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Cancer Care > Breast Malignancy > Flashcards

Breast Malignancy Flashcards

1
Q

When assessing a breast lump what are the key features to assess and describe?

A

Location, size, shape, consistency, tenderness, mobile/fixed, margins (smooth/irregular)

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2
Q

What makes up the triple assessment to exclude or diagnose breast cancer?

A

Clinical assessment (history and examination)
Imaging (mammogram or ultrasound)
Histology (fine needle aspiration or core biopsy)

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3
Q

What are clinical features which may suggest cancer as a cause of a breast lump?

A

Hard, irregular, painless, fixed, nipple retraction, skin dimpling or oedema, lumps tethered to skin or chest wall

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4
Q

Why does skin dimpling occur with breast cancer?

A

Coopers ligaments, which create and support normal breast morphology, retract in response to tumour infiltration which pulls the skin of the breast inwards

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5
Q

Why does nipple inversion or retraction occur with breast cancer?

A

Tumour invasion of the lactiferous ducts behind the nipple shortens them, pulling the nipple into the areola

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6
Q

Why can nipple discharge occur wit breast cancer?

A

Tumour invasion of the lactiferous ducts can enhance ductal secretions

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7
Q

What features of nipple discharge may indicate breast cancer as the cause?

A

If its unilateral, uni-ductal and spontaneous

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8
Q

Why can diffuse breast erythema occur with breast cancer?

A

Tumour cells in dermal layer produce cytokines causing local vasodilation of blood vessels under the skin

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9
Q

Why can we get the clinical sign of peau d’orange with breast cancer?

A

Tumour cells infiltrate and block lymphatic ducts preventing drainage of interstitial fluid

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10
Q

Which patients would be put through a 2 week wait referral for breast cancer?

A

> 30 with an unexplained breast lump, >50 with unilateral nipple changes, >30 with unexplained lump in axilla, skin changes suggestive of breast cancer

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11
Q

What are fibroadenomas?

A

Common benign tumours of the stroma/epithelial breast duct tissue

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12
Q

In what ages are fibroadenomas most common?

A

20-40

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13
Q

What are fibroadenomas like on examination?

A

Painless, firm, smooth, well circumscribed, mobile and up to around 3 cm in diameter

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14
Q

When are fibrocystic breast changes mos likely to occur around menstruation?

A

Within 10 days before menstruation then resolve once menstruation begins

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15
Q

What are fibrocystic breast changes?

A

When the connective tissue of the breast becomes fibrous and cystic in response to oestrogen and progesterone

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16
Q

hat are symptoms of fibrocystic breast changes?

A

Lumpiness of the breast(s), breast pain or tenderness, fluctuation of breast size

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17
Q

How can fibrocystic breast change symptoms be managed?

A

Wearing a supportive bra, NSAIDs, avoiding caffeine, applying heat to the area. Hormonal treatments can be started under specialist guidance (e.g danazol and tamoxifen)

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18
Q

What are breast cysts?

A

benign, fluid filled lumps in the breast. They can be painful and may fluctuate in size over the menstrual cycle

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19
Q

When are breast cysts most common?

A

Between the ages of 20 and 50, more so in the perimenopausal period

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20
Q

What are breast cysts like on examination?

A

Smooth, mobile, well circumscribed and possibly fluctuant

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21
Q

What investigations and management is required for breast cysts?

A

Imaging with potential fine needle aspiration or excision to rule out cancer. Aspiration may resolve symptoms

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22
Q

Do fibroadenomas, fat necrosis or breast cysts increase the risk of breast cancer?

A

Fibroadenomas= no
Fat necrosis= no
Cysts= may slightly increase the risk

23
Q

What causes fat necrosis?

A

Localised degeneration and scarring of fat tissue of the breast often triggered by an inflammatory reaction because of localised trauma, radiotherapy or surgery

24
Q

How may fat necrosis appear on examination?

A

Painless, firm, irregular, can be fixed in local structures,there may be skin dimpling or nipple inversion

25
Q

What investigations are carried out for suspected fat necrosis?

A

Imaging will often give similar appearance to breast cancer so histology may be required to confirm the diagnosis

26
Q

What are lipomas?

A

Benign tumours of adipose tissue

27
Q

On examination, what are lipomas like?

A

Soft, mobile, painless and do not cause skin changes

28
Q

How are lipomas treated?

A

Typically conservatively with reassurance but occasionally can be removed surgically

29
Q

What are galactocoeles?

A

Breast milk filled cysts occuring when there is blockage of the lactiferous ducts in lactating women

30
Q

What is a phyllodes tumour?

A

Rare tumour of the connective tissue of the breast, which are large and fast growing. Most commonly occuring between ages 40-50

31
Q

Are phyllodes tumours malignant?

A

25% can be malignant, with another 25% being borderline and 50% being benign

32
Q

What is a carcinoma in situ?

A

Pre-malignant within the basement membrane

33
Q

How are carcinomas in situ usually diagnosed?

A

Through imaging as usually are asymptomatic

34
Q

What is the most common type of non-invasive breast cancer?

A

DCIS

35
Q

What is the management of DCIS?

A

Surgical excision with wide local excision but mastectomy may be needed if widespread or multi focal DCIS

36
Q

How does DCIS appear on imaging?

A

Microcalcifications on mammogram which can be localised or widespread

37
Q

Which of DCIS or LCIS is more likely to become invasive and be diagnosed pre-menopause?

A

LCIS

38
Q

Why are LCIS harder to detect?

A

They dont appear as microcalcification on X-ray like DCIS often diagnosed as incidental finding on biopsy

39
Q

How do we manage LCIS?

A

If low grade, LCIS is monitored. Prophylactic bilateral mastectomy potentially in BRCA1/2 patients

40
Q

What are the different types of invasive breast cancer?

A

Ductal carcinoma (85%)
Lobular carcinoma (10%)
Other

41
Q

What are some risk factors for breast cancer?

A

Female, increasing age, BRCA mutations, obesity, prolonged oestrogen exposure, family history

42
Q

What are factors influencing oestrogen exposure?

A

Early menarche, late menopause, nulliparity, >5 years of HRT

43
Q

What is current screening program for breast cancer?

A

Mammogram every 3 years for women 50-70

44
Q

How does Paget’s disease present?

A

Roughened, thick, itchy, flaky, red, ulceration of the nipple

45
Q

What is one way to differentiate eczema and Paget’s disease?

A

Eczema does not affect the nipple just the areola, Paget’s disease also affects nipple

46
Q

What is wide local excision and when is it done?

A

Breast conserving surgery to remove localised disease with 1 cm microscopically clear margin.

47
Q

How are axillary surgeries done for breast cancer?

A

Injection of blue dye and radioisotope to identify sentinel node- remove and send for histology. If malignant change seen then may do axillary node clearance

48
Q

Which medication blocks oestrogen receptor and is given to pre-menopausal women with ER+ Breast Ca?

A

Tamoxifen

49
Q

What are two main side effects of tamoxifen?

A

Incresed risk of Thromboembolic events and may cause endometrial thickening increasing risk of endometrial cancer

50
Q

How does anastrozole work? Who is it given to?

A

Block oestrogen receptors and reduces production of oestrogen
Given to post-menopausal women with breast Ca

51
Q

What is herceptin?

A

Drug used in breast cancer than internalises HER-2 receptor to reduce this triggering growth

52
Q

What is a therapeutic mammoplasty?

A

WLE and breast reduction followed by reconstruction. Gives smaller, uplifted breasts and areola moved to better suited position

53
Q

What is a flap formation in breast surgery?

A

Uses a piece of muscle and its skin to reconstruct breast that has been removed

Cancer Care (10 decks)

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