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Breast > Breast - malignant > Flashcards

Breast - malignant Flashcards

1
Q

What is triple assessment

A

clinical assessment
Imaging assessment
Needle biopsy

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2
Q

What is the lifetime risk of breast ca`

A

1/8

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3
Q

What are the key features of a breast history

A 
Lump
Pain
Discharge
Menstrual history
Obstetric history
PMH
FH
Contraception
Smoking and alcohol
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4
Q

What things do you ask in a menstrual history

A

LMP
age of menarche
age of menoapuse

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5
Q

What things do you ask in a obstetric history

A

parity
age of first baby
breast feeding

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6
Q

What are the risk factors for breast cancer

A 
Ductal ca in situ
increasing age
older age at first child/menopause/ nulliparity
earlier menarche
FH
Oral contraceptives/HRT
post menopausal obesity
Jewish ancestry
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7
Q

What should you look for in a breast exam

A 
lump
assymetry
change in shape or size
inverted/retracted nipple
nipple discharge
erythema
swellings in armpits
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8
Q

What does peau d’orange suggest

A

Paget’s disease

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9
Q

What are the surgical options for breast cancer

A

radical mastectomy: breast, mm, axillary nodes
msatectomy
lumpectomy
Adjuvent chemotherapy

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10
Q

when can tamoxifen be given

A

if oestrogen receptor positive

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11
Q

When can Herceptin be given

A

If HER2 rceptor positive

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12
Q

What is a sentinel lymph node biopsy

A

First axillar node on pathyway is taken out, if negative can leave the rest in, if positive, full axillary clearance

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13
Q

What is Pagets disease

A

Intradermal spread of an intraductal carcinoma

looks like eczema aorund the nipple

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14
Q

What are the investigations and management of Pagets disease

A

Biopsy
breast conserving surgery and radiotherapy
Sentinel node biopsy

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15
Q

How do you describe a lump

A 
Site
Size
shape
Surface Edge: ill defined e.g 
Consistency: rubbery, soft, sponge, hard
Temperature
Mobility
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16
Q

At what age does breast screening take place

A

47-73

17
Q

What are the advantages of breast screening

A

Decreases the amount of women DYING of breast cancer

18
Q

What proportion of women are recalled vs what % are diagnosed with breast cancer

A

20% recalled

of that 20%. 25% diagnosed with breast cancer

19
Q

What are the disadvantages of breast screening

A
  • 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
20
Q

What advice do you give women prior to a mammogram

A
  • undress from waist down
  • avoid talc/deodorant: can cause artefacts
  • All screeners are female
    All scans read by 2 people independently
21
Q

What are Microcalcifications

A

Small specks of calcium salts that develop naturally as breasts age. they’re too small to feel and are painless

22
Q

What are the causes of microcalfications

A
  • 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
23
Q

What is ductal carcinoma in situ

A

Cancer cells have formed within the milk ducts but have not invaded through the basement membrane into the surrounding breast tissue

24
Q

What does ductal carcinoma in situ look like

A

Linear branching pattern of milk duct as necrotic cancer cells in centre of the duct often calcify

25
Q

What histology might you see in ductal carcinoma in situ

A

Pleomorphic nuclei
Calcification
comedo necrosis
intact BM

26
Q

What is BRCA1 & BRCA2

A

Genes that produce tumour supressor genes which help repaid damaged DNA

27
Q

How is BRCA1 & BRCA2 inherited

A

autosomal dominant

28
Q

What Cr is BRCA 1 associated with and what is the lifetime risk of CA

A
  • Cr 17
  • 72% lifetime risk
  • 44% lifetime ovarian risk
29
Q

What Cr is BRCA 6 associated with and what is the lifetime risk of CA

A
  • Cr 13
  • 69% lifetime risk
  • 17% risk of ovarian
30
Q

How do we manage cancer risk with BRCA

A
  • early detection: annual MRI and mammogram from 40
  • Risk reducing mastectomy/oopherectomy (decreases change by 90%)
  • risk reducing tamoxifen

Breast (2 decks)

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