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REPRODUCTION > Breast week > Flashcards

Breast week Flashcards

1
Q

Describe the surface anatomy of the breast

A

Between ribs 2 and 6

T4 dermatome

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2
Q

Describe the anatomy of the breast briefly

A

Sits infant of deep fascia and the pectorals major muscle

Made up of 15-25 lobes, each containing ducts leading to the nipple

Fibrous and adipose tissue between lobes

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3
Q

Where do the suspensory ligaments attach and what is their function

A

Suspensory ligaments attach between skin and the pec major/ deep fascia

They support the breast tissue

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4
Q

What kinds of epithelium lined the lactiferous duct?

A

Stratified squamous epithelium

Stratified cuboidal epithelium

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5
Q

What kinds of epithelium lines the acini?

A

Secretory epithelial cells (varies from cuboidal to columnar)

Outer layer of myoepithelial cells

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6
Q

What type of epithelium covers the nipple?

A

Keratinised squamous epithelium

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7
Q

What changes to breast tissue occur in pregnancy?

A

Reduced connective tissue and adipose tissue

Proliferation of secretory tissue

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8
Q

What changes to breast tissue occur with the menopause?

A

Secretory tissue degenerates, leaving only ducts

Reduced connective tissue

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9
Q

Describe what is meant by apocrine secretions

A

Lipid droplets are surrounded by a membrane which carry a small amount of cytoplasm with it

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10
Q

Describe what is meant by merocrine secretions

A

EXOCYTOSIS

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11
Q

Mastalgia is usually cyclical. When does the pain tend to be most intense?

A

During the immediate premenstrual phase of the cycle

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12
Q

What is the usual management for mastalgia?

A

Reassure

Well fitting bra and exercise

Tamoxifen/ NSAIDs

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13
Q

What is the most common cause of spontaneous nipple discharge?

A

Intraductal papilloma

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14
Q

What is the main advantage of breast histopathology over breast cytopathology?

A

Allows for the identification of invasive cancers vs carcinoma in situ

(rather than just identifying something as cytologically malignant)

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15
Q

What are 4 examples of developmental anomalies of the breast?

A

Hypoplasia

Juvenile hypertrophy

Accessory breast tissue

Accessory nipple

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16
Q

What are some inflammatory examples of benign breast disease?

A

Mastitis/ abscess

Fat necrosis

Duct ectasia

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17
Q

List some benign breast tumours

A

Phyllodes tumour

intraduct tumour

Lipoma

Adenolipoma

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18
Q

What is a galactocele?

How is it managed?

A

Palpable milk-filled cyst most commonly associated with pregnancy or lactation

Diagnosed and drained by FNA

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19
Q

What is gynaecomastia?

A

Breast development in the male

ductal growth without lobular involvement

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20
Q

What can cause gynaecomastia in males?

A

Exogenous or endogenous hormones

Cannabis

Prescription drugs

Liver disease

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21
Q

Fibrocystic change is very common in women. How does it present?

A

Smooth lumps

Sudden pain / cyclical pain

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22
Q

How is fibrocystic change managed?

A

Exclude malignancy

Reassure that they usually resolve after the menopause

Excise if necessary

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23
Q

What kind of epithelium lines cysts?

A

Apocrine epithelium

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24
Q

Describe the gross pathological appearance of cysts associated with fibrocystic change

A

Blue domed cysts with pale fluid

Intervening fibrosis

Usually multiple

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25
Q

What is a hamartoma?

A

Lesions composed of normal breast cell types but present in an abnormal proportion or distribution

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26
Q

What is the most common benign breast condition?

A

Fibroadenoma

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27
Q

Describe how fibroadenoma presents

A

Painless, firm, mobile mass

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28
Q

Which breast condition is described as the “breast mouse”

A

Fibroadenoma

Because the mass is small firm and mobile like a little mouse

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29
Q

Fibroadenomas are described as “biphasic”, what does this mean?

A

Contain both epithelium and stromal elements

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30
Q

How are fibroadenomas managed?

A

Ultrasound core biopsy to confirm diagnosis

Reassure

Excise if the woman wishes (usually decrease in size with the menopause)

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31
Q

What are sclerosing lesions of the breast?

A

Benign disorderly proliferation of acini and stroma

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32
Q

How do sclerosing lesions present?

A

Pain

Lumpiness/ thickening

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33
Q

Stellate architecture, central puckering, radiating fibrosis

These are pathological findings of which benign condition?

A

Sclerosing lesions

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34
Q

How are sclerosing lesions managed?

A

Excise / sample with vacuum biopsy

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35
Q

What can cause fat necrosis?

A

Local trauma (e.g seat belt injuries)

Warfarin therapy

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36
Q

How is fat necrosis managed?

A

Exclude malignancy

Usually subsides spontaneously

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37
Q

How does duct ectasia present?

A

Pain

Bloody discharge

Fistulation

Nipple retraction and distortion

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38
Q

How is duct ectasia managed?

A

Treat acute infections

Exclude malignancy

Stop smoking

Excise ducts

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39
Q

What are the two main causes of acute mastitis?

A

Duct ectasia

Lactation

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40
Q

If a case of mastitis is unresponsive to treatment, what condition should be considered?

A

Inflammatory carcinoma

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41
Q

How does breast abscess present?

A

Symptoms of mastitis with a central mass

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42
Q

What antibiotics should be used for mastitis caused by duct ectasia?

A

Metronidazole to cover anaerobes

As well as what other antibiotic is required

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43
Q

What organisms are most likely to cause mastitis from lactation?

A

Staph aureus

Strep pyogenes

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44
Q

How does mastitis present?

A

Fever

Erythema

Induration

Tenderness

Swelling

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45
Q

What investigation is used for abscess?

A

Ultrasound

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46
Q

How is mastitis / abscess managed?

A

Antibiotics

Percutaneous drainage

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47
Q

What is the advice about breastfeeding that should be given to patients with mastitis?

A

Breast feeding should be continued if already begun

Should check and advise on breastfeeding technique

48
Q

What is mondor’s disease?

A

phlebitis and clot formation in the superficial veins of the breast

49
Q

How do phyllodes tumours present?

A

Slow growing unilateral breast mass

50
Q

How intraduct papillomas present?

A

Slight bloody nipple discharge

or asymptomatic

51
Q

What is the most common type of malignant breast disease?

A

Ductal invasive and in situ carcinoma

52
Q

What factors in a women reproductive history increase and decrease breast cancer risk?

A

Early menarche and late menopause increase risk

Early pregnancy and breastfeeding decrease risk

53
Q

What things increase breast cancer risk?

A

Oestrogen (hormonal contraceptives, more menstrual cycles e.g late menopause/ early menarche

Obesity

Alcohol and smoking

Genetics

54
Q

What things decrease breast cancer risk?

A

Breastfeeding and early pregnancy

NSAIDs

Physical activity

55
Q

What are some of the possible symptoms and signs of breast cancer?

A

Hard, painless lump

Swelling/ lumps in the armpit

Dimpling of the skin

Bloody discharge

Nipple inversion

Colour and texture changes of the skin

56
Q

Where does breast cancer metastasise to?

A 
Bone 
Liver 
Brain 
Lungs 
Female genital tract (oestrogen rich site for the cancer to grow)
57
Q

What causes the “pea d’orange” skin appearance?

A

Spread of cancer to lymph which builds up in the interstitial space

Suspensory ligaments don’t allow the skin to stretch so it becomes thick and dimpled

58
Q

What is the guidance about use of chemotherapy for breast cancer in pregnant females?

A

Ok after 14 weeks of pregnancy

Should be stopped within 3-4 weeks of delivery to reduce risks of infection etc

59
Q

What is the guidance about use of radiotherapy and hormonal treatments for breast cancer in pregnant females?

A

Avoid both radiotherapy and hormonal therapy

60
Q

Which malignant breast tumour is associated with almost always occurring post radiotherapy?

A

Angiosarcoma

61
Q

Breast carcinomas are malignant tumours of which cell type?

A

Epithelial cells

62
Q

What is meant by in situ carcinoma?

A

Cytologically malignant but has not crossed the basement membrane

63
Q

What is lobular in situ neoplasia called depending on whether there is <50% or >50% of the lobule involved?

A

<50% = atypical lobular hyperplasia (ALH)

> 50% = lobular carcinoma in situ

64
Q

Ductal carcinoma in situ is typically “unicentric”, what does this mean?

A

Arises in a single duct system

65
Q

What is paget’s disease?

A

High grade DCIS extending along ducts to the nipple

66
Q

Calcification on mammography is often the first sign of DCIS. Which other breast condition may also present with calcification?

A

Benign duct ectasia

67
Q

What are the advantages of mammography?

A

Images the whole breasts

High sensitivity for detecting DCIS and invasive cancers

68
Q

What are the disadvantages of mammography?

A

Uses ionising radiation

Can be uncomfortable

69
Q

What is tomosynthesis?

A

3D mammography with multiple images from different angles

70
Q

How does contrast enhanced spectral mammography work?

A

Contrast is injected

Mammogram is done at two different energies

Low and high energy images are subtracted from each other

The subtraction image only shows breast tissue with a lot of vascularity

71
Q

What are the indications for doing breast ultrasound over a mammogram?

A

Breast problems during pregnancy

Palpable masses in younger women

Image guided biopsy

72
Q

What are the advantages of breast ultrasound?

A

No ionising radiation

Not uncomfortable for the patient

Good sensitivity and specificity

Can tell solid from cystic

73
Q

What are the advantages of MRI?

A

Most sensitive test there is for breast cancer

Most accurate method for sizing and locality assessment for breast cancer

74
Q

What are the disadvantages of MRI?

A

Find lots of extra bits of cancer you weren’t looking for - would have been mopped up by systemic therapies but now need to do surgery

75
Q

What are the indications for using MRI to image the breasts?

A

Poor assessment with US or mammography

High risk women/ FH

Positive axillary nodes

Looking at implant integrity

76
Q

What are the most common causes of breast lumps by age?

A

<30 fibroadenoma
30-50 cysts
>50 cancer

77
Q

What are the two main surgical options for breast cancer?

A

Breast conservation surgery

Masectomy

78
Q

What are the types of breast conservation therapy which can be done?

A

Lumpectomy

Wide local excision

Wire guided local excision

Oncoplastic breast conservation

79
Q

What are the survival rates like for breast conservation therapy vs mastectomy

A

Same survival

As long as breast conservation therapy is is done in combination with radiotherapy and the operation has clear margins > 1mm

80
Q

When is wire guided local excision surgery done?

A

For impalpable cancers

81
Q

What is oncoplastic breast surgery?

A

Plastic surgery is used to reshape the breasts at the time of resection

82
Q

Masectomy is the removal of all breast tissue. What are the options for reconstruction?

A

Implant

Latissmus dorsi flap and implant

Deep inferior epigastric artery perforator (DIEP) free flap

Inferior gluteal artery perforator (IGAP) free flap

83
Q

What are the complications that can occur with breast implants?

A

Loss of implants due to infection

Capsular contracture (body forms scar tissue around the implant)

Implant migration

Implant rippling (esp if the patient is very slim)

84
Q

What % of patients require revision surgery for their implant?

A

40%

85
Q

What are the advantages of breastfeeding for mother and baby?

A

Mother baby bond

Maternal protection for the baby

Reduced risk of breast cancer in the mother

Acts as a natural contraceptive

86
Q

What is colostrum?

A

The first milk produced

High levels of immune proteins

Laxative effect for the baby

87
Q

Describe the physiology of lactation

A

Baby suckles

Sensory impulses from nipple to brain

Prolactin produced

Milk glands produce ilk

Oxytocin causes contraction and ejection of milk

88
Q

What is neo-adjuvant therapy?

A

Treatment before the main treatment to improve outcomes

89
Q

What is adjuvant therapy?

A

Back up treatment given after the main treatment

90
Q

When can hormonal therapy be given?

A

When tumours have hormone receptors

Given as both neo adjuvant and adjuvant therapy

Also useful for patients who are not suitable for surgery

Aromatase inhibitors are more effective in post menopausal women

91
Q

What are the advantages and disadvantages of doing chemotherapy pre surgery?

A

Chemotherapy is associated with some overall survival advantage in younger women when it is done pre surgery

Shrinks the tumour pre surgery

Can render the patient unsuitable for surgery due to complications

92
Q

What adjuvant therapy is always necessary with breast conservation therapy?

A

Radiotherapy

93
Q

In which situations does radiotherapy need to be done post mastectomy?

A

Involvement of 3+ nodes

+ve surgical margins

Tumours >5cm

94
Q

What are the indications for boost therapy as part of radiotherapy?

A

Young age

Positive margins

95
Q

Which drug blocks oestrogen receptors and can be used in the management of breast cancer?

A

Tamoxifen

96
Q

Give some examples of aromatase inhibitors, hormonal therapy which can be used in the management or breast cancer

How do aromatase inhibitors work?

A

Letrozole, anastrozole

Aromatase converts androgens to oestrogen - so inhibitors decrease oestrogen levels

97
Q

Which chemotherapy drugs are used for breast cancer?

A

Taxane and anthracycline

98
Q

Which monoclonal antibody drug can be used in the management of breast cancer?

How does it work?

A

Trastuzumab (Herceptin)

Antibody against HER2 receptor

99
Q

Bisphosphonates can given as palliative treatment.

Give an example of a bisphosphonate

Why are they given?

A

Oral ibandronic acid

Used in metastatic disease when DXA scan is abnormal

100
Q

How does trastuzumab-emtansine work?

A

Delivers chemotherapy directly to the tumour

101
Q

What are some of the side effects of tamoxifen?

A

Vaginal bleeding

Endometrial hyperplasia/ polyps

Venous thromboembolism

Hot flushes

102
Q

Tamoxifen, a hormonal therapy for breast cancer, is associated with causing a slight increased risk of which cancer?

A

Endometrial cancer

103
Q

What are the side effects of aromatase inhibitors which can be used for breast cancer in post menopausal women?

A

Stiffness and sore joints/ bones

Hot flushes

104
Q

What are the possible side effects of herceptin (trastuzumab), a monoclonal antibody which can be used in the management of breast cancer?

A

Allergic reactions

Cardiac failure

105
Q

What are the possible side effects of radiotherapy?

A

Skin reactions

Lymphoedema

106
Q

When does a patient with neutropenia post chemotherapy need to be admitted?

A

Neutropenia can be ignored if the patient is well without fever

Patient needs to be admitted if they are septic or have a fever

107
Q

Which hormonal contraceptive needs to be removed in patients with hormone receptor +ve breast cancer?

A

Mirena coil

108
Q

What is the most likely cause of a breast lump appearing soon after breast cancer surgery?

A

Fat necrosis

109
Q

Which drugs used in the management of breast cancer can cause hot flushes?

A

Tamoxifen

Aromatase inhibitors

110
Q

Which drug can be used to manage hot flushes in patients who have developed this side effect from tamoxifen or aromatase inhibitor therapy?

A

Clonidine

111
Q

Spinal cord compression is common in breast cancers with multiple bone metastasis. How does it present?

A

Severe back pain

Difficulty walking

112
Q

Where is HER2 positive breast cancer most likely to metastasise to?

A

Pleura and the CNS

113
Q

Where is lobular breast cancer most likely to metastasise to?

A

Peritoneum and gut

114
Q

Why are aromatase inhibitors most effective in post menopausal women?

A

Aromatisation accounts for the majority of oestrogen production in post-menopausal women

115
Q

What is the medication of choice for suppressing lactation when breastfeeding cessation is indicated?

A

Cabergoline

REPRODUCTION (12 decks)

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