumps.

Smooth
Well defined borders
Mobile
Possibly fluctuate in size over menstrual period.

How well did you know this?

Not at all

Perfectly

What investigations are required for breast cysts?
Treatment?

Imaging to check cancer.
Excision/aspiration to treat.

How well did you know this?

Not at all

Perfectly

What is the most common cause of breast lumps?

breast cysts

How well did you know this?

Not at all

Perfectly

What commonly triggers fat necrosis of the breast?

Localised trauma, radiotherapy or surgery.

How well did you know this?

Not at all

Perfectly

How does fat necrosis present?

Similar to cancer:

Painless
Firm
Irregular
Fixed to local structure
May be skin dimpling or nipple inversion

How well did you know this?

Not at all

Perfectly

What is needed to confirm diagnosis of fat necrosis and exclude breast cancer?

Aspiration/biopsy with histology.

Imaging is often inconclusive.

How well did you know this?

Not at all

Perfectly

How does lipoma of the breast present?

Benign tumour of fat.

Soft
Painless
Mobile
No skin changes

How well did you know this?

Not at all

Perfectly

What is the management for a lipoma?

Conservative and reassurance.

How well did you know this?

Not at all

Perfectly

When does a galactocele occur?

Women that are lactating after stopping breastfeeding.

Lactiferous duct is blocked, causing a breast milk filled cyst.

How well did you know this?

Not at all

Perfectly

How does a galactocele present?

Firm
Mobile
Painless
(usually beneath the areola)

How well did you know this?

Not at all

Perfectly

What is the management for a galactocele?

Usually conservative, but can be drained with a needle if required.

How well did you know this?

Not at all

Perfectly

What is a phyllodes tumour?

Rare tumour of the connective tissue of the breast.

Large and fast growing.

How is a phyllodes tumour treated?

Surgical excision and potentially chemotherapy if malignant/metastatic.

What is mammary duct ectasia?

Dilation of the large ducts in the breasts.

How does mammary duct ectasia present?

Nipple discharge (white, grey or green)
Tenderness or pain
Nipple retraction or inversion.
Breast lump.

What investigations should be done in suspected mammary duct ectasia?

Triple assessment.

What is the management for mammary duct ectasia?

Reassurance with symptomatic management (supportive bra, warm compress)
Abx if infection suspected.

How does intraductal papilloma present?

Clear or blood-stained nipple discharge.
Tenderness or pain
A palpable lump.

What is the investigation for intraductal papilloma?

Triple assessment.

What is the management for intraductal papilloma?

Complete surgical excision with analysis for cancer of excised tissue.

What are the key signs of paget's disease of the nipple?

Scaling of the nipple and/or areola. Erythema Pruritis (like eczema)

What is pagets disease of the nipple a sign of?

Underlying malignancy.

What is the treatment for Paget's disease of the nipple?

Excision.

What are the indications for a mastectomy?

- Patient choice - Large volume of tumour (20% or more without reconstruction, 50% or more with reconstruction) - Multifocal (more than one lesion in the same quadrant) - Multicentric (Disease in multiple quadrants of the breast) - Failed conservative surgery - BRCA gene (bilateral mastectomy as prophylaxis) - Inflammatory breast cancer with red and oedematous breast).

When is lymph node clearance used?

If the patient is known to have lymph node involvement.

What is the mainstay treatment for oestrogen sensitive breast cancer?

Hormonal therapy - all women with oestrogen sensitive breast cancer are offered hormonal therapy for 5 or more years.

What is the first line hormonal therapy for breast cancer in pre-menopausal women?

Tamoxifen.

What is first line hormonal treatment for breast cancer in post-menopausal women?

Aromatase inhibitors. Exemestane Letrozole Anastrozole.

What is the treatment for HER2 expressing breast cancer?

Trastuzumab. Add pertuzumab for high risk bode positive HER2 breast cancer.

What is ductal carcinoma in situ?

Pre-malignant condition. Usually asymptomatic and detected on breast screening (microcalcifications).

What is the management for ductal carcinoma in situ?

Wide excision and radiotherapy, or mastectomy if more extensive disease.

How does HRT affect breast cancer risk?

Both combined and oestrogen only HRT increase breast cancer risk. Oestrogen only HRT increases breast cancer risk more.

What is mastitis? How does it present?

Inflammation of the breast associated with post-partum women. Key signs are localised pain, tenderness, redness and hear in the breast. Can also cause fever/headache.

What is the management for puerperal mastitis?

Continue breastfeeding. Analgesia.

If a patient has an episode of mastitis that is unresolved by abx what is the likely progression? What is the management for a breast abscess?

Breast abscess. Treat with incision and drainage.

What family history warrants referral to a specialist genetics or breast clinic even in asymptomatic women?

-Breast cancer in a first-degree male relative. -Breast cancer in a first-degree relative under the age of 40 -Bilateral breast cancer in a first-degree relative under the age of 50 -Breast cancer in two first-degree relatives

How does TNM staging work?

T1 - less than 2cm T2 - less than 5cm T3 - bigger than 5cm T4 - Spread into other tissues. N0 - no lymph nodes N1 - less than 4 lymph nodes N2 - 4-9 lymph nodes N3 - 10+ lymph nodes M0 - no metastasis M1 - metastasis found.