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Phase 3a conditions list flashcards > Breast medicine > Flashcards

Breast medicine Flashcards

1
Q

What is the main constituent of breasts?

A

Adipose tissue

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2
Q

What is the area around the nipple known as?

A

Areola

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3
Q

What structures sit behind the areola and allow milk to drain?

A

Network of ducts

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4
Q

Where is milk produced in the breast?

A

Lobules
these then drain into ducts –> out of nipple

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5
Q

How are women in the UK screened for breast cancer (age, how often)?

A
  • Between 50 and 71st birthday
  • Every 3 years
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6
Q

What are some downsides to breast cancer screening (4)?

A
  • Anxiety + stress
  • Exposure to radiation
  • Missing cancer –> false reassurance
  • Unnecessary further tests
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7
Q

How much does breast screening reduce the risk of death from breast cancer by?

A

About 20%

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8
Q

What are 2 genetic variations that increase your risk of breast cancer?

A
  • BRCA 1 (chromosome 17) and 2 (chromosome 13)
  • Li-Fraumeni
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9
Q

What cancers does Li-Fraumeni increase the risk of (5)?

A
  • Breast
  • Brain
  • Adrenal
  • Leukaemia
  • Osteosarcoma
    auto dom inheritance pattern
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10
Q

When should BRCA and Li-Fraumeni be screened for breast cancer?

A

Annually in over 20 year olds

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11
Q

What is the most common BRCA gene?

A

BRCA 1

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12
Q

What cancers do the BRCA genes increase the risk of (4)?

A
  • Breast
  • Ovarian
  • Prostate
  • Pancreatic
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13
Q

What is the most common site of breast lumps?

A

Upper outer quadrant
including tail of spence

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14
Q

What is the sentinel node for breast cancers?

A

Axillary nodes

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15
Q

What is the “triple lock” for breast cancer investigations (3)?

A
  • History + exam
  • Imaging
  • Biopsy
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16
Q

What imaging techniques are used to analyse breast lumps (3)?

A
  • Mammography
  • USS
  • MRI
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17
Q

When are USS better at identifying breast lumps compared to mammography?

A

In younger, dense breasts

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18
Q

When is an MRI particularly useful for identifying breast lumps?

A

When there is a breast implant

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19
Q

What are two biopsy techniques used for breast cancer?

A
  • Fine needle biopsy (now rarely used)
  • Core biopsy (can identify if cancer is invasive or in situ)
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20
Q

What are some causes of breast lumps/ changes (11)?

A
  • Fibroadenoma = very common
  • Cysts = very common
  • Breast cancer
  • Fibrocystic breast changes (mammary dysplasia)
  • Fat necrosis
  • Lipoma
  • Phyllodes tumours
  • Mastitis/ abscess
  • Duct ectasia
  • Intraductal papilloma
  • Pagets disease of the nipple
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21
Q

What is a fibroadenoma?

A

Benign tumours of epithelial breast tissue

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22
Q

What age is typically affected by fibroadenomas?

A

20 - 40 year olds
oestrogen + progesterone sensitive so often change throughout cycle and shrink after menopause

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23
Q

What are some key features of fibroadenomas (5)?

A
  • Mobile
  • Well defined
  • Painless
  • Firm
  • Fluctuating size
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24
Q

How should a fibroadenoma be treated?

A

Surgical excision if > 3cm

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25
Q

What is a breast cyst?

A

Individual fluid filled lump, usually caused by blockage in duct/ shrinking of tissues

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26
Q

What age are breast cysts most common?

A

40-60 years

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27
Q

What are some features of a breast cyst (5)?

A
  • Painful
  • Smooth
  • Well defined
  • Mobile
  • Fluctuate in size
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28
Q

How is a breast cyst treated?

A

Aspirated

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29
Q

What features of the aspiration of a breast cyst should indicate a biopsy may be needed (2)?

A
  • Blood stained fluid
  • Repeatedly refill
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30
Q

What are fibrocystic breast changes?

A

Fluctuating general lumpiness due to fibrous and cystic changes in the breast in response to oestrogen and progesterone

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31
Q

What is the pathophysiology of fat necrosis causing beast lumps?

A

Localised degeneration and scaring of fat tissue
often triggered by trauma, surgery or radiotherapy resulting in inflammation

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32
Q

What are some features of fat necrosis lumps in breasts (4)?

A
  • Irregular
  • Firm
  • Painless
  • Skin dimpling/ nipple inversion
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33
Q

How should fat necrosis in the breast be investigated?

A

Biopsy is often needed
due to the similarity to breast cancer lumps in examination and USS findings

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34
Q

What are lipomas?

A

Benign tumours of adipose tissue

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35
Q

What are some features of lipomas in the breast (4)?

A
  • Soft
  • Painless
  • Mobile
  • No skin changes
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36
Q

What is mastitis?

A

Inflammation of breast tissue

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37
Q

What are the two main causes of mastitis?

A
  • Obstruction in the ducts whilst breastfeeding
  • Infection
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38
Q

What bacteria most commonly causes mastitis?

A

Staph aureus

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39
Q

What are the features of mastitis (5)?

A
  • Breast pain + tenderness
  • Erythema
  • Warmth + inflammation
  • Nipple discharge
  • Fever
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40
Q

What is the main risk factor for mastitis?

A

Breast feeding

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41
Q

How should mastitis be treated (3)?

A
  • Lactating 1st = warm compress, expressing, analgesia
  • Lactating 2nd = flucloxacillin or erythromycin
  • Non-lactating = co-amox (erythromycin + metronidazole if penicillin allergy)
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42
Q

What organism commonly causes mastitis in breastfeeding women?

A

Candida

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43
Q

How does candida mastitis present?

A

Cracked flaky skin with baby also affected

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44
Q

How is candida mastitis treated (2)?

A
  • Topical miconazole
  • Oral fluconazole
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45
Q

What is a complication of mastitis?

A

Breast abscess

46
Q

What is a major risk factor for breast abscesses?

A

SMOKING

47
Q

What bacteria can cause breast abscesses (4)?

A
  • Staph aureus = mc
  • Streptococcal
  • Enterococcal
  • Anaerobes
48
Q

What features suggest a breast abscess, not just mastitis (3)?

A
  • Fluctuance (moving fluid around within lump)
  • Swollen
  • Very tender
49
Q

How should breast abscess be managed (2)?

A
  • Co-amox (or erythromycin + metronidazole)
  • Surgical drainage
50
Q

What is duct ectasia?

A

Benign condition where milk ducts become dilated and inflamed

51
Q

Who is most commonly affected by duct ectasia?

A

Peri + postmenopausal women

52
Q

What is the presentation of duct ectasia?

A

Sticky brown/ green nipple discharge

53
Q

How is duct ectasia managed (2)?

A
  • Conservatively
  • Antibiotics if severe
54
Q

What is an intraductal papilloma?

A

A lesion growing within one of the ducts in the breast

55
Q

What age are intraductal papillomas most common?

A

35-55 years

56
Q

How do intraductal papillomas present?

A

Clear/ blood stained nipple discharge

57
Q

How are intraductal papillomas treated?

A

Surgical excision + histological examination
risk of malignancy

58
Q

What are some risk factors for developing breast cancer (7)?

A
  • Female
  • Increased oestrogen exposure (early periods, late menopause)
  • Denser breast tissue
  • Obesity
  • Smoking
  • Family history
  • Genetics
59
Q

How does COCP affect risk of breast cancer?

A

Small increased risk
lasting only for 10 years

60
Q

How does HRT affect risk of breast cancer?

A

Increases risk of breast cancer (particularly combined HRT)

61
Q

What family history of breast cancer is considered high risk?

A
  • 1st degree relative < 40 years
  • 2 first degree relatives
  • 1st degree bilateral breast cancer < 50 years
  • 1st degree male breast cancer
62
Q

What is the lifetime risk of developing breast cancer for women?

A

1 in 8
most common cancer affecting women

63
Q

What is the average age of diagnosis for breast cancer?

A

62

64
Q

What is the histological type of the vast majority of breast cancers?

A

Adenocarcinoma

65
Q

What are the two most common types of breast cancer?

A
  • Ductal carcinoma (70 %)
  • Lobular carcinoma (10%)
66
Q

Other than ductal and tubular what are some other types of breast cancer (4)?

A
  • Tubular
  • Medullary
  • Mucinous
  • Phyllodes
67
Q

How can the spread of the tumour be categorised (2)?

A
  • In-situ = not invaded BM (asymptomatic)
  • Invasive = invaded BM
68
Q

How can women at high risk of developing breast cancer be managed?

A
  • Chemoprevention
  • Bilateral mastectomy
69
Q

What chemoprevention can be offered to women at higher risk of breast cancer?

A
  • Tamoxifen (premenopausal)
  • Anastrozole (postmenopausal)
70
Q

What are suspicious signs of breast cancer in terms of examination (6)?

A
  • Dimpling/ depression
  • Deviation (asymmetry)
  • Discolouration
  • Discharge
  • Tethering
  • Nipple eczema
71
Q

What examination findings should be referred under the 2 week wait for breast cancer?

A
  • Unexplained breast or axilla lump in patients 30+
  • Unilateral nipple changes in patients 50+
  • Skin changes suggestive of breast cancer
72
Q

What is an important investigation for all women diagnosed with breast cancer?

A

Sentinel node biopsy

73
Q

What is a useful feature of some breast cancers that help target treatments?

A

Breast cancer receptors

74
Q

What are the 3 breast cancer receptors?

A
  • Oestrogen receptors (ER)
  • Progesterone receptors (PR)
  • Human epidermal growth factor (HER2)
75
Q

What is it know as when breast cancer does not contain any of the receptors?

A

Triple negative breast cancer
worse prognosis as can’t target chemo

76
Q

What is a method of predicting how aggressive a breast cancer may be?

A

Gene expression profiling

77
Q

What investigations are done to stage breast cancer (5)?

A
  • Lymph node assessment + biopsy
  • MRI breast + axilla
  • Liver USS (for metastasis)
  • CT thorax, abdomen, pelvis
  • Isotope bone scan (for bony mets)
78
Q

What staging system is used to grade breast cancer?

A

TNM (1-4)

79
Q

What are some common sites of metastasis for breast cancer (4)?

A
  • Liver
  • Lung
  • Bone
  • Brain
    2 Ls, 2 Bs
80
Q

How are breast cancers managed (5)?

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Hormone treatment
  • Targeted treatments
81
Q

What are the two surgical options to treat breast cancer?

A
  • Mastectomy
  • Lumpectomy (wide local excision)
82
Q

What would indicate the need for a mastectomy?

A

> 4cm/ more than 20% of breast affected

83
Q

What treatment is a lumpectomy usually coupled with?

A

Radiotherapy

84
Q

What treatment is often given before surgery for breast cancer?

A

Chemotherapy to shrink the tumour

85
Q

What procedure is often done alongside the removal of the tumour for those with breast cancer?

A

Axillary lymph node clearance

86
Q

What is a side effect of axillary lymph node clearance?

A

Chronic lymphoedema in the arm
can treat with compression bandages

87
Q

What are some side effects of radiotherapy (4)?

A
  • General fatigue
  • Local skin irritation + swelling
  • Fibrosis of breast
  • Shrinking of breast
88
Q

What are the scenarios chemotherapy is given for breast cancer (3)?

A
  • Neoadjuvant = before surgery to shrink tumour
  • Adjuvant = after surgery to reduce recurrence
  • Treatment = for metastatic or recurrent breast cancer
89
Q

What are two hormone treatments for ER +ve breast cancer?

A
  • Tamoxifen (used for premenopausal women)
  • Aromatase inhibitor - anastrozole or letrozole (used for postmenopausal women)
90
Q

How does tamoxifen work?

A

Selective oestrogen receptor modulator - antagonist to oestrogen in breast tissue

91
Q

What are 3 side effects of tamoxifen?

A
  • Increased VTE risk
  • Hot flushes
  • Increased endometrial cancer risk
92
Q

How does anastrozole/ aromatase inhibitors work?

A

Block the creation of oestrogen in adipose tissue (the main source of oestrogen in postmenopausal women)

93
Q

What is a side effect of anastrozole?

A

Osteoporosis

94
Q

What is a targeted treatment for HER2 +ve breast cancer?

A

Trastuzumab (Herceptin) - monoclonal antibody targeting HER2 receptor

95
Q

What is a key side effect of trastuzumab (Herceptin)?

A

Cardiotoxicity (needs monitoring)

96
Q

What are 2 options for reconstruction of breast after surgery?

A
  • Silicone implants
  • Flap reconstruction
    can be delayed or immediate
97
Q

What is an option for women who do not want surgical reconstruction after breast cancer surgery?

A

External implant in bra

98
Q

What are some complications of breast implants (3)?

A
  • Rupture
  • Capsular contractures (fibrous scar tissue formation)
  • BIA-ALCL (lymphoma associated with breast implant)
99
Q

What is pages disease of the nipple?

A

A specific presentation of some breast cancers

100
Q

What are the signs/ symptoms of pagets disease?

A

Persistent eczema of the nipple

101
Q

What does pagets disease of the nipple often indicate (2)?

A
  • Lump behind the nipple - usually invasive carcinoma
  • In situ cancer
102
Q

What is breast pain known as medically?

A

Mastalgia

103
Q

What are the two presentations of breast pain?

A
  • Cyclical
  • Non-cyclical
104
Q

What is the main cause of cyclical breast pain?

A

Pre menstrual syndrome

105
Q

What age are typically affected by non-cyclical breast pain

A

40-50 years olds

106
Q

What are some causes of non-cyclical breast pain (3)?

A
  • Medications (hormonal medications)
  • Infection
  • Pregnancy
107
Q

What is important to exclude in those with breast pain?

A

Cancer
although it rarely presents with pain

108
Q

What is Galactorrhoea?

A

Discharge of milk from the nipple not related to breastfeeding or pregnancy

109
Q

What are some causes of Galactorrhoea (4)?

A
  • Idiopathic
  • Prolactinoma
  • Endocrine (e.g. hypothyroid, PCOS)
  • Medications (dopamine antagonists - antipsychotics)
110
Q

What are some causes of gynaecomastia (7)?

A
  • Obesity (high oestrogen)
  • Testicular cancer (secretes oestrogen- leydig cell)
  • Liver failure
  • Hyperthyroid
  • Reduced testosterone
  • Kleinfelters
  • Medications

Phase 3a conditions list flashcards (31 decks)

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