Breast - malignant Flashcards
What is triple assessment
clinical assessment
Imaging assessment
Needle biopsy
What is the lifetime risk of breast ca`
1/8
What are the key features of a breast history
Lump Pain Discharge Menstrual history Obstetric history PMH FH Contraception Smoking and alcohol
What things do you ask in a menstrual history
LMP
age of menarche
age of menoapuse
What things do you ask in a obstetric history
parity
age of first baby
breast feeding
What are the risk factors for breast cancer
Ductal ca in situ increasing age older age at first child/menopause/ nulliparity earlier menarche FH Oral contraceptives/HRT post menopausal obesity Jewish ancestry
What should you look for in a breast exam
lump assymetry change in shape or size inverted/retracted nipple nipple discharge erythema swellings in armpits
What does peau d’orange suggest
Paget’s disease
What are the surgical options for breast cancer
radical mastectomy: breast, mm, axillary nodes
msatectomy
lumpectomy
Adjuvent chemotherapy
when can tamoxifen be given
if oestrogen receptor positive
When can Herceptin be given
If HER2 rceptor positive
What is a sentinel lymph node biopsy
First axillar node on pathyway is taken out, if negative can leave the rest in, if positive, full axillary clearance
What is Pagets disease
Intradermal spread of an intraductal carcinoma
looks like eczema aorund the nipple
What are the investigations and management of Pagets disease
Biopsy
breast conserving surgery and radiotherapy
Sentinel node biopsy
How do you describe a lump
Site Size shape Surface Edge: ill defined e.g Consistency: rubbery, soft, sponge, hard Temperature Mobility
At what age does breast screening take place
47-73
What are the advantages of breast screening
Decreases the amount of women DYING of breast cancer
What proportion of women are recalled vs what % are diagnosed with breast cancer
20% recalled
of that 20%. 25% diagnosed with breast cancer
What are the disadvantages of breast screening
- mammograms are uncomfy
- small amounts of radiation (2 months background)
- False positives/false negatives
- Cancer may occur in interval of screening
- May diagnose a cancer that doesn’t need treating
What advice do you give women prior to a mammogram
- undress from waist down
- avoid talc/deodorant: can cause artefacts
- All screeners are female
All scans read by 2 people independently
What are Microcalcifications
Small specks of calcium salts that develop naturally as breasts age. they’re too small to feel and are painless
What are the causes of microcalfications
- occur naturally as breast age
- Seen in assoc with benigng changes e.g fibroadenoma
- Can occur in response to trauma or surgery
- If in milk ducts ? DCIS
What is ductal carcinoma in situ
Cancer cells have formed within the milk ducts but have not invaded through the basement membrane into the surrounding breast tissue
What does ductal carcinoma in situ look like
Linear branching pattern of milk duct as necrotic cancer cells in centre of the duct often calcify
