Breast Medicine Flashcards
risk factors of breast cancer
- age
- FH
- genetics- BRCA 1/2
- duration of oestrogen exposure
- late first pregnancy
- HRT
- obesity
- alcohol
- weight
Clinical features of breast cancer
- small lump
- inflammatory- peau d’orange in drawn nipple and lymphatic
oedema - metastatic- bones (pain in hip/ fracture presentation)
how would a patient with breast cancer typically present?
- painless lump- hard/ irregular/ fixed
- nipple discharge
- nipple in-drawing
- skin tethering
- pain and tenderness are rare
how is breast cancer diagnosed?
triple assessment (1-5 of each of the below, 1 is normal, 5 is malignant)
- clinical score
- imaging score
- biopsy score
- mammography
- high resolution US
- MRI
- core biopsy
- tumour markers- CA 15-3
When is breast conservation treatment most appropriate?
- small tumour relative to breast size (less than 25%)
- cannot be under nipple
- pre op chemotherapy
when is a mastectomy performed?
- large tumour relative to breast size
- tumour underneath nipple/ in drawing nipple
- more than one cancer in same breast
- delayed reconstruction
- patient choice
what are the surgical options for any axillary disease presenting with breast cancer?
full axillary clearance
- used if glands are clinically involved
- accurate staging
- high complication rate- seromas, arm stiffness, drain, axillary numbness
limited axillary surgery
- if glands are clinically normal
- no significant complications
- no drains
- no effect on mortality
what are the 2 most common histological morphology subtypes in breast cancer?
ductal carcinoma (70%)
lobular (10%)
what is the TNM staging in breast cancer?
tumour size T0-N4
Nodes N0-3
Metastases M0-1
breast cancer- if a woman is ER (oestrogen receptor) positive what adjuvant therapies are offered if they are:
pre-menopausal
post menopausal
pre= tamoxifen (use for 5 years)
post= aromatase inhibitors (anastrazole)
what breast cancer patients will receive radiotherapy?
- all women who undergo lumpectomy
- aggressive disease after mastectomy
- some tumour subtypes
what breast cancer patients will receive chemotherapy?
- aggresive disease phenotype
- high risk disease- young age, ER negative, HER2 positive, grade 3, tumour size
if a woman if HER-2 positive what treatment is offered?
Trastuzumab
HER-2 positive has a worse prognosis
risk factors for pagets disease of the nipple
- age (60’s)
- female
- afro-carribean
- alcohol
- dense breasts
- obesity
- FH
- BRCA 1/2
clinical features of pagets disease of the nipple
- scaling and flaking of the skin of the nipple
- tingling
- itching
- sensitivty
- burning
- pain
- bloody/ yellow discharge from nipple
- nipple appears ‘flat’ against breast
diagnosis of pagets disease of the nipple
biopsy
mammogram
breast MRI
tx of pagets disease of the nipple
mastectomy
lumpectomy
when do fibroadenoma’s typically occur?
<30
what is a fibroadenoma?
benign overgrowth of collagenous mesenchyme of one breast lobule
how does a fibroadenoma present clinically?
painless, mobile, firm, smooth lump
how are fibroadenoma’s managed and treated?
reassure and observe
excise if large
when do breast cysts typically present and how do they present clinically?
35-50
fluid-filled rounded lump, occasionally painful, smooth, mobile
how are breast cysts diagnosed and treated?
both by aspiration
how does a breast abscess present clinically?
warm, painful swelling
nipple discharge (purulent pus)
tenderness
how is a breast abscess managed?
drain, and then culture to decide on ABx- co-amoxiclav
why might a mastectomy be indicated as opposed to a lumpectomy in someone with breast cancer?
- If the tumour is large relative to the size of breast.
- If there are multiple tumours.
- Patient preference
what biopsy is done to ensure that breast cancer has not spread to axillary lymph nodes?
sentinel node biopsy
what is a possible side effect of tamoxifen therapy in pre-menopausal women?
increased risk of endometrial cancer
where do breast cancers commonly metastasise to?
liver, lung, bone, brain
guidance on breast feeding in lactational mastitis/ breast abscess
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
how does an intraductal papilloma present
Nipple discharge (clear or blood-stained)
Tenderness or pain
A palpable lump
causes of lactational mastitis
- obstruction leading to accumulation of milk
- infection- staph aureus
