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NP- Phase 3a Medicine > Breast Medicine > Flashcards

Breast Medicine Flashcards

1
Q

risk factors of breast cancer

A
  • age
  • FH
  • genetics- BRCA 1/2
  • duration of oestrogen exposure
  • late first pregnancy
  • HRT
  • obesity
  • alcohol
  • weight
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2
Q

Clinical features of breast cancer

A
  • small lump
  • inflammatory- peau d’orange in drawn nipple and lymphatic
    oedema
  • metastatic- bones (pain in hip/ fracture presentation)
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3
Q

how would a patient with breast cancer typically present?

A
  • painless lump- hard/ irregular/ fixed
  • nipple discharge
  • nipple in-drawing
  • skin tethering
  • pain and tenderness are rare
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4
Q

how is breast cancer diagnosed?

A

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
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5
Q

When is breast conservation treatment most appropriate?

A
  • small tumour relative to breast size (less than 25%)
  • cannot be under nipple
  • pre op chemotherapy
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6
Q

when is a mastectomy performed?

A
  • large tumour relative to breast size
  • tumour underneath nipple/ in drawing nipple
  • more than one cancer in same breast
  • delayed reconstruction
  • patient choice
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7
Q

what are the surgical options for any axillary disease presenting with breast cancer?

A

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
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8
Q

what are the 2 most common histological morphology subtypes in breast cancer?

A

ductal carcinoma (70%)

lobular (10%)

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9
Q

what is the TNM staging in breast cancer?

A

tumour size T0-N4
Nodes N0-3
Metastases M0-1

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10
Q

breast cancer- if a woman is ER (oestrogen receptor) positive what adjuvant therapies are offered if they are:

pre-menopausal
post menopausal

A

pre= tamoxifen (use for 5 years)

post= aromatase inhibitors (anastrazole)

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11
Q

what breast cancer patients will receive radiotherapy?

A
  • all women who undergo lumpectomy
  • aggressive disease after mastectomy
  • some tumour subtypes
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12
Q

what breast cancer patients will receive chemotherapy?

A
  • aggresive disease phenotype

- high risk disease- young age, ER negative, HER2 positive, grade 3, tumour size

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13
Q

if a woman if HER-2 positive what treatment is offered?

A

Trastuzumab

HER-2 positive has a worse prognosis

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14
Q

risk factors for pagets disease of the nipple

A
  • age (60’s)
  • female
  • afro-carribean
  • alcohol
  • dense breasts
  • obesity
  • FH
  • BRCA 1/2
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15
Q

clinical features of pagets disease of the nipple

A
  • scaling and flaking of the skin of the nipple
  • tingling
  • itching
  • sensitivty
  • burning
  • pain
  • bloody/ yellow discharge from nipple
  • nipple appears ‘flat’ against breast
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16
Q

diagnosis of pagets disease of the nipple

A

biopsy
mammogram
breast MRI

17
Q

tx of pagets disease of the nipple

A

mastectomy

lumpectomy

18
Q

when do fibroadenoma’s typically occur?

A

<30

19
Q

what is a fibroadenoma?

A

benign overgrowth of collagenous mesenchyme of one breast lobule

20
Q

how does a fibroadenoma present clinically?

A

painless, mobile, firm, smooth lump

21
Q

how are fibroadenoma’s managed and treated?

A

reassure and observe

excise if large

22
Q

when do breast cysts typically present and how do they present clinically?

A

35-50

fluid-filled rounded lump, occasionally painful, smooth, mobile

23
Q

how are breast cysts diagnosed and treated?

A

both by aspiration

24
Q

how does a breast abscess present clinically?

A

warm, painful swelling

nipple discharge (purulent pus)

tenderness

25
Q

how is a breast abscess managed?

A

drain, and then culture to decide on ABx- co-amoxiclav

26
Q

why might a mastectomy be indicated as opposed to a lumpectomy in someone with breast cancer?

A
  1. If the tumour is large relative to the size of breast.
  2. If there are multiple tumours.
  3. Patient preference
27
Q

what biopsy is done to ensure that breast cancer has not spread to axillary lymph nodes?

A

sentinel node biopsy

28
Q

what is a possible side effect of tamoxifen therapy in pre-menopausal women?

A

increased risk of endometrial cancer

29
Q

where do breast cancers commonly metastasise to?

A

liver, lung, bone, brain

30
Q

guidance on breast feeding in lactational mastitis/ breast abscess

A

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

31
Q

how does an intraductal papilloma present

A

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

32
Q

causes of lactational mastitis

A
  • obstruction leading to accumulation of milk

- infection- staph aureus

NP- Phase 3a Medicine (22 decks)

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