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Phase 3a🩺 > Breast Medicine 🤱🏽 > Flashcards

Breast Medicine 🤱🏽 Flashcards

1
Q

What is Paget’s disease of the nipple?

A

An eczema like rash on the nipple that is associated with malignancy

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2
Q

What is paget’s disease of the nipple suggestive of?

A

An underlying ductal carcinoma in situ

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3
Q

What is the presentation of paget’s disease of the nipple?

A

Eczema like rash on the nipple that is itchy, red and inflamed
Bloody nipple discharge
Burning sensation or pain in the nipple
Retraction or inversion
Palpable breast lump
Non-healing ulcers

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4
Q

What are the differentials of paget’s disease of the nipple?

A

Atopic dermatitis Contact dermatitis Intraductal papilloma Mastitis Breast abscessPsoriasis

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5
Q

What investigations are used to diagnose paget’s disease of the nipple?

A

Physical breast examination Mammogram Breast ultrasound Biopsy of the skin Nipple discharge cytologyMRI

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6
Q

What is the management of paget’s disease of the nipple?

A

Surgery- Mastectomy - Modified radical mastectomy - LumpectomyChemotherapy Radiotherapy

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7
Q

What is a modified radical mastectomy?

A

Where the entire breast, as well as axilliary lymph node is removed

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8
Q

What are fibrocystic breast changes?

A

Fibrocystic breast changes are normal changes that cause lumpiness in the breast

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9
Q

What is the aetiology of fibrocystic breast changes?

A

The cyclical effects of hormones such as progesterone and oestrogen lead to chronic proliferative changes, and the formation of small cysts

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10
Q

Which women are fibrocystic breast changes common in?

A

Common in women aged 20 to 50

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11
Q

When are symptoms of fibrocystic breast disease typically worst?

A

Symptoms are worst in the week before menstruation

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12
Q

What are the differentials of fibrocystic breast changes?

A

Fibroadenoma Breast cancerBreast cysts Mastitis/breast abscess

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13
Q

What are the symptoms of fibrocystic breast changes?

A

Bilateral lumpy breastsBreast pain Symptoms that worsen in the week before menstruation

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14
Q

What are the investigations for fibrocystic breast changes?

A

Mammogram Ultrasound Biopsy

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15
Q

What is the management of fibrocystic breast changes?

A

Soft and well fitting braAnalgesiaReassurance about symptoms resolving post-menopause

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16
Q

What is cyclical mastalgia?

A

Breast pain that occurs in the weeks leading up to menstruation and improves once menstruation begins

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17
Q

What is the difference between cyclical mastalgia and fibrocystic breast changes?

A

In both conditions, symptoms are worst in the weeks leading up to menstruation In cyclical mastalgia there are no nodules throughout the breast - examination is normal

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18
Q

What are breast cysts?

A

Benign, individual fluid filled lumps

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19
Q

When do breast cysts typically occur?

A

30-50 years of age

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20
Q

What is the most common cause of breast lumps?

A

Breast cysts

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21
Q

What are the features of breast cysts on examination?

A

Smooth Well-circumscribedMobile Possibly fluctuant

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22
Q

What is fat necrosis of the breast?

A

A benign breast lump caused by localised degeneration and scarring of fat tissue in the breast

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23
Q

What is fat necrosis commonly triggered by?

A

Trauma to the breast
Surgery
Radiotherapy

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24
Q

What are the features of fat necrosis on examination?

A

Painless Firm Irregular Fixed in local structures Skin dimpling or nipple inversion

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25
Q

What investigations are used to diagnose fat necrosis?

A

Ultrasound Mammogram Fine needle aspiration or core biopsy

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26
Q

What is a lipoma?

A

A benign tumour of adipose tissue

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27
Q

What are the features of lipoma on examination?

A

Soft PainlessMobile Do not cause skin changes

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28
Q

What is mastitis?

A

Inflammation of the breast tissue that is typically associated with breastfeeding

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29
Q

What is the epidemiology of mastitis?

A

10-20% of breastfeeding women will experience mastitis - Incidence peaks at the second and third weeks of breastfeeding, and is most common in the first 3 months

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30
Q

What is the aetiology of mastitis?

A

It can be caused by blocked ducts, or by bacteria entering the breast tissue, often through a cracked or sore nipple

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31
Q

What is the most common causative organism in infective causes of mastitis?

A

Staphylococcus aureus

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32
Q

What is the presentation of mastitis?

A

Painful, tender, red, hot breast Systemic symptoms - Fever- Malaise - Fatigue - Nausea - Headache Unilateral symptoms

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33
Q

What are the differential diagnoses of mastitis?

A

Plugged duct Breast abscessInflammatory breast cancer Engorgement

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34
Q

What investigations are used to diagnose mastitis?

A

Mainly clinical diagnosis Ultrasonography used to rule out an abscessCulture of any fluid drained

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35
Q

What is the first line management of mastitis?

A

Conservative management and analgesia
Warm compresses
Continuation of breastfeeding

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36
Q

What is the second line management of mastitis?

A

Oral flucloxacillin

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37
Q

What is a fibroadenoma?

A

Benign tumours of fibrous and epithelial tissue

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38
Q

What is the presentation of a fibroadenoma?

A

A firm, non-tender breast massMass is rounded and has smooth edges Mass is highly mobile upon palpation Mass is not bigger than 3cm in diameter

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39
Q

What is the epidemiology of fibroadenoma?

A

Fibroadenoma is more common in younger women- Highest incidence is in early 20s

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40
Q

What are the differntial diagnoses of fibroadenoma?

A

Breast cystsInvasive breast cancerFibrocystic changes Intraductal papilloma Lipoma

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41
Q

What investigations are used to diagnose fibroadenoma?

A

Ultrasound Mammogram Needle biopsy

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42
Q

What is the management of fibroadenoma?

A

Many fibroadenomas do not require treatment Surgical excision may be considered if the fibroadenoma is large, is growing, or is causing significant problems

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43
Q

What is the indication for surgical resection of a fibroadenoma?

A

Fibroadenoma > 3cm

44
Q

What are the risk factors for developing breast cancer?(5)

A

Increased oestrogen exposure (early menarche, late menopause, COCP, combined HRT, nulliparity)
Obesity
Age > 50
1st degree family history of breast or ovarian cancer
BRCA 1 or BRCA 2 genes
Jewish ancestry

45
Q

What is the lifetime risk of breast cancer in someone with BRCA1 or 2 genes ?

A

40%

46
Q

What factors would increase oestrogen exposure?

A

Early menarche Late menopause Combined HRT COCPNulliparity

47
Q

Where are the BRCA1 and BRCA2 genes?

A

BRCA1 - chromosome 17 BRCA2 - chromsome 13

48
Q

What are the types of breast cancer?

A

Invasive ductal carcinoma Invasive lobular carcinoma Ductal carcinoma in situ Lobular carcinoma in situ

49
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

50
Q

What is an invasive ductal carcinoma?

A

A breast cancer that originates from cells in the breast ducts

51
Q

What is an invasive lobular carcinoma?

A

A breast cancer that orginates from cells in the breast lobules

52
Q

What is ductal carcinoma in situ?

A

Pre-cancerous or cancerous cells of the epithelial tissue They are localised to a single area and have the potential to spread

53
Q

What is lobular carcinoma in situ?

A

A pre-cancerous condition that is typically asymptomatic and seen in pre-menopausal womenRepresents an increased risk of invasive breast cancer in the future

54
Q

What is inflammatory breast cancer?

A

Where cancerous cells block the lymphatic drainage of the breast causing an inflammatory picture

55
Q

What age women are offered breast screening?

A

50-70

56
Q

How often are women aged 50-70 offered a breast screening appointment?

A

Every 3 years

57
Q

Which high risk patients should be referred for assessment?

A

A first degree relative with breast cancer under 40 A first degree male relative with breast cancer A first degree relative with bilateral breast cancer under 50 Two first degree relatives with breast cancer

58
Q

Which patients should be referred urgently for suspected breast cancer?

A

Age 30 and over with an unexplained breast lump with or without pain Age 50 and over with any of the following symptoms in one nipple only:- Nipple discharge, retraction or other changes of concernAge 30 and over with an unexpected pain in the axilla People with skin changes that are indicative of breast cancer

59
Q

What is the triple diagnostic assessment?

A

Triple diagnostic assessment is the initial assessment for women referred under a two week wait:Clinical assesment Mammogram or ultrasoundBiopsy

60
Q

What type of imaging is used for women under 30 and why?

A

Ultrasound is typically performed in women under 30 due to more dense breast tissue

61
Q

When would MRI be used in the diagnosis of breast cancer?

A

To screen women at high risk of breast cancer
To determine size and features of a tumour

62
Q

What type of receptors may a breast cancer have?

A

Oestrogen receptors Progesterone receptors HER2 (human epidermal growth factors)

63
Q

What is triple negative breast cancer?

A

Breast cancer with a worse prognosis due to having no receptors that can be targeted by medication

64
Q

Where does breast cancer typically metastasise to?

A

Lungs Liver Bone Brain

65
Q

What investigations are carried out to stage breast cancer?

A

Lymph node biopsyMRI of breast and axillaLiver ultrasound CT thorax, abdo, pelvis Isotope bone scan

66
Q

What are the differential diagnoses of breast cancer?

A

Fibroadenoma Cyst Mastitis Lipoma

67
Q

What are the presenting features of breast cancer?

A

Nipple discharge Breast lump with or without pain Skin thickening or discolourationNipple inversion Axillary mass

68
Q

Where can breast cancer spread to?

A

Breast cancer can spread anywhere in the body

69
Q

What types of breast cancer surgery exist?

A

Wide local excision Mastectomy

70
Q

When would a wide local excision be considered?

A

Solitary lesion Peripheral tumourSmall lesion Ductal carcinoma in situ < 4cm

71
Q

When would a mastectomy be considered?

A

Multiple lesions Central tumours Larger lesions Ductal carcinoma in situ > 4cm

72
Q

What treatements other than surgery are offered to women with breast cancer?

A

Radiotherapy Chemotherapy Biological therapy Hormonal therapy

73
Q

What is the main complication of axillary lymph node clearance?

A

Chronic lymphodema

74
Q

What is chronic lymphodema?

A

Impaired lymphatic drainage that leads to a build up of lymph (typically in one arm after breast surgery with lymph node removal)

75
Q

What are the side effects of radiotherapy?

A

General fatigue Local skin irritation and swellingFibrosis of breast tissue Shrinking of breast tissue Long term skin discolouration

76
Q

What medications can be given to patients with oestrogen receptor positive breast cancer?

A

Tamoxifen for premenopausal women Aromatase inhibitors for post-menopausal women

77
Q

What class of drug is tamoxifen?

A

Selective oestrogen receptor modulator

78
Q

What is the action of tamoxifen?

A

Blocks oestrogen receptors in breast tissue Stimulates oestrogen receptors in bones and the uterus

79
Q

What is the action of aromatase inhibitors?

A

Aromatase blocks the creation of oestrogen in fat tissue

80
Q

What treatments are used in patients with HER2 positive breast cancer?

A

Trastuzamab Pertuzamab

81
Q

What are the side effects of tamoxifen?

A

Menopausal symptoms Increased risk of endometrial cancer Increased VTE risk

82
Q

What are the options for reconstructive surgery?

A

Immediate reconstruction
Delayed reconstruction

83
Q

What type of radiotherapy is recommended after a wide local excision?

A

Whole breast radiotherapy

84
Q

What is the action of anastrazole?

A

Aromatase inhibitor - reduces the peripheral synthesis of oestrogen

85
Q

What is the action of tamoxifen?

A

SERM (selective oestrogen receptor modulator) - partial oestrogen receptor antagonist

86
Q

What is a breast abscess?

A

A collection of pus within an area of the breast, usually caused by a bacterial infection

87
Q

What are the two types of breast abscess?

A

Lactational abscessNon-lactational abscess

88
Q

What are the most common bacterial causes of breast abscesses?

A

Staphylococcus aureus Streptococcal speciesEnterococcal speciesAnaerobic bacteria

89
Q

What is the presentation of a breast abscess?

A

Nipple changes Purulent nipple discharge Localised pain TendernessWarmth Erythema RednessHardening of the skin Swelling

90
Q

What is the key feature of a breast abscess that helps differentiate from other lumps?

A

Fluctulance - being able to move around the fluid within the lump

91
Q

What are the differentials of a breast abscess?

A

Breast engorgement Galactocele Fibrocystic breastsBreast trauma Breast cancerFibroadenoma

92
Q

What are the risk factors for breast abscess?(6)

A

Lactation Poor breastfeeding technique Nipple injury Previous mastitis Nipple piercings Skin infection Underlying breast diseaseSmoking

93
Q

What investigations are used to diagnose a breast abscess?

A

Breast ultrasoundDiagnostic needle aspiration

94
Q

What is the management of a breast abscess?

A

Antibiotics Incision and drainage or needle aspiration

95
Q

What is duct ectasia?

A

A benign condition characterised by dilation of the large ducts in the breast

96
Q

What is the presentation of duct ectasia?

A

Green nipple discharge
Tenderness or pain
Nipple retraction or inversion
A breast lump

97
Q

What is the epidemiology of duct ectasia?

A

Occurs mostly in perimenopausal women

98
Q

What imaging can be used to help diagnose duct ectasia?

A

Mammogram Ultrasound MRI

99
Q

What other investigations can be helpful in the diagnosis of duct ectasia?

A

Ductography Nipple discharge cytology Ductoscopy

100
Q

What is the management of duct ectasia?

A

Exclusion of cancerSymptomatic management of mastalgiaAntibiotics if infection is suspected Surgical excision of affected duct

101
Q

What is an intraductal papilloma?

A

A warty lesion that grows within one of the ducts in the breast

102
Q

When do intraductal papillomas most commonly occur?

A

35-55 years

103
Q

What is the typical presentation of an intraductal papilloma?

A

Nipple discharge - clear or blood stained Tenderness or pain Palpable lump

104
Q

What investigations are used to diagnose intraductal papilloma?

A

Triple assessment:- Clinical assessment - Imaging - ultrasound, mammogram, MRI- Histology - core biopsy or vacuum assisted biopsy

105
Q

What is ductography?

A

Involved injecting contrast into the affected duct and performing a mammogram - the papilloma will be seen as an area that does not fill with contrast

106
Q

What is the management of an intraductal papilloma?

A

Complete surgical excision

Phase 3a🩺 (12 decks)

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