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Reproduction and Sexual Health > Breast week > Flashcards

Breast week Flashcards

1
Q
  1. Name the ligaments that support the breast tissue
  2. What is the basic functional secretory unit of the breast
  3. In the non-lactating breast, terminal _______ lead into an
    _________ collecting duct which leads into the _________ duct for that lobe.
    The ___________ duct leads to the nipple, passing through an expanded duct
    region near the nipple termed the lactiferous ______.
A
  1. Suspensory ligaments
  2. Terminal Duct Lobular Unit
  3. Ductules, intralobular, lactiferous duct, lactiferous, sinus.
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2
Q
  1. Name the cells that surround the Acini and their purpose
  2. Describe the epithelium of the nipple
  3. During pregnancy _________ and __________ stimulate _________ of secretory tissue and fibro-fatty tissue becomes sparse.
A
  1. Myoepithelial cells, contractile cells that surround the secretory acini
  2. thin, highly pigmented, keratinized stratified
    squamous epithelium
  3. Oestrogen, Progesterone, proliferation.
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3
Q
  1. The lipid droplets of milk are secreted into it by ________ secretion whereas the protein is secreted by _________ secretion (exocytosis).
  2. Following menopause the secretory cells of the TDLU degenerate leaving only the _______ ___. The amount of __________ _____ and _____ _____ decrease like ageing skin.
  3. Blood supply to the breasts is from the Lateral and Medial _________ arteries which branch from the _______ ________ and _______ _______ respectively. Venous drainage is from the lateral and medial ______ veins
A
  1. Apocrine, Mesocrine
  2. Lactiferous ducts, connective tissue, elastic fibres.
  3. Mammary, Lateral thoracic and Medial thoracic, Mammary.
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4
Q
  1. Lymphatic drainage from the breast mainly moves superolaterally to the ________ lymph nodes. However , it may also move medially to the __________ lymph nodes or superiorly to the ___________ lymph nodes.
A
  1. Axillary, parasternal, supraclavicular.
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5
Q
  1. What is the standard assessment of breast disease collectively known as?
  2. What does this consist of?
  3. What are the possible cytopathological investigations?
  4. What are the possible histopathological investigations?
A
  1. Triple assessment.
  2. Clinical assessment- history and examination
    Imaging- Mammogram, Ultrasound, MRI
    Pathology- Cytopathology and histopathology investigations.
  3. FNA, fluid/nipple scrape/nipple discharge cytology.
  4. Needle Core Biopsy, Vacuum Assisted Biopsy, Wide Excision Biopsy, Mastectomy
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6
Q
  1. Define Gynaecomastia
  2. What is the most common differential to breast cancer in women aged 20-50yrs?
  3. How does this present?
  4. Describe the pathology.
  5. How may it be treated?
A
  1. Breast development in a male- there is ductal growth but no lobular development.
  2. Fibrocystic change
  3. Smooth lumps which may cause sudden or cyclical pain and resolve following menopause (related to menstrual cycle)
  4. Cysts with intervening fibrosis.
  5. Passive conservative management. Exclude malignancy.
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7
Q
  1. Define a breast hamartoma
  2. Name the main type of hamartoma of the breast.
  3. How does it present?
  4. How should it be treated?
A
  1. Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution.
  2. Fibroadenoma.
  3. Painless, firm, mobile mass.
  4. Diagnosis, reassurance (as with all benign breast lumps) and excision.
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8
Q
  1. Define sclerosing lesions of the breast.
  2. What are the two types of these?
  3. What is the clinical significance of these for breast cancer?
  4. How ought they to be treated?
A
  1. Benign, disorderly proliferation of acini and stroma. Can cause a mass or calcification.
  2. Sclerosing adenosis, Radial Scar (if large called Complex sclerosing lesion)
  3. They can mimic carcinoma and can lead to carcinoma.
  4. Excision!
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9
Q
  1. Identify three inflammatory pathologies of the breasts.
  2. What are the two main aetiologies of fat necrosis? How managed?
  3. Define Duct Ectasia and add some clinical features
A
  1. Mastitis, Fat Necrosis, Duct Ectasia
  2. Local trauma e.g. seatbelt injury, warfarin therapy. Passive
  3. Inflammatory condition of the sub-areolar ducts. Causes pain and bloody/purulent discharge. Treated by excision.
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10
Q
  1. What are the two main aetiologies of acute mastitis/abscess?
  2. What are the treatment options?
A
  1. Duct Ectasia (anaerobes etc) and Lactation (staph aureus and strep pyrogenes).
  2. Antibiotics, Percutaneous drainage, Incision & drainage, Treat underlying cause
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11
Q
  1. Identify two largely benign tumours of the breast.
  2. Describe the clinical features of the first and how it should be treated.
  3. Describe the clinical features of the second
A
  1. Phyllodes tumour and Intraduct papilloma.
  2. Slow growing unilateral breast mass, age 40-50yrs. Should be adequately excised, rarely metastasises.
  3. Presents with nipple discharge +/- blood or maybe asymptomatic and picked up on screening. Epithelial proliferation occurs in sub-areolar ducts.
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12
Q
  1. What does DCIS and LCIS stand for? What are they?
  2. What is the difference between In-situ and invasive?
  3. What is the name for DCIS affecting the nipple? What is the appearance of this?
  4. What is the treatment/prognosis of DCIS?
A
  1. Ductal Carcinoma In-situ, Lobular Carcinoma In-situ. They are precursors of Invasive Breast Carcinoma.
  2. IN-SITU: Confined within the basement membrane
    INVASIVE: Invades through the basement membrane.
  3. Paget’s Disease of the Nipple. Looks like eczema of the nipple ( erythema and scaly).
  4. Full excision and adjuvant therapy, good prognosis if successfully excised.
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13
Q
  1. Define Invasive Breast Carcinoma.
  2. Identify some of the risk factors of Breast cancer.
  3. Name the two gene mutations most commonly associated with breast cancer.
A
  1. Malignant Epithelial cells which have breached the Basal Membrane.
  2. Ageing, Family History, Hormonal status, Early Menarche, Late Menopause, Nulliparous, Hormonal Therapy, Precursor pathologies.
  3. BRAC1 and BRAC2 on chromosomes 17 and 13 respectively. They are tumour suppressor genes.
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14
Q
  1. In the natural history of Breast carcinoma what do the following letters mean: TNM? How many stages are in each and what does this mean?
  2. What are the three Hormone Receptor Expressions associated with Breast Carcinoma
  3. Name three prognostic indices for breast carcinoma
A
  1. Tumour Node Metastasis. T1-T4 extent of tumour and invasion into neighbouring structures, N0-N3 lymphatic spread , M0-M1 Blood-borne spread.
  2. Oestrogen Receptors (ER), Progesterone receptors (PR) and Human Epidermal growth factor Receptor 2.
  3. Nottingham Prognostic Index, Adjuvant! Online, NHS Predict
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15
Q
  1. What is the most common cancer in women?
  2. Which is more common: DCIS or LCIS?
  3. Identify the 6 most common presenting symptoms/signs or breast cancer.
A
  1. Breast cancer.
  2. DCIS
  3. Dimpled or depressed skin, visable lump, Nipple change (Exversion/Inversion), Bloody discharge, Texture change, Colour change.
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16
Q
  1. What is the PREFFERED treatment of breast carcinoma? What does this consist of?
  2. What type of surgery might be needed following BCS or Radical Mastectomy?
  3. What types of adjuvant therapy are there?
  4. Identify a symptom of the breast which is common for women and almost always benign.
A
  1. Breast-Conserving Surgery: Conservatory surgery and radiotherapy.
  2. Cosmetic Reconstruction surgery.
  3. Hormonal Therapy: Tamoxifen. Targeted Therapies such as Herceptin (Trastuzumab), recombinant humanized monoclonal antibodies (bevacizumab and lapatinib)
  4. Mastalgia.
17
Q
  1. What is the difference between specificity and sensitivity?
  2. What is a mammogram?
  3. What pathology can be seen on a mammogram?
  4. What is the advantage of a mammogram with regards malignancy?
A
  1. Specificity= How well a test identifies a patient without disease
    Sensitivity= How well a test identifies a patient with disease.
  2. An X-ray of the breast tissue.
  3. Benign calcifications and DCIS, invasive cancers also.
  4. It is highly sensitive to DCIS and invasive carcinoma
18
Q
  1. When is mammography indicated?
  2. How might an ultrasound of benign breast masses compare to that of malignant masses?
  3. How does the sensitivity of US compare to that of a mammogram?
A
  1. Screening (50 – 70yrs)
    Higher risk screening > 40 years
    Symptomatic assessment > 40 years
    Monitoring response to systemic treatment: NACT (NET)
    Follow-up after cancer treatment
  2. Benign- ‘wide’ and well defined and black, Malignant- ‘tall’ and ill defined and mixed.
  3. Good sensitivity for invasive carcinoma but poor for DCIS unlike mammogram.
19
Q
  1. Name two Advanced Mammographic Techniques
A
  1. Tomosynthesis, Contrast Enhanced Spectral Mammography (CESM).
20
Q
  1. Define Tomosynthesis

2. What is the advantage of it over a normal mammogram?

A
  1. Effectively a 3D Mammogram where images are taken in an arc
  2. Removes overlap, may increase sensitivity in denser breasts.
21
Q
  1. Define CESM

2. What is the main advantage of CESM?

A
  1. Effectively an IV contrast enhanced mammogram.

2. Greater Specificity and sensitivity, especially in dense breasts.

22
Q
  1. Identify some Advanced Ultrasound techniques for the breast.
  2. What is the advantage of MRI over the other types of imaging for breast cancer.
A 
1.Strain Elastography
Shear Wave Elastography
Contrast Enhanced US (CE-US)
Automated breast ultrasound (ABUS)
2. It has the best sensitivity of all the imaging techniques for breast cancer. However its specificity isn't as good.
23
Q
  1. What age group is supplied with breast screening? What type of imaging is it? How often is an individual screened?
  2. What is a stereotactic biopsy?
A
  1. 50-70yrs, Mammogram, every 3 yrs.

2. A biopsy guided by a mammogram.

24
Q
  1. Identify two neo-adjuvant treatments that are considered for breast cancer.
  2. What are the two surgical options for breast cancer?
A
  1. Neo-adjuvant Chemotherapy and Neo-adjuvant Endocrine therapy (Aromatase inhibitors)
  2. Breast Conservation Surgery (with radiotherapy) and Mastectomy.
25
Q
  1. What are the three types of Breast Conservation Surgery?

2. Identify some of the aims of successful Breast Conservation Surgery.

A
  1. Wide local excision (Skin to pectoral muscle), Image guided local excision, Oncoplastic breast conservation including therapeutic mammoplasty.
  2. Clear margins >1mm (aim for 1cm), should be full thickness excision, plus breast radiotherapy.
26
Q
  1. What makes a mastectomy differ from BCS?

2. What are the two main types?

A
  1. Involves removal of whole breast.

2. standard transverse excision and skin sparing mastectomy.

27
Q
  1. What types of cosmetic services are available?

2. What are the drawbacks of reconstructive surgery?

A
  1. External prosthesis, immediate or delayed reconstruction.

2. Multiple complications e.g. infection or slippage therefore 40% require revisionist surgery.

28
Q
  1. Axillary _________ are carried out in patients with known breast cancer to examine the ______ _____. If they appear suspicious then an ultrasound guided biopsy is needed. If macrometastases are not detected or the nodes appear normal on initial ultrasound then a _______ _____ __________ is performed. If macrometastases are found _______ lymph node _______ is performed.
  2. What sign may be visible if lymph nodes are effected?
A
  1. Ultrasound, axillary nodes, sentinel node biopsy, axillary, clearance.
  2. Arm lymphoedema.
29
Q
  1. What is the characteristic symptom of intraductal papilloma?
  2. How might Paget’s disease of the nipple be distinguished CLINICALLY from eczema?
  3. If a mother has acute mastitis what is the best advice for breastfeeding?
A
  1. Bloody nipple discharge
  2. Itch and erythema begins with nipple then to areola; vice-versa for eczema.
  3. Breastfeed baby from the unaffected breast.
30
Q
  1. What hormone stimulates the lactiferous ducts to grow at puberty?
  2. What is the commonest histological type of breast cancer?
  3. What are malignant appearing microcalcifications of the breast diagnostic for?
  4. What symptom is related to adjuvant chemotherapy but not radiotherapy?
A
  1. Oestrogen.
  2. Invasive ductal carcinoma.
  3. Ductal carcinoma in-situ.
  4. Hair loss

Reproduction and Sexual Health (13 decks)

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