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3a Women's Health > Breast Medicine > Flashcards

Breast Medicine Flashcards

1
Q

What is a fibroadenoma of the breast?

A

Benign breast tumour consisting of stromal + epithelial cells breast duct tissue
* Young women
* Well circumscribed (well-defined borders) mobile mass
* Round, smooth, painless

  • Respond to female hormones (oestrogen + progesterone) → why they are more common in young women
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2
Q

How do breast cysts clinically present?

A

Benign, individual, fluid-filled lumps
* Can be painful
* Size may fluctuate over menstrual cycle

O/E:
* Smooth
* Well-circumscribed
* Mobile
* Possibly fluctuant

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3
Q

Ix + management of breast cyst

A

Ix: Imagining (USS or mamogram (dependent on age) - to exclude cancer

Management:
* Aspiration (can resolve pain)
* Excision

Having a breast cyst may slightly increase the risk of breast cancer.

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4
Q

What is a lipoma and how do they oresent O/E?

A

Lipoma = benign tumours of fat (adipose) tissue

O/E:
* Soft
* Painless
* Mobile
* No skin changes

Management:
* Reassurance (conservatively)
* Surgical removal

Lipomas can occur anywhere in the body where there is adipose tissue

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5
Q

What are fibrocystic breast changes?
(Previously called fibrocystic breast disease)

A
  • Benign
    The connective tissues (stroma) + ducts + lobules of the breast = respond to oestrogen + progesterone → becoming fibrous (irregular + hard) + cystic (fluid-filled)
  • Changes fluctuate with the menstrual cycle
  • Common in menstruating women
  • Symptoms often occur prior to menstruating (within 10 days) and resolve once menstruation begins.
  • Symptoms usually improve or resolve after menopause

Fibrocystic breast changes + generalised lumpiness to the breast = normal variation (not disease)

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6
Q

Symptoms of fibrocystic breast changes

A

Symptoms can affect different areas of the breast, or both breasts, with:
* Lumpiness
* Breast pain or tenderness (mastalgia)
* Fluctuation of breast size

Varies in severity + can significantly affect a patient’s quality of life if severe

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7
Q

Management for fibrocystic breast changes

A

Exclude cancer

Options to manage cyclical breast pain (mastalgia) include:
Wearing a supportive bra
* Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
* Avoiding caffeine
* Applying heat to the area
* Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance

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8
Q

What is fat necrosis of the breast?

A

Fat necrosis = causes a benign lump formed by localised degeneration + scarring of fat tissue in the breast.

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9
Q

What can trigger fat necrosis in the breast?

A

Fat necrosis = may be associated with an oil cyst

Triggers:
* Localised trauma
* Radiotherapy
* Surgery

….with an inflammatory reaction → resulting in fibrosis + necrosis (death) of fat tissue

Fat necrosis = does not increase risk of Breast Ca

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10
Q

How does fat necrosis in the breast present on O/E?

A
  • Painless
  • Firm
  • Irregular
  • Fixed in local structures
  • May be skin dimpling or nipple inversion
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11
Q

Ix for fat necrosis in breast

A
  • Ultrasound or mammogram = can show a similar appearance to breast cancer.
  • Histology (by fine needle aspiration or core biopsy) = may be required to confirm the diagnosis and exclude breast cancer.
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12
Q

Management for fat necrosis of breast

A

Exclude cancer

  • Usually conservatively → resolves spontaneously
  • Surgical excision if symptomatic
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13
Q

What is a galactocele?

A
  • Benign
  • Galactoceles = occur in breastfeeding women - usually when they’ve stopped breasfeeding
  • Galactoceles = lactiferous duct becomes blocked → breast milk filled cyst → prevents gland from draining milk
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14
Q

How do galactoceles present?

A
  • Firm
  • Mobile
  • Painless
  • Usually beneath the areola
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15
Q

Management for galactocele

A
  • Usually resolve without treatment
  • Drain with needle
  • Rarely become infected → require Abx
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16
Q

What is a Phyllodes tumour?

A

Phyllodes tumour = rare tumours of connective tissue (stroma) of breast
* Large + fast-growing

They can be:
* Benign (~50%)
* Borderline (~25%)
* Malignant (~25%).

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17
Q

What age do Phyllodes tumour usually occur in?

A

40-50

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18
Q

Management of Phyllodes tumour

A
  • Surgical excision of tumour + surrounding tissue (‘wide excision’)
  • Chemotherapy (if malignant or metastatic)

Phyllodes tumour can reoccur after removal

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19
Q

An obese 26-year-old woman is involved in a car accident and injures her right breast. Once this initial injury heals, she develops a firm lump within the breast tissue at the trauma site. What diagnosis would a biopsy show?

A

Fat necrosis

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20
Q

A 28-year-old woman presents to her GP having noticed a lump in her left breast. She is otherwise asymptomatic, with no constitutional symptoms. On examination, she has a smooth, mobile lump in her left breast measuring ~1cm x 1cm. Diagnosis?

A

Fibroadenoma

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21
Q

Investigations for fibroadenoma

A
  • Mammogram: well-circumscribed, oval hypodense or isodense mass, may contain calcifications
  • Breast ultrasound: well-circumscribed, round to ovoid, or macrolobulated mass with generally uniform hypoechogenicity
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22
Q

Management for fibroadenoma

A
  • Resolve spontaneously

Large or for cosmetic reasons → surgery:
* Lumpectomy: surgical removal of the fibroadenoma
* Cryoablation : cryoprobe used to freeze and destroy the fibroadenoma

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23
Q

Pathophysiology of fibroadenoma

A
  • Arise from proliferation of stromal + epithelial connective tissue cells within the breast tissue
  • These tissues = rich in receptors for oestrogen + proliferation → can therefore proliferate significantly during pregnancy
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24
Q

What is an intraductal papilloma?

A
  • Intraductal papilloma = warty lesion that grows within a breast duct - as a result of proliferation of epithelial cells
  • Intraductal papillomas = benign tumours (but can be associated with atypical hyperplasia or breast cancer)
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25
Q

How does an intraductal papilloma present?

A

Typically asymptomatic
Occur at any age - typically 35-55 years

  • Nipple discharge (clear or blood-stained)
  • Tenderness or pain
  • A palpable lump
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26
Q

Ix for an intraductal papilloma

A

Patients require triple assessment with:
* Clinical assessment (history and examination)
* Imaging (ultrasound, mammography and MRI)
* Histology (usually by core biopsy or vacuum-assisted biopsy)

Ductography = may also be used
This involves injecting contrast into the abnormal duct and performing mammograms to visualise that duct. The papilloma will be seen as an area that does not fill with contrast (a “filling defect”).

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27
Q

Management for an intraductal papilloma

A

Complete surgical excision
After removal, the tissue is examined for atypical hyperplasia or cancer that may not have been picked up on the biopsy.

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28
Q

What is a breast abscess?

A

Collection of pus within the area of the breast - usually caused by a bacterial infection

  • Lactational abscess (associated with breastfeeding)
  • Non-lactational abscess (unrelated to breastfeeding)
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29
Q

Which type of breast abscess is associated with breastfeeding?

A

Lactational abscess

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30
Q

What does pus contained?

A

Dead white blood cells
Pus = a thick fluid produced by inflammation.

It contains dead white blood cells of the immune system and other waste from the fight against the infection. When pus becomes trapped in a specific area and cannot drain, an abscess will form and gradually increase in size.

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31
Q

What is mastitis?

A

Mastitis = inflammation of breast tissue
* Often related to breastfeeedimg (lactational mastitis) - although can be caused by infection

  • Bacteria can enter at the nipple and back-track into the ducts, causing infection and inflammation.
  • Mastitis caused by infection = may precede the development of an abscess
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32
Q

What lifestyle factor is a key risk factor for infective mastitis + breast abscesses?

A

Smoking

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33
Q

Name some instances that can increase the risk of breast abscesses

A

Damage to the nipple:
* Nipple eczema
* Candidal infectiom
* Piercings

Underlying breast disease:
* Cancer
(Can affect the drainage of the breast - prepdisposing it to infection)

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34
Q

What are some causative bacteria for breast abscesses?

A
  • Staphylococcus aureus (the most common)
  • Streptococcal species
  • Enterococcal species
  • Anaerobic bacteria (such as Bacteroides species and anaerobic streptococci)
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35
Q

Staph aureus, streptococcal and enterococcal bacteria = gram-positive bacteria → so what group of antibiotics are likely to be effective?

A

Penicillins

Flucloxacillin = used against staph aureus skin infections

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36
Q

What antibiotics are effective against anaeorbic bacteria?

A
  • Co-amoxiclav (plus clavulanic acid)
  • Metronidazole

Simple penicillins (amoxicillin or flucloxacillin) = wont work

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37
Q

What is the nature of the onset of mastitis or breast abscess?

A

Usually acute (a few days)

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38
Q

How does mastitis with infection present?

A
  • Nipple changes
  • Purulent nipple discharge (pus from the nipple)
  • Localised pain
  • Tenderness

General inflammation:
* Warmth
* Erythema (redness)
* Hardening of the skin or breast tissue
* Swelling

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39
Q

What are the key features of a breast abscess?

A

Swollen, fluctuant, tender lump within the breast

Fluctuance = being able to move fluid around within the lump using pressure during palpation.

Where there is infection without an abscess, there can still be hardness of the tissue, forming a lump, but it will not be fluctuant as it is not filled with fluid.

40
Q

What is the key difference between an infection in the breast with an abscess and without an abscess?

A

Abscess → fluctuance around the hard lump

Where there is infection without an abscess, there can still be hardness of the tissue, forming a lump, but it will not be fluctuant as it is not filled with fluid.

41
Q

What are the general signs/symptoms in someone with an infection within the breast?

A
  • Muscle aches
  • Fatigue
  • Fever
  • Signs of sepsis (e.g., tachycardia, raised respiratory rate and confusion)
42
Q

Management for lactational mastitis

A

Lactational mastitis = caused by blockage of the ducts

Conservative management:
* Continued breastfeeding, expressing milk, breast massage
* Heat packs, warm showers, simple analgesia

Antibiotics (flucloxacillin or erythromycin/clarithromycin (penicillin allergy)) = required where infection is suspected or symptoms do not improve

43
Q

Management for non-lactational mastitis

A
  • Analgesia
  • BROAD-SPECTRUM ANTIBIOTICS (co-amoxiclav; or erythromycin/clarithromycin + metronidazole)
  • Treatment for underlying cause (e.g. eczema or candidal infection)

Erythromycin/clarithromycin (macrolides)
Metronidazole (to cover anaerobes)

44
Q

Management of a breast abscess

A
  • Referral to the on-call surgical team in the hospital for management
  • Antibiotics
  • Ultrasound (confirm the diagnosis and exclude other pathology)
  • Drainage (needle aspiration or surgical incision and drainage)
  • Microscopy, culture and sensitivities of the drained fluid

Women who are breastfeeding are advised to continue breastfeeding when they have mastitis or breast abscesses. They should regularly express breast milk if feeding is too painful, then resume feeding when possible. This is not harmful to the baby and is important in helping resolve the mastitis or abscess

45
Q

What is mammary duct ectasia?

A

Mammary duct ectasia = benign condition - there is dilation of the large ducts in the breasts

Ectasia = dilation
There is inflammation in the ducts → leading to intermittent discharge from the nipple → white, grey, or green discharge

46
Q

When does mammary duct ectasia frequently occur?

A

Perimenopausal women

47
Q

What is a significant risk factor of mammary duct ectasia?

A

Smoking

Smoking is very bad for boobs!

48
Q

How does mammary duct ectasia present?

A
  • Nipple discharge (white, grey, green)
  • Tenderness or pain
  • Nipple retraction or inversion
  • A breast lump (pressure on the lump may produce nipple discharge)
49
Q

Ix for mammary duct ectasia

A

Priority is to exclude breast cancer (as they can present in similar ways)

  • Clinical assessment (history and examination)
  • Imaging (ultrasound, mammography and MRI)
  • Histology (fine needle aspiration or core biopsy)

Microcalcifications = are found on the mammogram (but no specific to mammary duct ectasia)

Other investigations:
* Ductography – contrast is injected into an abnormal duct, and mammograms are performed to visualise the duct
* Nipple discharge cytology – examining the cells in a sample of the nipple discharge
* Ductoscopy – inserting a tiny endoscope (camera) into the duct

50
Q

Management for mammary duct ectasia

A

May resolve without any treatment
* Reassurance
* Symptomatic management of mastalgia (supportice bra + warm compress)
* Antibiotics (if infected)
* Surgical excision (microdochectomy) - may be required in problematic cases

51
Q

Ix for mastitis or beast abscess

A

Normally clinical diagnosis

Investigations to consider:
* Breast ultrasound: used to confirm breast abscess

52
Q

Management for lactational mastitis

A
  • Effective milk removal (encourage breastfeeding)
  • Antibiotics: Flucloxacillin = first-line
53
Q

Management for non-lactational mastitis

A
  • First-line: co-amoxiclav
  • Analgesia
  • Hot compress
54
Q

Management for breast abscess

A

Refer urgently to surgeons: for confirmation of diagnosis by ultrasound and drainage of the abscess (by ultrasound-guided aspiration or incision and drainage)

55
Q

Complications of mastitis

A
  • Cessation of breastfeeding → increased risk of **breast abscess **
  • Emotional distress
  • Sepsis (immunocomprised patients are at higher risk)
56
Q

A 60-year-old female presents to the GP with a two-month history of a lump in the right breast with associated skin tethering. Her last screening mammogram was normal. She is currently on HRT and her mother was treated for breast cancer. Possible diagnosis?

A

Breast cancer

57
Q

Risk factors for breast cancer

A
  • Female (99% of breast cancers)
  • Increased oestrogen exposure (earlier onset of periods and later menopause)
  • More dense breast tissue (more glandular tissue)
  • Obesity
  • Smoking
  • Family history (first-degree relatives)

The combined contraceptive pill = gives a small increase in the risk of breast cancer, but the risk returns to normal ten years after stopping the pill

Hormone replacement therapy (HRT) = increases the risk of breast cancer, particularly combined HRT (containing both oestrogen and progesterone).

MORE OESTROGEN EXPOSURE THROUGHOUT LIFE

58
Q

Info: Genetics and breast cancer

A

BRCA = refers to the BReast CAncer gene.
* BRCA genes = tumour suppressor genes
* Mutations in these genes lead to an increased risk of breast cancer (as well as ovarian and other cancers).

The BRCA1 gene is on chromosome 17. In patients with a faulty gene:
* Around 70% will develop breast cancer by aged 80
* Around 50% will develop ovarian cancer
* Also increased risk of bowel and prostate cancer

The BRCA2 gene is on chromosome 13. In patients with a faulty gene:
* Around 60% will develop breast cancer by aged 80
* Around 20% will develop ovarian cancer

There are other rarer genetic abnormalities associated with breast cancer (e.g., TP53 and PTEN genes).

59
Q

What type of cancer are 99% of breast cancers?

A

Adenocarcinomas

60
Q

How are breast cancers classified?

A

Site: ductal or lobular
Invasion of basement membrane (BM) :
* In-situ: no invasion of the BM
* Invasive: invasion of the BM

61
Q

Info: Ductal Carcinoma In Situ (DCIS)

A
  • ** Pre-cancerous** or cancerous epithelial cells of the breast ducts
  • Localised to a single area
  • Often picked up by mammogram screening
  • Potential to spread locally over years
  • Potential to become an invasive breast cancer (around 30%)
  • Good prognosis if full excised and adjuvant treatment is used
62
Q

Info: Lobular Carcinoma In Situ (LCIS)

A
  • A pre-cancerous condition occurring typically in pre-menopausal women
  • Usually asymptomatic and undetectable on a mammogram
  • Usually diagnosed incidentally on a breast biopsy
  • Represents an increased risk of invasive breast cancer in the future (around 30%)
  • Often managed with close monitoring (e.g., 6 monthly examination and yearly mammograms)
63
Q

Info: Invasive Ductal Carcinomas - NST

NST means no special/specific type, where it is not more specifically classified (e.g., medullary or mucinous)

A
  • NST means no special/specific type, where it is not more specifically classified (e.g., medullary or mucinous)
  • Also known as invasive breast carcinoma of no special/specific type (NST)
  • Originate in cells from the breast ducts
  • 80% of invasive breast cancers fall into this category
  • Can be seen on mammograms
64
Q

Info: Invasive Lobular Carcinomas (ILC)

A
  • Around 10% of invasive breast cancers
  • Originate in cells from the breast lobules
  • Not always visible on mammograms
65
Q

Info: Inflammatory breast cancer

A
  • 1-3% of breast cancers
  • Presents similarly to a breast abscess or mastitis
  • Swollen, warm, tender breast with pitting skin (peau d’orange)
  • Does not respond to antibiotics
  • Worse prognosis than other breast cancers
66
Q

Info: Paget’s disease of the nipple

A
  • Looks like eczema of the nipple/areolar
  • Erythematous, scaly rash
  • Indicates breast cancer involving the nipple
  • May represent DCIS or invasive breast cancer
  • Requires biopsy, staging and treatment, as with any other invasive breast cancer
67
Q

Types of breast cancer

A
  • Ductal Carcinoma In Situ (DCIS)
  • Lobular Carcinoma In Situ (LCIS)
  • Invasive Ductal Carcinoma - NST
  • Invasive Lobular Carcinoma (ILC)
  • Inflammatory Breast Cancer
  • Paget’s Disease of the Nipple
68
Q

Categorised risk factors for breast cancer

A

Endogenous vs exogenous oestrogen

Endogenous oestrogen:
* Obesity
* Early menarche
* Late menopause
* Late pregnancy/nulliparity (breast feeding + multiparity are protective)

Exogenous oestrogen:
* Hormone replacement therapy
* Oral contraceptive use

69
Q

Classical features of breast cancer

A

Signs:
* Palpable mass (firm + non-tender; poorly defined; located in the upper outer quadrant most commonly)
* Evidence of metastasis (Axillary lymphadenopathy; bone, liver, lung, brain)

Symptoms:
* Tethering: mass fixes to surrouning structures e.g. fascia, pectoral muscle or Cooper ligaments
* Discolouration
* Erythema, sweeling and Peau d’orange = suggestive of inflammatory carcinoma

Nipple changes:
* Inversion
* Bloody discharge
* Eczema

70
Q

Referral Criteria for breast cancer

A

Two week wait referral for suspected breast cancer:
* An unexplained breast lump in patients aged 30 or above
* Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)

Also:
* Unexplained lump in the axilla in patients aged 30 or above
* Skin changes suggestive of breast cancer

The NICE guidelines suggest considering non-urgent referral for unexplained breast lumps in patients under 30 years.

71
Q

What is involved in the triple diagnostic assessment for suspected breast cancer?

A

Once a patient has been referred for specialist services under a two week wait referral for suspected cancer, they should initially receive a triple diagnostic assessment comprising of:
* Clinical assessment (history and examination)
* Imaging (ultrasound or mammography)
* Biopsy (fine needle aspiration or core biopsy)

72
Q

Difference in imaging for breast cancer in younger and older women

A
  • Younger women (under 30) → more dense breasts with more glandular tissue → ultrasound scan (helpful in distinguishing solid lumps (e.g., fibroadenoma or cancer) from cystic (fluid-filled) lumps)
  • Older women → mammogram (pick up calcifications missed by ultrasound)

MRI scans may be used:
* For screening in women at higher risk of developing breast cancer (e.g., strong family history)
* To further assess the size and features of a tumour

73
Q

Types of biopsy for breast cancer

A
  • Core biopsy
  • Fine needle aspiration
74
Q

Ix for breast cancer

A
  • Triple assessment
  • Biopsy (core biopsy, fine needle aspiration)
75
Q

A patient has been diagnosed with breast cancer, what further assessment do they require?

A

Lymph node assessment
* To see if cancer has spread to the lymph nodes
* Ultrasound of the axilla (armpit) and ultrasound-guided biopsy of any abnormal nodes.

A sentinel lymph node biopsy may be used during breast cancer surgery where the initial ultrasound does not show any abnormal nodes.

76
Q

What is a sentinel lymph node biopsy?

A
  • Sentinel node biopsy is performed during breast surgery for cancer.
  • An isotope contrast and a blue dye are injected into the tumour area.
  • The contrast and dye travel through the lymphatics to the first lymph node (the sentinel node).
  • The first node in the drainage of the tumour area shows up blue and on the isotope scanner. A biopsy can be performed on this node, and if cancer cells are found, the lymph nodes can be removed.
77
Q

What are the breast cancer receptors that can be targeted for treatment?

A
  • Oestrogen receptor (ER)
  • Progesterone (PR)
  • Human epidermal growth factor (HER2)

Triple-negative breast cancer is where the breast cancer cells do not express any of these three receptors. This carries a worse prognosis, as it limits the treatment options for targeting the cancer.

78
Q

Where are the 4 notable locations for breast cancer metastasis occur?

A

2Ls + 2Bs

  • L - Lungs
  • L - Liver
  • B - Bones
  • B - Brain
79
Q

Tom Tip

A

TOM TIP: Breast cancer can spread to any region of the body. In patients with a metastatic tumour, regardless of where it is, the primary could be breast cancer. This is worth remembering, as you may be asked “where might this metastasis have originated” in an exam or OSCE scenario. If the patient is female, answering “breast cancer” will be a good answer. The other cancer that can spread practically anywhere, and may be less obvious, is melanoma (a type of skin cancer).

80
Q

What staging system is used in breast cancer?

A

TNM system
* T - Tumour
* N - Node
* M - Metastasis

81
Q

Ix for breast cancer staging

A

First step → triple assessment

Additional investigations:
* Lymph node assessment and biopsy
* MRI of the breast and axilla
* Liver ultrasound for liver metastasis
* CT of the thorax, abdomen and pelvis for lung, abdominal or pelvic metastasis
* Isotope bone scan for bony metastasis

82
Q

Options for breast tumour removal surgery

A
  • Breast-conserving surgery (e.g., wide local excision) - usually coupled with radiotherapy
  • Mastectomy (removal of the whole breast), potentially with immediate or delayed breast reconstruction
  • Axillary clearance - Removal of the axillary lymph nodes is offered to patients where cancer cells are found in the nodes. Usually, the majority or all lymph nodes are removed from the axilla → increases risk of chronic lymphoedema in that arm

Areas of lympoedema = prone to infection → avoid taking blood/cannulating from that arm

83
Q

What 3 scenerios is chemotherapy used in?

A
  • Neoadjuvant therapy – intended to shrink the tumour before surgery
  • Adjuvant chemotherapy – given after surgery to reduce recurrence
  • Treatment of metastatic or recurrent breast cancer
84
Q

The 2 main first-line treatment options for oestrogen-receptor positive breast cancer
(Disrupts the oestrogen stimulating the breast cancer)

A
  • Tamoxifen (for premenopausal women)
  • Aromatase inhibitors e.g. letrozole, anastrozole (for postmenopausal women)
85
Q

How does tamoxifen work?

A

Tamoxifen = a selective oestrogen receptor modulator (SERM) → either blocks or stimulates oestrogen receptors (depending on the site of action)

  • Blocks oestrogen receptors in breast tissue
  • Stimulates oestrogen receptors in the uterus + bones

So - it helps prevent osteoporosis - but increases risk of endometrial cancer

Blocks breast

86
Q

How does aromatase inhibitors work?

A

Aromatase = an enzyme found in fat (adipose) tissue - that converts androgens to oestrogen

After menopause - the action of aromatase in fat tissue is the primary source of oestrogen

Aromatase inhibitors = block the creation of oestrogen in fat tissue

87
Q

How long are tamoxifen or aromatase inhibitors given to women with oestrogen-receptor positive breast cancer?

A

5-10 years

88
Q

What are the other treatments for oestrogen-receptor positive breast cancer (apart from tamoxifen or aromatase inhibitors)?

A
  • Fulvestrant (selective oestrogen receptor downregulator)
  • GnRH agonists (e.g., goserelin or leuprorelin)
  • Ovarian surgery
89
Q

Name 3 targeted treatments for HER2 positive breast cancer

A
  • Trastuzumab (Herceptin) = a monoclonal antibody → targets HER2 receptor
  • Pertuzumab (Perjeta) = a monoclonal antibody → targets the HER2 receptor
  • Neratinib (Nerlynx) = tyrosine kinase inhibitor → reducing growth of breast cancers
90
Q

What is the mammogram follow up for patients with breast cancer?

A

Mammograms yearly for 5 years
(longer if they are not yet old enough for the regular breast screening programme)

91
Q

What are 2 options for reconstructive surgery?

A
  • Immediate reconstruction, done at the time of the mastectomy
  • Delayed reconstruction, which can be delayed for months or years after the initial mastectomy
92
Q

r breast-conserving surgery, reconstruction may not be required. What are possible options?

A
  • Partial reconstruction (using a flap or fat tissue to fill the gap)
  • Reduction + reshaping (removing tissue + reshaping both breasts to match)
93
Q

After a mastectomy, what are the two options for reconstructing the breast(s)?

A
  • Breast implants (inserting a synthetic implant)
  • Flap reconstruction (using tissue from another part of the body to reconstruct the breast)
94
Q

What is a Latissimus Dorsi flap?

A

The breast can be reconstructed using a portion of the latissimus dorsi + associated skin and fat tissue. The tissue is tunnelled under the skin to the breast area.

  • “Pedicled” = refers to keeping the original blood supply and moving the tissue under the skin to a new location.
  • “Free flap” = refers to cutting the tissue away completely and transplanting it to a new location.
95
Q

What is a Transverse Rectus Abdominas Flap (TRAM flap)?

A

The breast can be reconstructed using a portion of the rectus abdominis, blood supply and skin.

This can be either as a:
* Pedicled flap (tunnelled under the skin)
* Free flap (transplanted).

It poses a risk of developing an abdominal hernia due to the weakened abdominal wall.

96
Q

What is a Deep Inferior Epigastric Perforator Flap (DIEP Flag)?

A
  • The breast can be reconstructed using skin + subcutaneous fat from the abdomen (no muscle) - as a free flap.
  • The deep inferior epigastric artery, with the associated fat, skin and veins, is transplanted from the abdomen to the breast.
  • The vessels are attached to branches of the internal mammary artery and vein. This is a complex procedure involving microsurgery. There is less risk of an abdominal wall hernia than with a TRAM flap, as the abdominal wall muscles are left intact.

3a Women's Health (8 decks)

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