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A TO REVISE - PHASE 3A > BREAST TO DO > Flashcards

BREAST TO DO Flashcards

1
Q

NON-INVASIVE DUCTAL CARCINOMA IN SITU (DCIS)
What is the pathology?

A
  • Epithelial lining of breast ducts thickens as cells proliferate, often with central necrosis
  • Microcalcification on mammography, unifocal lesion in one area of breast
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2
Q

PAGET’S DISEASE OF THE NIPPLE
What causes Paget’s disease of the nipple?

A
  • Infiltration of tumours cells through the ducts onto nipple surface where they infiltrate the epidermis
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3
Q

BREAST CANCER
What are some protective factors of breast cancer?

A
  • Breastfeeding
  • Multiparity
  • Late menarche + early menopause
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4
Q

BREAST CANCER
What are some other genetic mutations associated with breast cancer?

A
  • TP53 (Li Fraumeni)
  • Peutz-Jeghers
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5
Q

BREAST CANCER
What tumour marker can be used to monitor response to breast cancer treatment and disease recurrence?

A
  • CA 15-3
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6
Q

BREAST CANCER SCREENING
What is the NHS breast screening programme?

A
  • 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%
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7
Q

BREAST CANCER
What are some complications of breast cancer?

A
  • 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
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8
Q

BREAST CANCER
What adjuvant endocrine therapy may be given to women?

A
  • 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
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9
Q

BREAST CANCER
What endocrine therapy is given if…

i) pre-menopausal?
ii) post-menopausal?

A

i) Tamoxifen –inhibits oestrogen receptor on breast cancer cells
ii) Anastrozole (aromatase inhibitors) – inhibits aromatase which converts androgens > oestrogen

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10
Q

BREAST CANCER
Reconstruction surgery can either be primary (immediately) or delayed.
What are the pros and cons of primary reconstruction?

A
  • Increased skin preservation options, reduced psychological trauma
  • May delay chemo/radiotherapy if complications, radiotherapy may ruin results (fibrosis)
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11
Q

BREAST CANCER
Reconstruction surgery can either be primary (immediately) or delayed.
What are the pros and cons of delayed reconstruction?

A
  • Minimal risks of delay in adjuvant therapies, healthy tissue used to recreate breast
  • Limited skin preservation options, psychological impact (no breast)
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12
Q

NIPPLE DISCHARGE
What are some causes of nipple discharge?

A
  • Duct ectasia
  • Duct papilloma
  • Galactorrhoea
  • Infection
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13
Q

PAPILLOMA
What is duct papilloma?
How does it present?

A
  • Benign warty growth behind nipple
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14
Q

BREAST INFECTION
What is the management of non-lactational mastitis?

A
  • Same as lactational mastitis (flucloxacillin or erythromycin) but + metronidazole
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15
Q

BREAST INFECTION
What is the most common cause of mastitis?
What is there a caution with?

A
  • S. Aureus then anaerobes (esp. non-lactational)
  • Repeated incision in non-lactational abscess as can develop mammary fistula which is difficult to treat
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16
Q

GYNAECOMASTIA
What is gynaecomastia?
What is a differential?

A
  • > 2cm lump of breast tissue behind male nipple
  • Pseudo-gynaecomastia (deposition of fat in overweight men)
17
Q

GYNAECOMASTIA
What are the two broad causes of gynaecomastia?

A
  • Physiological = oestrogen + testosterone imbalance (puberty)
  • Pathological
18
Q

GYNAECOMASTIA
What are some pathological causes of gynaecomastia?

A
  • Drugs (spironolactone, oestrogen, anabolic steroids)
  • Marijuana
  • Liver failure
  • Testicular failure or tumour (Can produce beta-hCG)
19
Q

METASTATIC BREAST CANCER
What is the management?

A
  • Bisphosphonates + denosumab, radio/chemo + Sx control
20
Q

FIBROADENOMA
What is the rule with fibroadenomas?

A
  • 1/3 shrink, 1/3 same, 1/3 enlarge
21
Q

BREAST CANCER
what is tamoxifen?

A

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

22
Q

BREAST CANCER
what are the complications of tamoxifen?

A

hot flushes
nausea
vaginal bleeding
rarely thrombosis and endometrial cancer

23
Q

BREAST CANCER
what are aromatase inhibitors?

A

letrozole
Inhibit aromatase enzyme responsible for the conversion of androgens to oestogen in post-menopausal woman
slightly better anticancer efficacy than tamoxifen

24
Q

BREAST CANCER
what are the side effects of aromatase inhibitors?

A

hot flushes
reduced bone density
joint pains

25
Q

BREAST CANCER
what is Her-2?

A

HER2-positive breast cancer is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells

long known as a marker for poor prognosis

26
Q

BREAST CANCER
how is HER-2 breast cancer managed?

A

Currently 1 year of 3 weekly adjuvant Trastuzumab given alongside chemotherapy (usually FEC-T).

27
Q

BBREAST CANCER
how can you find impalpable cancers?

A

wire localisation

28
Q

PAGET’S DISEASE OF THE NIPPLE
what are the risk factors?

A
  • old age
  • FHx of breast cancer
  • Previous breast cancer
  • overweight
  • excess alcohol
  • smoking
  • risk factors for breast cancer
29
Q

PAGET’S DISEASE OF THE NIPPLE
what are the risk factors?

A
  • old age
  • FHx of breast cancer
  • Previous breast cancer
  • overweight
  • excess alcohol
  • smoking
  • risk factors for breast cancer
30
Q

PAPILLOMA
what is the clinical presentation?

A
  • bloody or clear discharge from a single duct
31
Q

PAPILLOMA
what is the management?

A
  • removal via vacuum assisted excision (VAE)
32
Q

PAPILLOMA
what are they associated with?

A

atypical hyperplasia - this increases the risk of developing breast cancer

A TO REVISE - PHASE 3A (16 decks)

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