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Clinical > Breast Surgery > Flashcards

Breast Surgery Flashcards

1
Q

Common sites of breast cancer metastases

A

Bone
Liver
Lung
Brain

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2
Q

Common age of breast cancer diagnosis

A

50-70

affects 1/10 women in Ireland

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3
Q

Breast cancer subtypes

A 
The 3 main receptors looked at are oestrogen R, Progesterone R ( both called HR)  and HER2 
	• HR+/HER2-
		Ø 75% of all cancers 
	• HR-/HER2-
		Ø i.e. triple negative
	• HR+/HER2+
HR-/HER2+
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4
Q

What does triple assessment refer to?

A

Triple assessment

1. Clinical hx and examination
2. Radiological investigations
    3. Histology
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5
Q

What are the differentials for a lump in the breast?

A
  1. Tumor
  2. Sebaceous cyst
  3. Abscess
  4. Fibroadenoma
  5. Lipoma
  6. Lymphoma
  7. Papilloma
  8. Fat necrosis
  9. Enlarged lymph node
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6
Q

What are the histological types of breast cancer?

A 
5 types
Ductal 
Lobular
Tubular
Papillary 
Mucinous
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7
Q

Symptoms that patients with breast disease might present with

A

Could be asymptomatic

- Lump 
- Nipple discharge / bleeding
- Nipple changes
- Skin changes - colour or texture Skin dimpling
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8
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

followed by invasive lobular

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9
Q

Risk factors for breast cancer

A 
Female gender
Age
Obesity 
Radiation exposure
Hormone related
- early menarche
- late menopause
- nulliparity
- HRT
Genetic factors
- single gene - BRCA1 &2
- multigenic ( 1 in 4 risk group )
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10
Q

What lifestyle factors increase the risk of breast cancer?

A

Smoking
Obesity
Alcohol

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11
Q

What are the indications for a mastectomy?

A 
Tumor size relative to size of breast
Inflammatory breast cancer
Not eligible for radiotherapy
Patient choice
BRCA1 or 2
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12
Q

Management of inflammatory breast cancer

A

Neoadjuvant chemo
Mastectomy
Axillary clearance
Radiotherapy

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13
Q

In what situation could you not do radiotherapy?

A

Scleroderma

Unsuitable skin e.g. from previous skin grafts

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14
Q

What impact does the removal of axillary LNs have on prognosis?

A

does not improve prognosis

Cancer in the lymph is a marker of spread but not the only route i.e. could have haemorrhage spread

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15
Q

What mastectomy patients should also have radiotherapy?

A

T4 disease
T4 and LNs involved
Tumor 4-5cm in size

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16
Q

How is the axilla assessed?

A

Clinical exam for palpable nodes
US to see cortex and medulla clearly
US guided FNA

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17
Q

How does tamoxifen work?

A

Block oestrogen from stimulating cancer cells.

Acts as normal oestrogen at other cells so there is no loss of 2º sex characteristics

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18
Q

Why would you not use tamoxifen as prophylaxis to breast cancer?

A

There is a risk of causing endometrial cancer

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19
Q

What group of patients could take tamoxifen?

A

pre and post menopausal

women and men

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20
Q

Side effect of tamoxifen?

A

Night sweats and hot flushes

21
Q

What patients should have a SLNB?

A

Patients with node-negative disease on imaging

22
Q

Should a patient with a high oncotype Dx score be given adjuvant chemo?

A

Yes should be considered with scores above 26

23
Q

What is the role of hormone therapy in breast cancer?

A

Given to patient with hormone receptor ( ER or PR) positive breast cancer to reduce the risk of local and distant recurrenc

24
Q

What are aromatase inhibitors?

A

Aromatase inhibitors inhibit the synthesis of oestrogen from androgens.
Used in post-menopausal women

25
Q

Possible side effects of tamoxifen?

A

Endometrial cancer
Hot flushes
Thromboembolic events

26
Q

Role of radiotherapy in systemic breast cancer?

A

No

it is used to reduce local recurrence of breast cancer

27
Q

When is oncotype Dx used?

A

Used in patients with early luminal breast cancer to determine if chemo will give an added survival benefit.

28
Q

Why not use MRI for all breast cancer diagnosis?

A

Higher sensitivity so used in patients with lobular breast cancer and for high risk screening. But higher false positive rates so not suitable for general population

29
Q

ER+ premenopausal woman medication

A

Tamoxifen

30
Q

ER+ postmenopausal woman medication

A

Anastrozole

31
Q

Role of trastuzumab in breast cancer tx?

A

aka herceptin.

Used for HER+ breast cancer

32
Q

Surgery for DCIS >4cm

A

Mastectomy

33
Q

Surgery for multifocal tumor

A

Mastectomy

34
Q

Breast staging T1,T2,T3,t4

A 
T1 = < 2cm
T2 = 2 - 5cm
T3 = > 5cm
T4a = Invades skin 
T4c = Invades chest wall and skin
T4d = Inflammatory breast cancer [no matter the size]
35
Q

Antibiotic for acute mastitis

A

Flucloxacillin

36
Q

Lumpy breasts, may be painful, Symptoms worse before period

A

Fibroadenosis

Benign

37
Q

Most malignant form of brain tumor

A

Gliobastoma

38
Q

What is the prognosis of triple neg breast cancer?

A

Worst prognosis

agressive

39
Q

Which breast cancer subtype has the best prognosis?

A

HR+ ( ER or PR) and HER -ve

40
Q

surgical mgmt of DCIS (ductal carcinoma in situ)

A

Wide local excision [ v low risk pts] or lumpectomy and XRT or mastectomy w or w/o SLNB

41
Q

Surgical options for Invasive ca

A

Lumpectomy and XRT with SLNB or mastectomy w SLNB

42
Q

Size for removal of a fibroadenoma

A

more than 3cm if causing discomfort

43
Q

1st line tx of mastitis

A

continue breast feeding

44
Q

tender lump around areola ± green nipple discharge in a 50yo woman

A

mammary duct ectasia

45
Q

halo sign

A

most likely breast cyst

46
Q

symmetrical slit like retraction with cheese like discharge

A

duct ectasia

47
Q

Aromatase inhibitor anastrozole side effects

A

Osteoporosis
suitable for post menopausal women only
old women get osteoporosis

48
Q

osteoporosis is a side effect of what type of medication used in breast cancer?

A

Aromatase inhibitors

used in ER+ cancer in post menopausal women

49
Q

endometrial cancer is a possible side effect of which type of breast cancer medication ?

A

tamoxifen - used for ER+ cancer

can be used in both pre and peri menopausal women

Clinical (45 decks)

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