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Finals > Breast Surgery > Flashcards

Breast Surgery Flashcards

1
Q

Lactational Mastitis

what is it

A

inflammation of breast tissue

common complication of breast feeding

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2
Q

Lactational Mastitis

causes of mastitis

A
  • obstruction in ducts and accumulation of milk

- infection (Staph aureus)

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3
Q

Lactational Mastitis

how may obstruction be prevented

A

Regularly expressing breast milk

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4
Q

Lactational Mastitis

presentation

A
  • Breast pain and tenderness (unilateral)
  • Erythema in a focal area of breast tissue
  • Local warmth and inflammation
  • Nipple discharge
  • Fever
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5
Q

Lactational Mastitis

mnx when caused by blockage of ducts

A

conservative:

  • continued breastfeeding, expressing milk
  • breast massage
  • heat packs, warm showers
  • simple analgesia
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6
Q

Lactational Mastitis

mnx if infection suspected or conservative doesn’t work

A
  • flucloxacillin
  • erythromycin if allergic
  • sample of milk sent for C&S
  • Fluconazole if suspected candidal infection
  • continue breastfeeding
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7
Q

Lactational Mastitis

rare complication of mastitis

A

breast abscess

may need surgical incision and drainage

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8
Q

Lactational Mastitis

why may candidal infection cause recurrent mastitis

A

it causes cracked skin on the nipple that creates an entrance for infection.

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9
Q

Lactational Mastitis

if there is candida of the nipple, what may the infant get

A

oral thrush and candidal nappy rash

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10
Q

Lactational Mastitis

presentation of candida of the nipple

A
  • Sore nipples bilaterally, particularly after feeding
  • Nipple tenderness and itching
  • Cracked, flaky or shiny areola
  • baby: white patches in mouth and tongue, or candidal nappy rash
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11
Q

Lactational Mastitis

mnx of candida of the nipple

A
  • Topical miconazole 2% to the nipple after each breastfeed

- baby: PO miconazole gel or nystatin

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12
Q

Breast Pain (Mastalgia)

types

A

cyclical

non cyclical

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13
Q

Breast Pain (Mastalgia)

what may non-cyclical breast pain be caused by

A
  • Medications (e.g., hormonal contraceptive medications)
  • Infection (e.g., mastitis)
  • Pregnancy

no originating from breast:

  • costochondritis
  • shingles, post-herpetic neuralgia
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14
Q

Breast Pain (Mastalgia)

3 things to exclude when presenting with breast pain

A
  • cancer
  • infection
  • pregnancy
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15
Q

Breast Pain (Mastalgia)

what can help diagnose cyclical breast pain

A

a breast pain diary

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16
Q

Breast Pain (Mastalgia)

mnx of cyclical breast pain

A
  • supprotive bra
  • NSAIDs
  • avoid caffeine
  • heat
  • Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance
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17
Q

Breast Cancer

what does triple assessment involve

A
  • clinical assessment (hx + exam)
  • imaging (US or mammography)
  • histology (fine needle aspiration or core biopsy)
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18
Q

Breast Cancer

clinical features which may suggest its breast cancer

A
  • hard, irregular, painless or fixed in place lumps
  • lump tethered to skin or chest wall
  • nipple retraction
  • skin dimpling or oedema (peau d’orange)
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19
Q

Breast Cancer

when should you do a 2 week wait referral

A
  • unexplained breast lump in patients ≥ 30
  • unilateral nipple changes in patients ≥50 (discharge, retraction or other changes)
  • unexplained lump in the axilla in patients ≥ 30
  • skin changes suggestive of breast cancer
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20
Q

Breast Cancer

when should you consider a non-urgent referral

A

unexplained breast lumps in patients <30

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21
Q

Fibroadenoma

what are they

A

benign tumours of stromal/epithelial breast duct tissue

‘breast mouse’

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22
Q

Fibroadenoma

what age group are they common in

A

20 - 40

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23
Q

Fibroadenoma

what do they respond to

A

the female hormones (oestrogen and progesterone)

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24
Q

Fibroadenoma

examination findings

A
  • painless
  • smooth
  • round
  • well circumscribed
  • firm
  • mobile
  • usually up to 3cm
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25
Q

Fibroadenoma

are they associated with an increased risk of developing breast cancer

A

no

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26
Q

Fibrocystic Breast Changes

what are they

A

generalised lumpiness to the breast

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27
Q

Fibrocystic Breast Changes

when do these changes fluctuate

A

with the menstral cycle

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28
Q

Fibrocystic Breast Changes

when do symptoms occur in the the menstrual cycle

A

prior to menstruating (within 10 days) and resolve once menstruation begins

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29
Q

Fibrocystic Breast Changes

symptoms

A

different areas of the breast, or both breasts, with:

  • Lumpiness
  • Breast pain or tenderness (mastalgia)
  • Fluctuation of breast size
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30
Q

Fibrocystic Breast Changes

options to manage cyclical breast pain

A
  • supportive bra
  • NSAIDs
  • avoid caffeine
  • apply heat
  • hormonal trx (e.g., danazol and tamoxifen) under specialist guidance
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31
Q

what are the most common cause of breast lumps

A

breast cysts

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32
Q

Breast Cysts

do they increase risk of breast cancer

A

it may slightly

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33
Q

Breast Cysts

examination findings

A

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

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34
Q

Breast Cysts

affected by menstrual period?

A

may fluctuate in size over the menstrual cycle.

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35
Q

Fat necrosis

what is it

A

a benign lump formed by localised degeneration and scarring of fat tissue in the breast

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36
Q

Fat necrosis

what is it commonly triggered by

A
  • localised trauma
  • radiotherapy
  • surgery
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37
Q

Fat necrosis

how do the triggers cause fibrosis and necrosis of fat tissue

A

inflammatory reaction

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38
Q

Fat necrosis

does it increase the risk of breast cancer

A

no

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39
Q

Fat necrosis

examination findings

A
  • painless
  • firm
  • irregular
  • fixed in local structures
  • may be skin dimpling or nipple inversion
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40
Q

Fat necrosis

what may US or mammogram show

A

similar appearance to breast cancer.

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41
Q

Fat necrosis

what may be required to confirm the dx and exclude breast cancer

A

histology (by fine needle aspiration or core biopsy)

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42
Q

Fat necrosis

mnx

A
  • conservative, resolved spontaneously with time

- surgical excision may be used if required for sx

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43
Q

Lipoma

what are they

A

benign tumours of fat (adipose) tissue

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44
Q

Lipoma

examination findings

A
  • soft
  • painless
  • mobile
  • do not cause skin changes
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45
Q

Lipoma

trx

A

treated conservatively with reassurance. Alternatively, they can be surgically removed.

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46
Q

Galactocele

what are they

A

breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk

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47
Q

Galactocele

who do they commonly occur in

A

lactating women who have stopped breastfeeding

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48
Q

Galactocele

presentation

A

firm, mobile, painless lump, usually beneath the areola.

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49
Q

Galactocele

trx

A

resolve without any treatment. It is possible to drain them with a needle.

Rarely, they can become infected and require antibiotics.

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50
Q

Phyllodes tumour

what are they

A

rare tumours of the connective tissue (stroma) of the breast, occurring most often between ages 40 and 50

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51
Q

Phyllodes tumour

features

A
  • large

- fast growing

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52
Q

Phyllodes tumour

types

A

benign (~50%), borderline (~25%) or malignant (~25%)

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53
Q

Phyllodes tumour

trx

A

surgical removal of the tumour and wide excision

chemo if malignant

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54
Q

Gynaecomastia

what is it

A

enlargement of the glandular breast tissue in males

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55
Q

Gynaecomastia

which hormones stimulate glandular breast tissue development

A

oestrogen and prolactin

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56
Q

Gynaecomastia

why can antipsychotic medication cause gynaecomastia

A

they are dopamine antagonists

dopamine inhibits prolactin

less dopamine = more prolactin = gynaecomastia and galactorrhea

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57
Q

Gynaecomastia

why can there be gynaecomastia in adolescents

A

proportionally higher oestrogen levels around puberty

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58
Q

Gynaecomastia

causes (conditions that increase oestrogen)

A
  • obesity (aromatase converts androgens to oestrogen)
  • testicular cancer (oestrogen secretion from Leydig cell tumour)
  • liver cirrhosis + liver failure
  • hyperthyroidism
  • hCG secreting tumour (e.g. small cell lung cancer)
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59
Q

man presenting with gynaecomastia. what additional examination should be performed

A

testicular examination for leydig cell tumour

Also, examine for signs of liver failure and hyperthyroidism.

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60
Q

Gynaecomastia

causes (conditions that reduce testosterone)

A
  • testosterone deficiency in older age
  • hypothalamus or pituitary conditions that reduce LH + FSH (tumour, radio, surgery)
  • Klinefelter syndrome (XXY sex chromosomes)
  • orchitis (infection of testicles with mumps)
  • testicular damage
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61
Q

Gynaecomastia

drug causes

A
  • Anabolic steroids (raise oestrogen levels)
  • Antipsychotics (increase prolactin levels)
  • Digoxin (stimulates oestrogen receptors)
  • Spironolactone (inhibits testosterone production and blocks testosterone receptors)
  • Gonadotrophin-releasing hormone (GnRH) agonists (e.g., goserelin used to treat prostate cancer)
  • Opiates (e.g., illicit heroin use)
  • Marijuana
  • Alcohol
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62
Q

Gynaecomastia

difference between gynaecomastia and breast enlargement due to obesity (pseudogynaecomastia) on palpation

A

gynaecomastia: firm tissue behind the areolas
obese: tissue soft and more evenly distributed

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63
Q

Gynaecomastia

key points to cover in hx

A
  • age of onset, duration , change over time
  • sexual dysfunction (indicates low testosterone)
  • breast lumps or skin changes (breast cancer)
  • testicular lumps or sx of hyperthyroidism
  • medications
  • anabolic steroids, illicit drugs or alcohol
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64
Q

Gynaecomastia

key points to cover in examination

A
  • true gynaecomastia vs adipose tissue
  • unilateral or bilateral (palpable lumps, skin changes or lymphadenopathy)
  • BMI
  • testicular exam
  • reduced hair (testosterone deficiency)
  • liver disease (jaundice, hepatomegaly, spider naevi, ascites)
  • hyperthyroidism (sweating, tachycardia, weight loss)
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65
Q

Gynaecomastia

inx for simple gynaecomastia in an otherwise healthy adolescent

A

watchful waiting

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66
Q

Gynaecomastia

inx for unexplained rapid-onset gynaecomastia in a 30 year old male with no apparent cause

A

bloods and imaging

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67
Q

Gynaecomastia

trx in problematic causes (e.g. pain or psychological distress)

A
  • tamoxifen (reduces oestrogen in breast tissue)

- surgery

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68
Q

Galactorrhoea

what is it

A

breast milk production not associated with pregnancy or breastfeeding

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69
Q

Galactorrhoea

what is breast milk produced in response to

A

prolactin

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70
Q

Galactorrhoea

what produces prolactin

A

anterior pituitary gland

breast and prostate also produce it

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71
Q

Galactorrhoea

what blocks the secretion of prolactin

A

dopamine

so dopamine antagonists (i.e., antipsychotic medications) can result in raised prolactin and galactorrhea

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72
Q

Galactorrhoea

what can suppress prolactin secretion

A

Dopamine agonists (e.g., bromocriptine or cabergoline)

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73
Q

Galactorrhoea

when may milk production start in pregnancy

A

2nd or 3rd trimester

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74
Q

Galactorrhoea

in pregnancy, what inhibits the secretion of prolactin

A

Oestrogen and progesterone

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75
Q

Galactorrhoea

in pregnancy, what stimulates breast milk excretion

A

oxytocin

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76
Q

Galactorrhoea

what stimulates full milk production shortly after birth

A

response to oxytocin release and a rapid drop in oestrogen and progesterone

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77
Q

Galactorrhoea

what is usually the cause

A

hyperprolactinaemia

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78
Q

Galactorrhoea

key causes of hyperprolactinaemia

A
  • idiopathic
  • prolactinomas
  • endocrine: hypothyroidism, PCOS
  • meds: dopamine antagonists e.g. antipsychotics
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79
Q

Galactorrhoea

what does prolactin suppress and therefore cause

A

GnRH by the hypothalamus

leading to reduced LH and FSH release

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80
Q

Galactorrhoea

what does hyperprolactinaemia present with (due to reduced LH and FSH)

A
  • amenorrhoea
  • reduced libido
  • erectile dysfunction
  • gynaecomastia
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81
Q

Galactorrhoea

what are prolactinomas

A

tumours of the pituitary gland that secrete excessive prolactin

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82
Q

Galactorrhoea

what condition may prolactinomas be associated with

A

multiple endocrine neoplasia (MEN) type 1

an autosomal dominant genetic condition

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83
Q

Galactorrhoea

what are microprolactinomas

A

<10mm

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84
Q

Galactorrhoea

what are macroprolactinomas

A

> 10mm

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85
Q

Galactorrhoea

what adverse effects can macroadenomas have relating to their size

A
  • Headaches

- Bitemporal hemianopia

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86
Q

Galactorrhoea

why is there bitemporal hemianopia in prolactinomas

A
  • optic chiasm sits just above pituitary gland
  • the optic chiasm is where the optic nerves cross over
  • Only the nerves fibres containing the signal from the outer visual fields cross over,
  • fibres from the inner visual fields continue on the same side
  • pituitary tumour of sufficient size will press on the optic chiasm
  • outer visual fields in both eyes (the inner visual fields are spared
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87
Q

Galactorrhoea

what conditions can cause nipple discharge that is not breast milk

A
  • mammary duct ectasia
  • duct papilloma
  • pus from a breast abscess
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88
Q

Galactorrhoea

initial investigations

A

PREGNANCY TEST

  • Serum prolactin
  • U&Es
  • LFTs
  • TFTs
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89
Q

Galactorrhoea

diagnostic inx for pituitary tumour

A

MRI scan

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90
Q

Galactorrhoea

what can be used to trx the sx of hyperprolactinaemia

A

Dopamine agonists (e.g., bromocriptine or cabergoline)

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91
Q

Galactorrhoea

what is the definitive treatment of hyperprolactinaemia secondary to a prolactinoma.

A

Trans-sphenoidal surgical removal of the pituitary tumour

92
Q

Mammary Duct Ectasia

what is it

A

a benign condition where there is dilation of the large ducts in the breasts

ectasia = dilatation

93
Q

Mammary Duct Ectasia

what does inflammation of the ducts lead to

A

intermittent white, grey or green discharge from the nipple

94
Q

Mammary Duct Ectasia

who does it occur most frequently in

A

perimenopausal women

95
Q

Mammary Duct Ectasia

what is a significant RF

96
Q

Mammary Duct Ectasia

  • presentation
A
  • nipple discharge
  • tenderness or pain
  • nipple retraction or inversion
  • breast lump (pressure may produce nipple discharge)
97
Q

Mammary Duct Ectasia

what is the initial priority when investigating

A

exclude breast cancer

98
Q

Mammary Duct Ectasia

what inx to exclude breast cancer

A

triple assessment:
- clinical assessment (hx + exam)

  • imaging (US, mammography, MRI)
  • histology (fine needle aspiration or core biopsy)
99
Q

Mammary Duct Ectasia

what is a key finding on a mammogram

A

microcalcifications

but not specific to mammary duct ectasia

100
Q

Mammary Duct Ectasia

other inx that may be performed (apart from triple assessment)

A
  • ductography
  • nipple discharge cytology
  • ductoscopy
101
Q

Mammary Duct Ectasia

what is ductography

A

contrast is injected into an abnormal duct, and mammograms are performed to visualise the duct

102
Q

Mammary Duct Ectasia

what is nipple discharge cytology

A

examining the cells in a sample of the nipple discharge

103
Q

Mammary Duct Ectasia

what is ductoscopy

A

inserting a tiny endoscope (camera) into the duct

104
Q

Mammary Duct Ectasia

mnx

A
  • may resolve
  • reassurance after excluding cancer
  • mnx of mastalgia: supportive bra, warm compresses
  • abx if infection
105
Q

Mammary Duct Ectasia

what may be required in problematic cases

A

surgical excision

106
Q

Intraductal Papilloma

what is it

A

a warty lesion that grows within one of the ducts in the breast.

the result of proliferation of epithelial cells

107
Q

Intraductal Papilloma

are they cancerous

A

the are benign tumours

but can be associated with atypical hyperplasia or breast cancer.

108
Q

Intraductal Papilloma

what age do most occur in

109
Q

Intraductal Papilloma

presentation

A
  • Nipple discharge (clear or blood-stained)
  • Tenderness or pain
  • A palpable lump
110
Q

Intraductal Papilloma

inx

A
  • triple assessment (clinical, imaging, histology)

- ductography

111
Q

Intraductal Papilloma

what will it show on ductography

A

The papilloma will be seen as an area that does not fill with contrast (a “filling defect”).

112
Q

Intraductal Papilloma

mnx

A
  • complete surgical excision

- tissue is examined for atypical hyperplasia or cancer that may not have been picked up on the biopsy

113
Q

Breast Abscess

what is it

A

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

114
Q

Breast Abscess

what types are there

A

Lactational abscess (associated with breastfeeding)

Non-lactational abscess (unrelated to breastfeeding)

115
Q

Breast Abscess

what does pus contain

A

dead white blood cells of the immune system and other waste from the fight against the infection

116
Q

Breast Abscess

how does an abscess form

A

When pus becomes trapped in a specific area and cannot drain

117
Q

Breast Abscess

what may precede the development of an abscess

A

Mastitis caused by infection

118
Q

Breast Abscess

what is a key RF for infective mastitis and breast abscesses

119
Q

Breast Abscess

what can predispose the woman to infection

A

Damage to the nipple (e.g., nipple eczema, candidal infection or piercings) provides bacteria entry

underlying breast disease (e.g., cancer) can affect the drainage of the breast

120
Q

Breast Abscess

what is the most common causative bacteria

A
  1. staph aureus

strep, enterococcal, anaerobics

121
Q

Breast Abscess

what are penicillins effective against

A

gram positive bac

  • staph aureus
  • strep
  • enterococcal
122
Q

Breast Abscess

what is co-amoxiclav and metronidazole effective against

123
Q

Breast Abscess

onset

A

acute (within a few days)

124
Q

Breast Abscess

how does Mastitis with infection in the breast tissue presents with

A
  • Nipple changes
  • Purulent nipple discharge (pus from the nipple)
  • Localised pain
  • Tenderness
  • Warmth
  • Erythema (redness)
  • Hardening of the skin or breast tissue
  • Swelling
125
Q

Breast Abscess

what is the key feature that suggests a breast abscess

A

a swollen, fluctuant, tender lump within the breast

126
Q

Breast Abscess

what does fluctuance refer to

A

being able to move fluid around within the lump using pressure during palpation

127
Q

Breast Abscess

examination findings of infection without an abscess

A

hardness of the tissue, forming a lump

but it will not be fluctuant as it is not filled with fluid.

128
Q

Breast Abscess

dx of mastitis or a breast abscess

A

clinical with hx + exam

129
Q

Breast Abscess

mnx of lactational mastitis (caused by blockage of the ducts)

A
  • conservative
  • continue breastfeeding
  • heat packs
  • warm showers
  • analgesia
  • flucloxacillin if infection suspected
130
Q

Breast Abscess

mnx of non-lactational mastitis

A
  • Analgesia
  • Antibiotics
  • Treatment for the underlying cause (e.g., eczema or candidal infection)
131
Q

Breast Abscess

what abx for non-lactational mastitis

A

broad spectrum
- co-amoxiclav
or
- erythromycin/clarithromycin + metronidazole

132
Q

Breast Abscess

mnx

A
  • refer to on-call surgical team
  • abx
  • drainage (needle aspiration or surgical incision + drainage)
  • MC&S
133
Q

Breast Abscess

should women continue breastfeeding

134
Q

what is the most common form of cancer in the UK

A

breast cancer

Around 1 in 8 women will develop breast cancer in their lifetime.

135
Q

Breast Cancer

RFs

A
  • female
  • increased oestrogen exposure (earlier onset of periods + later menopause)
  • more glandular tissue
  • obesity
  • smoking
  • FH (1st degree relative)
  • COCP, HRT
136
Q

Breast Cancer

what happens to the risk 10 years after stopping the COCP

A

risk returns to normal

137
Q

Breast Cancer

what is BRCA

A

BReast CAncer gene

tumour suppressor genes `

138
Q

Breast Cancer

where is the BRCA1 gene located

139
Q

Breast Cancer

in patients with a faulty BRCA1 gene, what will patients’ risk of cancers be

A
  • 70% will develop breast cancer by 80y
  • 50% will develop ovarian cancer
  • increased risk of bowel + prostate cancer
140
Q

Breast Cancer

where is the BRCA2 gene located

141
Q

Breast Cancer

in patients with a faulty BRCA2 gene, what will patients’ risk of cancers be

A
  • 60% will develop breast cancer by 80y

- 20% will develop ovarian cancer

142
Q

Breast Cancer

what are the other rarer genetic abnormalities associated with breast cancer

A

TP53 and PTEN genes

143
Q

Breast Cancer

what are the more common types

A
  • Ductal Carcinoma In Situ (DCIS)
  • Lobular Carcinoma In Situ (LCIS)
  • Invasive Ductal Carcinoma – NST
  • Invasive Lobular Carcinomas (ILC)
  • Inflammatory Breast Cancer
  • Paget’s Disease of the Nipple
144
Q

Breast Cancer

DCIS: what is it

A

Pre-cancerous or cancerous epithelial cells of the breast ducts

145
Q

Breast Cancer

DCIS: is it localised to a single area

A

yes but potential to spread locally over years

146
Q

Breast Cancer

DCIS: when is it often picked up

A

by mammogram screening

147
Q

Breast Cancer

DCIS: can it become invasive breast cancer

A

30% potential

148
Q

Breast Cancer

DCIS: prognosis

A

Good prognosis if fully excised and adjuvant treatment is used

149
Q

Breast Cancer

LCIS: what is it

A

A pre-cancerous condition occurring typically in pre-menopausal women

150
Q

Breast Cancer

LCIS: how is it usually picked up

A

diagnosed incidentally on a breast biopsy

Usually asymptomatic and undetectable on a mammogram

151
Q

Breast Cancer

LCIS: is there a risk of invasive breast cancer in the future

A

yes around 30%

152
Q

Breast Cancer

LCIS: how is it often managed

A

close monitoring (e.g. 6 monthly examination and yearly mammograms)

153
Q

Breast Cancer

Invasive Ductal Carcinoma (NST): what is it

A

NST: no special/specific type, where it is not more specifically classified e.g. medullary or mucinous

154
Q

Breast Cancer

Invasive Ductal Carcinoma (NST): where does it originate

A

in cells from the breast ducts

155
Q

Breast Cancer

Invasive Ductal Carcinoma (NST): is it invasive

A

80% of invasive breast cancers fall into this category

156
Q

Breast Cancer

Invasive Ductal Carcinoma (NST): can it be seen on mammograms

157
Q

Breast Cancer

Invasive Lobular Carcinoma (ILC): where does it originate

A

in cells from the breast lobules

158
Q

Breast Cancer

Invasive Lobular Carcinoma (ILC): is it invasive

A

Around 10% of invasive breast cancers

159
Q

Breast Cancer

Invasive Lobular Carcinoma (ILC):is it visible on mammograms

A

not always visible

160
Q

Breast Cancer

Inflammatory Breast Cancer: what % of breast cancers

161
Q

Breast Cancer

Inflammatory Breast Cancer: what does it present similarly to

A

breast abscess or mastitis

162
Q

Breast Cancer

Inflammatory Breast Cancer: presentation

A

Swollen, warm, tender breast with pitting skin (peau d’orange)

163
Q

Breast Cancer

Inflammatory Breast Cancer:does it respond to abx

164
Q

Breast Cancer

Inflammatory Breast Cancer: prognosis

A

Worse prognosis than other breast cancers

165
Q

Breast Cancer

Paget’s Disease of the Nipple: what does it look like

A
  • eczema of the nipple/areolar
166
Q

Breast Cancer

Paget’s Disease of the Nipple: presentation

A

Erythematous, scaly rash

167
Q

Breast Cancer

Paget’s Disease of the Nipple: what may it represent

A

DCIS or invasive breast cancer

168
Q

Breast Cancer

Paget’s Disease of the Nipple: what does it indicate

A

breast cancer involving the nipple

169
Q

Breast Cancer

Paget’s Disease of the Nipple: mnx

A

Requires biopsy, staging and treatment, as with any other invasive breast cancer

170
Q

Breast Cancer

name some rarer types of breast cancer

A
  • Medullary breast cancer
  • Mucinous breast cancer
  • Tubular breast cancer
  • Multiple others
171
Q

Breast Cancer

who is screening offered to

A

mammogram every 3 years to women aged 50 – 70 years

172
Q

Breast Cancer

which patients are at high-risk

A
  • 1st degree relative w/ breast cancer <40y
  • 1st degree male relative w/ breast cancer
  • 1st degree relative w/ bilateral breast cancer. first diagnosed <50y
  • Two 1st degree relatives w/ breast cancer
173
Q

Breast Cancer

what do patients require before genetic tests

A

genetic counselling and pre-test counselling

174
Q

Breast Cancer

who is annual mammograms offered to

A

women with increased risk

potentially starting from aged 30

175
Q

Breast Cancer

what chemoprevention may be offered for women at high risk

A
  • tamoxifen if premenopausal

- anastrozole if postmenopausal (except w/ severe osteoporosis)

176
Q

Breast Cancer

what is an option for a small number of high risk women

A

Risk-reducing bilateral mastectomy or bilateral oophorectomy

177
Q

Breast Cancer

clinical features

A
  • Lumps that are hard, irregular, painless or fixed in place
  • Lumps may be tethered to the skin or the chest wall
  • Nipple retraction
  • Skin dimpling or oedema (peau d’orange)
  • Lymphadenopathy, particularly in the axilla
178
Q

Breast Cancer

NICE recommend a 2 week wait referral for suspected breast cancer for…

A
  • an unexplained lump in in pts aged ≥30

- unilateral nipple changes in pts aged ≥50 (discharge, retraction or other changes)

179
Q

Breast Cancer

NICE recommend considering a 2 week wait referral for…

A
  • an unexplained lump in the axilla in pts aged ≥30

- skin changes suggestive of breast cancer

180
Q

Breast Cancer

NICE suggest considering a non-urgent referral for…

A

unexplained breast lumps in patients <30y

181
Q

Breast Cancer

what does a triple diagnostic assessment comprise of

A
  1. Clinical assessment (history and examination)
  2. Imaging (ultrasound or mammography)
  3. Biopsy (fine needle aspiration or core biopsy)
182
Q

Breast Cancer

when may US be used for imaging and why

A

assess lumps in women <30y

because they have more dense breasts with more glandular tissue

helpful in distinguishing solid lumps (e.g., fibroadenoma or cancer) from cystic (fluid-filled) lumps

183
Q

Breast Cancer

who are mammograms used in

A

generally more effective in older women. They can pick up calcifications missed by ultrasound.

184
Q

Breast Cancer

when may MRI scans be used

A
  • For screening in women at higher risk of developing breast cancer (e.g., strong family history)
  • To further assess the size and features of a tumour
185
Q

Breast Cancer

what is involved in a lymph node assessment

A

US of the axilla

US-guided biopsy of any abnormal nodes

A sentinel lymph node biopsy may be used during breast cancer surgery where the initial US does not show any abnormal nodes

186
Q

Breast Cancer

what happens in sentinel lymph node biopsy

A
  • isotope contrast and a blue dye injected into tumour area
  • it travels through the lymphatics to the 1st lymph node (the sentinel node)
  • shows up blue on the isotope scanner
  • biopsy of this node performed
  • if cancer cells found, lymph node removed
187
Q

Breast Cancer

what are the 3 types of breast cancer receptors

A

Oestrogen receptors (ER)

Progesterone receptors (PR)

Human epidermal growth factor (HER2)

188
Q

Breast Cancer

what is triple-negative breast cancer

A

the breast cancer cells do not express any of these three receptors.

worst prognosis because it limits trx options

189
Q

Breast Cancer

what does gene expression profiling involve

A

assessing which genes are present within the breast cancer on a histology sample

helps predict the probability that the breast cancer will reoccur as a distal metastasis within 10y

190
Q

Breast Cancer

NICE recommend gene expression profiling for whom

A

women with early breast cancers that are ER positive but HER2 and lymph node negative.

It helps guide whether to give additional chemotherapy.

191
Q

Breast Cancer

notable locations that breast cancer metastase to

A

2 L and 2 B

liver
lungs
bones
brain

but can spread anywhere

192
Q

Breast Cancer

which 2 cancers can spread practically anywhere

A

melanoma and breast cancer

193
Q

Breast Cancer

inx for staging

A
  • triple assessment
  • Lymph node assessment + biopsy
  • MRI of breast and axilla
  • Liver US for liver metastasis
  • CT of thorax, abdo + pelvis for metastasis
  • Isotope bone scan for bony metastasis
194
Q

Breast Cancer

which system is used to stage breast cancer

A

TNM system

This grades the tumour (T), nodes (N) and metastasis (M).

195
Q

Breast Cancer

what are the options for tumour removal

A
  • Breast-conserving surgery (e.g. wide local excision), usually coupled with radiotherapy
  • Mastectomy (removal of the whole breast), potentially with immediate or delayed breast reconstruction
196
Q

Breast Cancer

what is offered to pts where cancer cells are found in the nodes

A

axillary clearance (removal of axillary lymph nodes)

197
Q

Breast Cancer

what does axillary clearance increase the risk of and why

A

chronic lymphoedema

due to impaired lymphatic drainage

198
Q

Breast Cancer

non-surgical trx for chronic lymphedema

A
  • Massage techniques to manually drain the lymphatic system (manual lymphatic drainage)
  • Compression bandages
  • Specific lymphoedema exercises to improve lymph drainage
  • Weight loss if overweight
  • Good skin care
199
Q

Breast Cancer

why should you avoid taking blood or putting a cannula in the arm on the side of previous breast cancer removal surgery

A

higher risk of complications and infection due to the impaired lymphatic drainage on that side.

200
Q

Breast Cancer

when is radiotherapy usually used

A

in patients with breast-conserving surgery to reduce the risk of recurrence

201
Q

Breast Cancer

common side effects of radiotherapy

A
  • General fatigue from the radiation
  • Local skin and tissue irritation and swelling
  • Fibrosis of breast tissue
  • Shrinking of breast tissue
  • Long term skin colour changes (usually darker)
202
Q

Breast Cancer

when is chemo used

A

1 in 3 scenarios:

  • Neoadjuvant therapy: shrink tumour before surgery
  • Adjuvant chemotherapy: after surgery to reduce recurrence
  • Trx of metastatic or recurrent breast cancer
203
Q

Breast Cancer

trx for oestrogen-receptor positive breast cancer in premenopausal women

204
Q

Breast Cancer

what is tamoxifen

A

a selective oestrogen receptor modulator (SERM)

blocks oestrogen receptors in breast tissue, and stimulates oestrogen receptors in the uterus and bones

helps prevent osteoporosis, but it does increase the risk of endometrial cancer.

205
Q

Breast Cancer

trx for oestrogen-receptor positive breast cancer in postmenopausal women

A

Aromatase inhibitors

e.g., letrozole, anastrozole or exemestane

206
Q

Breast Cancer

what are aromatase inhibitors

A

blocking the creation of oestrogen in fat tissue

because aromatase is an enzyme found in fat (adipose) tissue that converts androgens to oestrogen

207
Q

Breast Cancer

how long is tamoxifen or an aromatase inhibitor given for

208
Q

Breast Cancer

what are the other options for women with oestrogen-receptor positive breast cancer

A
  • Fulvestrant (selective oestrogen receptor downregulator)
  • GnRH agonists (e.g., goserelin or leuprorelin)
  • Ovarian surgery
209
Q

Breast Cancer

what trx can be used for HER2 positive breast cancer

A

Trastuzumab (Herceptin)

and/or Pertuzumab (Perjeta)

or Neratinib (Nerlynx)

210
Q

Breast Cancer

what are Trastuzumab (Herceptin)

and Pertuzumab (Perjeta)

A

monoclonal antibodies that target the HER2 receptor

211
Q

Breast Cancer

what is Neratinib (Nerlynx)

A

a tyrosine kinase inhibitor, reducing the growth of breast cancer

212
Q

Breast Cancer

if patients have been treated for breast cancer, how do you follow them up

A

surveillance mammograms yearly for 5 years

213
Q

Breast Cancer

what are the 2 options for reconstructive surgery following a mastectomy

A

Immediate reconstruction, done at the time of the mastectomy

Delayed reconstruction, which can be delayed for months or years after the initial mastectomy

214
Q

Breast Cancer

After breast-conserving surgery. what reconstructive surgery may be given

A
  • Partial reconstruction (using a flap or fat tissue to fill the gap)
  • Reduction and reshaping (removing tissue and reshaping both breasts to match)
215
Q

Breast Cancer

what are the options for reconstructing the breast after mastectomy

A

Breast implants (inserting a synthetic implant)

Flap reconstruction (using tissue from another part of the body to reconstruct the breast)

216
Q

Breast Cancer

what are the long term problems with implants

A

hardening, leakage and shape change.

217
Q

Breast Cancer

what are the different flap options

A
  • Latissimus Dorsi Flap
  • Transverse Rectus Abdominis Flap (TRAM Flap)
  • Deep Inferior Epigastric Perforator Flap (DIEP Flap)
218
Q

Breast Cancer

what is a pedicled flap

A

keeping the original blood supply and moving the tissue under the skin to a new location

219
Q

Breast Cancer

what is a free flap

A

cutting the tissue away completely and transplanting it to a new location.

220
Q

what is a well documented side effect of Trastuzumab ( Herceptin)

A

cardiotoxicity resulting in heart failure

221
Q

microcalcifications on mammogram

cells do not extend past the basement membrane into the myo-epithelial layer on core needle biopsy

what is it

222
Q

what is the difference between cytology and histology

A

histology: studying tissues under a microscope
cytology: studying cells under a microscope

223
Q

what is the difference between fine needle aspiration and core needle biopsy

A

core needle biopsy: for histology

fine needle aspiration: for cytology

224
Q

25y female presents with swelling of her nipple on her right breast. There is a bloody discharge from the nipple and the nipple is inverted. Just laterally to the areola there is a sinus discharging pus. smoker

what is it

A

Periductal mastitis

The mammary duct fistula is a feature associated with periductal mastitis. This condition occurs when the ducts behind the nipple become infected.

225
Q

what should all patients be offered with wide local excision

A

radiotherapy

Finals (47 decks)

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