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Phase 3A Conditions > Breast key facts > Flashcards

Breast key facts Flashcards

1
Q

What is triple assessment of a breast lump?

A

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

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2
Q

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

A
  • An unexplained breast lump in a patient over 30.
  • Unilateral nipple changes in patient aged 50 or above (including nipple discharge).
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3
Q

When is a non-urgent referral warranted?

A

Under 30 with an unexplained breast lump.

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4
Q

How does a fibroadenoma present?

A

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

Not cancerous.

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5
Q

How does fibrocystic breast changes present?

A

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

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6
Q

What is the management for fibrocystic breast changes?

A

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

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7
Q

How do breast cysts present?

A

Individual fluid filled lumps.

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

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8
Q

What investigations are required for breast cysts?
Treatment?

A

Imaging to check cancer.
Excision/aspiration to treat.

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9
Q

What is the most common cause of breast lumps?

A

breast cysts

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10
Q

What commonly triggers fat necrosis of the breast?

A

Localised trauma, radiotherapy or surgery.

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11
Q

How does fat necrosis present?

A

Similar to cancer:

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

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12
Q

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

A

Aspiration/biopsy with histology.

Imaging is often inconclusive.

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13
Q

How does lipoma of the breast present?

A

Benign tumour of fat.

Soft
Painless
Mobile
No skin changes

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14
Q

What is the management for a lipoma?

A

Conservative and reassurance.

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15
Q

When does a galactocele occur?

A

Women that are lactating after stopping breastfeeding.

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

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16
Q

How does a galactocele present?

A

Firm
Mobile
Painless
(usually beneath the areola)

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17
Q

What is the management for a galactocele?

A

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

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18
Q

What is a phyllodes tumour?

A

Rare tumour of the connective tissue of the breast.

Large and fast growing.

19
Q

How is a phyllodes tumour treated?

A

Surgical excision and potentially chemotherapy if malignant/metastatic.

20
Q

What is mammary duct ectasia?

A

Dilation of the large ducts in the breasts.

21
Q

How does mammary duct ectasia present?

A

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

22
Q

What investigations should be done in suspected mammary duct ectasia?

A

Triple assessment.

23
Q

What is the management for mammary duct ectasia?

A

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

24
Q

How does intraductal papilloma present?

A

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

25
Q

What is the investigation for intraductal papilloma?

A

Triple assessment.

26
Q

What is the management for intraductal papilloma?

A

Complete surgical excision with analysis for cancer of excised tissue.

27
Q

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

A

Scaling of the nipple and/or areola.
Erythema
Pruritis

(like eczema)

28
Q

What is pagets disease of the nipple a sign of?

A

Underlying malignancy.

29
Q

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

A

Excision.

30
Q

What are the indications for a mastectomy?

A
  • 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).
31
Q

When is lymph node clearance used?

A

If the patient is known to have lymph node involvement.

32
Q

What is the mainstay treatment for oestrogen sensitive breast cancer?

A

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

33
Q

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

A

Tamoxifen.

34
Q

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

A

Aromatase inhibitors.
Exemestane
Letrozole
Anastrozole.

35
Q

What is the treatment for HER2 expressing breast cancer?

A

Trastuzumab.

Add pertuzumab for high risk bode positive HER2 breast cancer.

36
Q

What is ductal carcinoma in situ?

A

Pre-malignant condition.

Usually asymptomatic and detected on breast screening (microcalcifications).

37
Q

What is the management for ductal carcinoma in situ?

A

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

38
Q

How does HRT affect breast cancer risk?

A

Both combined and oestrogen only HRT increase breast cancer risk.

Oestrogen only HRT increases breast cancer risk more.

39
Q

What is mastitis? How does it present?

A

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.

40
Q

What is the management for puerperal mastitis?

A

Continue breastfeeding.
Analgesia.

41
Q

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?

A

Breast abscess.

Treat with incision and drainage.

42
Q

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

A

-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

43
Q

How does TNM staging work?

A

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.

Phase 3A Conditions (13 decks)

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