BREAST TO DO Flashcards
NON-INVASIVE DUCTAL CARCINOMA IN SITU (DCIS)
What is the pathology?
- Epithelial lining of breast ducts thickens as cells proliferate, often with central necrosis
- Microcalcification on mammography, unifocal lesion in one area of breast
PAGET’S DISEASE OF THE NIPPLE
What causes Paget’s disease of the nipple?
- Infiltration of tumours cells through the ducts onto nipple surface where they infiltrate the epidermis
BREAST CANCER
What are some protective factors of breast cancer?
- Breastfeeding
- Multiparity
- Late menarche + early menopause
BREAST CANCER
What are some other genetic mutations associated with breast cancer?
- TP53 (Li Fraumeni)
- Peutz-Jeghers
BREAST CANCER
What tumour marker can be used to monitor response to breast cancer treatment and disease recurrence?
- CA 15-3
BREAST CANCER SCREENING
What is the NHS breast screening programme?
- Women 50–70 invited every 3 years for dual-view mammography
- it improves stage at diagnosis so 5 year survival risen from 80% to 95%
BREAST CANCER
What are some complications of breast cancer?
- Locally advanced (rare), try shrink with radio, chemo, or hormone therapy to try operate, salvage surgery + stage for mets
- Metastatic breast cancer (2Ls 2Bs) = Lungs, Liver, Bones, Brain
BREAST CANCER
What adjuvant endocrine therapy may be given to women?
- All ER+ve women need endocrine therapy as increases survival
- Bisphosphonates to reduce rate of bone mets in ER+ve
- Trastuzumab (Herceptin) used in HER2+ve + chemo
BREAST CANCER
What endocrine therapy is given if…
i) pre-menopausal?
ii) post-menopausal?
i) Tamoxifen –inhibits oestrogen receptor on breast cancer cells
ii) Anastrozole (aromatase inhibitors) – inhibits aromatase which converts androgens > oestrogen
BREAST CANCER
Reconstruction surgery can either be primary (immediately) or delayed.
What are the pros and cons of primary reconstruction?
- Increased skin preservation options, reduced psychological trauma
- May delay chemo/radiotherapy if complications, radiotherapy may ruin results (fibrosis)
BREAST CANCER
Reconstruction surgery can either be primary (immediately) or delayed.
What are the pros and cons of delayed reconstruction?
- Minimal risks of delay in adjuvant therapies, healthy tissue used to recreate breast
- Limited skin preservation options, psychological impact (no breast)
NIPPLE DISCHARGE
What are some causes of nipple discharge?
- Duct ectasia
- Duct papilloma
- Galactorrhoea
- Infection
PAPILLOMA
What is duct papilloma?
How does it present?
- Benign warty growth behind nipple
BREAST INFECTION
What is the management of non-lactational mastitis?
- Same as lactational mastitis (flucloxacillin or erythromycin) but + metronidazole
BREAST INFECTION
What is the most common cause of mastitis?
What is there a caution with?
- S. Aureus then anaerobes (esp. non-lactational)
- Repeated incision in non-lactational abscess as can develop mammary fistula which is difficult to treat
GYNAECOMASTIA
What is gynaecomastia?
What is a differential?
- > 2cm lump of breast tissue behind male nipple
- Pseudo-gynaecomastia (deposition of fat in overweight men)
GYNAECOMASTIA
What are the two broad causes of gynaecomastia?
- Physiological = oestrogen + testosterone imbalance (puberty)
- Pathological
GYNAECOMASTIA
What are some pathological causes of gynaecomastia?
- Drugs (spironolactone, oestrogen, anabolic steroids)
- Marijuana
- Liver failure
- Testicular failure or tumour (Can produce beta-hCG)
METASTATIC BREAST CANCER
What is the management?
- Bisphosphonates + denosumab, radio/chemo + Sx control
FIBROADENOMA
What is the rule with fibroadenomas?
- 1/3 shrink, 1/3 same, 1/3 enlarge
BREAST CANCER
what is tamoxifen?
tamoxifen inhibits the oestrogen receptor on breast cancer cells
It increases survival by 15-25% in woman with ER+ cancer
give for 10 years in higher risk women
BREAST CANCER
what are the complications of tamoxifen?
hot flushes
nausea
vaginal bleeding
rarely thrombosis and endometrial cancer
BREAST CANCER
what are aromatase inhibitors?
letrozole
Inhibit aromatase enzyme responsible for the conversion of androgens to oestogen in post-menopausal woman
slightly better anticancer efficacy than tamoxifen
BREAST CANCER
what are the side effects of aromatase inhibitors?
hot flushes
reduced bone density
joint pains
