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Gynaecology and Breast Disease > Breast Medicine > Flashcards

Breast Medicine Flashcards

1
Q

List some differential diagnoses for breast lump

A 
Malignancy
Fibroadenoma
Cyst
Breast abscess
Fat necrosis
Sclerosing adenosis
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2
Q

Describe what you would find on examination of a patient with a breast cyst

A

A smooth, firm, mobile lump which is not tethered to the skin.

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3
Q

What is the peak age for fibroadenoma of the breast?

A

16-24

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4
Q

Describe what you would find on examination of a patient with a fibroadenoma of the breast

A

Discrete, firm, non-tender, highly mobile lump

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5
Q

True / False: Fibroadenomas predispose to cancer and therefore should be removed

A

False - Fibroadenomas of the breast do NOT predispose to cancer and can be left alone

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6
Q

What is the management of mastitis in a woman who is breastfeeding?

A

Antibiotics e.g. co-amoxiclav, flucloxacillin
Warm compress
Encourage the woman to express milk in order to prevent stagnation of the infection

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7
Q

What is the common bacterial cause of mastitis?

A

Staph. aureus

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8
Q

Breast lump in a woman with a history of road traffic accident whilst wearing a seatbelt might lead you to suspect what breast pathology?

A

Fat necrosis

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9
Q

A patient presents with ‘breast pain’ - what important question must you ask?

A

What relationship does the pain have to her periods?

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10
Q

What is duct ectastia and when does it typically present?

A

Blocking of the breast duct and stagnation of fluid behind it. Typically occurs around menopause as ducts are becoming smaller.

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11
Q

What is sclerosing adenosis of the breast?

A

Benign condition resulting from over-proliferation of the terminal duct lobules

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12
Q

True / False: Breast cancer is the most common female cancer, accounting for over 20% of female cancers

A

True

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13
Q

What is the process of breast cancer screening?

A

Women aged 50 - 70 are offered a mammogram every 3 years. After age 70, women can request a mammogram if they wish to have one.

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14
Q

What does the ‘triple assessment’ involve?

A

Clinical examination i.e. full history and examination of the breast and axilla
Radiological assessment i.e. mammography and/or ultrasound
Histological assessment i.e. core biopsy or fine needle aspiration cytology

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15
Q

What does FNAC mean?

A

Fine needle aspiration biopsy

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16
Q

Women over how old can receive a mammogram as part of the triple assessment?

A

Women over 35 years old will receive a mammogram in breast clinic. Women below this age will have breast tissue which is too dense.

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17
Q

What is carcinoma in situ?

A

Carcinoma which has not invaded through the basement membrane

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18
Q

What is the most common form of non-invasive breast cancer?

A

Ductal carcinoma in situ

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19
Q

What is the characteristic appearance of ductal carcinoma in situ on mammography?

A

Presence of microcalcifications

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20
Q

What type of non-invasive breast cancer is more common in pre-menopausal women?

A

Lobular carcinoma in situ (c.f. ductal CIS which is usually in peri-menopausal or post-menopausal women)

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21
Q

Which 3 hormone receptors are important in breast cancer?

A 
Oestrogen receptor (ER)
Progesterone receptor (PgR)
HER2 receptor
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22
Q

What is tamoxifen?

A

An oestrogen receptor antagonist - used for treatment of oestrogen receptor positive breast cancers

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23
Q

List some presenting symptoms of breast cancer

A 
Breast lump
Nipple changes i.e. inversion
Skin changes e.g. peau d'orange
Symptoms of metastatic disease
Detection on screening
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24
Q

What is Paget’s disease?

A

Eczema of the breast skin caused by an underlying carcinoma

25
Q

Which surgical options are available for removal of breast cancer?

A

Wide local excision

Mastectomy

26
Q

Into which lymph nodes does breast cancer drain?

A

Axillary lymph nodes

Internal mammary nodes

27
Q

What are the 2 options for management of lymph nodes in breast cancer

A

Sentinel node biopsy

Axillary node clearance

28
Q

What are 2 complications of axillary node clearance?

A

Arm swelling

Lymphoedema

29
Q

Give one example of an aromatase inhibitor

A

Anastrazole

30
Q

What is the treatment for a breast cyst?

A

Usually nothing - manage conservatively

Some may opt for aspiration

31
Q

What is the typical presentation of inflammatory breast cancer?

A

Erythema and oedema of the breast, in the absence of fever or other infective markers. WCC and CRP are normal.

32
Q

What is the tumour marker which is usually raised in inflammatory breast cancer?

A

CA 15-3

33
Q

What is Mondor’s disease?

A

Thrombophlebitis of breast veins

34
Q

What factors might indicate a wide local excision is indicated in the management of a breast tumour?

A 
Small tumour (4cm in large breast
Single focus of the lesion
35
Q

True / False: All women who have a wide local excision as management of a breast tumour will need post-operative radiotherapy

A

True

36
Q

What are the complications of a mastectomy?

A 
Failure to completely excise the tumour
Bleeding
Infection
Seroma
Psychological impacts
37
Q

What is a seroma?

A

Accumulation of serous fluid in the space left after removal of breast tissue in mastectomy. Drains are inserted during surgery to minimise risk.

38
Q

Where does breast cancer metastasise to?

A 
Lymph nodes (axillary and mammary)
Lung
Liver
Brain
Bone
39
Q

Which endocrine treatment can be given to a patient if their breast cancer is found to be oestrogen receptor positive?

A 
Tamoxifen for pre-menopausal women
Aromatase inhibitors (anastrozole, letrozole) in post-menopausal women
40
Q

True / False: Most breast cancers which are oestrogen receptor positive will also be positive for the HER2 receptor?

A

False - Most breast cancers which are oestrogen receptor positive are likely to be positive for the progesterone receptor, but negative for the HER2 receptor

41
Q

What does it mean if a breast cancer is ‘triple negative’?

A

The cancer does not have oestrogen, progesterone or HER2 receptors

42
Q

What does HER2 stand for?

A

Human epidermal growth factor

43
Q

What are the side effects of tamoxifen?

A

Menopausal symptoms: Vaginal dryness, VTE, hot flushes, altered libido, weight gain, menstrual disturbance, endometrial cancer

44
Q

True / False: A pre-menopausal woman found to have oestrogen receptor positive breast cancer will be given Letrozole?

A

False - Letrozole is an aromatase inhibitor (also anastrozole) and these are contraindicated in pre-menopausal women. Tamoxifen is given to these patients.

45
Q

What are the side effects of aromatase inhibitors?

A

Vaginal dryness
Osteoporosis
Joint / muscle pain
Hot flushes

46
Q

What is the mechanism of action of aromatase inhibitors?

A

Stops the synthesis of oestrogen

47
Q

What does a biopsy result of B5a indicate?

A

Carcinoma in situ

48
Q

What 2 views are taken on a mammogram?

A 
CC = Crania-Caudal
MLO = Mediolateral oblique
49
Q

Which patients are offered MRI scanning as part of their assessment?

A
  • Yearly MRI for patients with FHx or who had supra-diaphragmatic radiotherapy
  • Diagnosed lobular carcinoma when helping to decide whether breast conserving surgery is appropriate
  • Discordance in triple assessment results
  • Dense breast tissue
50
Q

What are the different types of mastectomy?

A

Simple: Removal of breast only
Completion: Removal of remaining breast after previous wide local excision
Skin sparing: Breast and nipple removed but skin of breast remains
Nipple sparing: Breast tissue removed but skin of the nipple remains
Risk reducing: ‘Prophylactic’ mastectomy i.e. offered to high risk women

51
Q

What non-surgical options are available for management of breast cancer?

A

Radiotherapy
Chemotherapy (adjuvant or neo-adjuvant)
Hormone therapy

52
Q

Give the indications for neo-adjuvant chemotherapy in the management of breast cancer

A
  • Locally advanced breast cancer to allow for surgery

- To allow immediate reconstruction for extensive disease

53
Q

Give the indications for adjuvant chemotherapy in the management of breast cancer

A 
Node positive
HER2 positive
Triple negative
Grade 3 cancer
Young at presentation
54
Q

Give the indications for radiotherapy after a mastectomy

A

More than 4 positive nodes
Tumour larger than 5cm
Positive margins

55
Q

After surgery, what medical treatment will a patient with HER2 positive breast cancer receive?

A

Herceptin AND chemotherapy - The 2 are given alongside one another

56
Q

‘Slit-like’ retraction of the nipple is typical of which condition?

A

Duct ectasia

57
Q

Give some presenting features of mammary duct ectasia

A

Patients around the time of menopause
Nipple discharge - might be cream, green, bloodstained (usually comes from several ducts)
Slit-like retraction of the nipple

58
Q

Bloodstained discharge originating from one duct might indicate which condition?

A

Intraductal papilloma

Gynaecology and Breast Disease (6 decks)

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