Breast Week - General Flashcards
Give examples of risk factors for breast cancer
Precursor lesions Age Firth child after 30 Nulliparous Post-menopausal obesity Early menarche Genetics
What is the most common type of breast cancer?
Ductal
How does invasive and in situ carcinoma present normally?
Through screening or patient presents to GP with a lump
How may a breast lump be investigated in a young woman?
Ultrasound and mammography
Which type of breast cancer present with an “Indian file” appearance?
Invasive lobular carcinoma
How is radiotherapy given for breast cancer?
4500-5000 centigrays 5 days per week for 6 weeks
What does a radical mastectomy remove?
Entire breast, overlying skin and lymph nodes
How can breast reconstruction be achieved?
Through breast prosthesis
Lat dorsi myocutaneous flap plus breast prothesis
Deep inferior epigastric perforator free flap
Transverse rectus abdominis myocutaneous flap
Superior/inferior gluteal artery perforator free flaps
What are the indications for post-mastectomy radiotherapy?
Involvement of >3 nodes
Positive surgical margins
Tumour >5cm
Which drug is used to block oestrogen receptors on breast cancer cells?
Tamoxifen
Which drug is used to block HER2 receptors in breast cancer?
Herceptin/trastuzumab
Bevacizumab
Lapatinib
How does lapatinib work?
Dual inhibtion of epidermal growth factor receptor and HER-2 receptor
What is lapatinib used in combination with for advanced breast cancer?
Capecitabine
How does a fibroadenoma in the breast present?
Palpable mass 1-3cm on breast in early reproductive years
How does a fibroadenoma in the breast feel on examination?
Rubbery-firm Mobile Smooth Distinct borders Non-tender
How is a fibroadenoma treated?
Can be excised for cosmetic reasons but not necessary
Compare a phyllode tumour and a fibroadenoma
Phyllode tumour is larger (3-6cm); age 35-45 and grow
Which drug can be used for mastalgia?
Tamoxifen
Topical NSAID
How does a breast cyst feel on examination?
Mobile
Smooth Well-defined
Soft
When should fluid from a cyst be sent for cytology?
If there is blood
What is suspected if there is bloody discharge from a cyst?
Intracystic carcinoma
Describe physiological nipple discharge
Watery
Clear
Yellow
How is nipple discharge investigated?
Mammography
Ultrasonography
Surgical excision of duct
How can Paget’s disease of the breast present?
Erythematous weeping lesion on surface of nipple and areola.
Can be dry and scaly
Often underlying palpable mass
How is mastitis caused by staph aureus treated?
Fluclox 500mg orally every 6 hours
or
Augmentin 625mg every 8 hours for 7 days
How does mastitis present?
Erythema
Fever
Tenderness
Swelling
How often should a patient with mastitis be examined?
Every 3 days
How does a breast abscess present?
Loose or bulging mass
In central area of mastitis
How is a breast abscess investigated?
Aspirated with 18-gauge needle under LA
Do every 3 days, esp if >10ml of pus aspirated
Which pathogens tend to cause non-puerperal or post menopausal mastitis?
Peptostrep magnus
Bacteroides fragilis
How is non-staph mastitis treated?
Augmentin 625mg every 8 hours for 7 days
or
Cephalexin 500mg every 6 hours for 7 days
What is associated with chronic mastitis?
Subareolar abscess
What should be considered if mastitis is unresponsive to any antibiotic therapy?
Inflammatory carcinoma
How does an adenolipoma classically present?
Smooth palpable mass
Which cells are associated with apocrine metaplasia of the epithelial cells?
Eosinophils
What is a galactocoele?
Palpable milk-filled cyst a/w pregnancy or lactation
How is a galactocoele diagnosed and drained?
FNA
Which type of cells does a lipoma contain?
Adipose
What is Mondor’s disease?
Phlebitis and then clot formation in the superficial veins of breast
How does Mondor’s disease present?
Firm, vertical cord-like structure
a/w history of trauma
How is Mondor’s disease managed?
Usually not, should resolve itself in 8-12 weeks
How is a mammogram carried out?
X-Ray used in low dose
Breasts compressed to keep tissue immobile and thickness consistent as exposure time is long
How does breast density affect cancer risk?
More dense = higher risk
What are the advantages of mammography?
Images whole breasts
High sensitivity for DCIS and invasive cancer
What is the false positive rate in mammography?
1 in 5
What is tomosynthesis?
3D mammogram
Taken from multiple angles
Slides reconstructed
When would an ultrasound be preferred over a mammogram?
Younger women
Inflammation/infection
Breast problems during pregnancy
What does strain elastography measure?
“Stiffness of lumps”
Produces a colour map of the stiffness
What colour is normal breast tissue on shear wave elastography?
Blue
Why may contrast enhanced ultrasound be used in breast cancer assessment?
Assess response to chemo
Look at nodes
How does the stroma aid tumour growth?
Allows neovascularisation
Can dissolve “good” collagen
May produce some nutrients for cancer
What is the downside of using MRI to assess breast cancer?
Pick up tiny bits of cancer that would have been dealt with by chemo/radiotherapy causing mastectomy rates to go up
What is a breast lump in a woman under 30 most likely to be?
Fibroadenoma
What is a breast lump in a woman 30-50 most likely to be?
Cyst
What is a breast lump in a woman over 50 most likely to be?
Cancer
How are abnormal lymph nodes identified on ultrasound?
Cortical thickness
Shape
What are the main types of surgery used in breast cancer?
Breast conserving (wide local excision) Mastectomy
How is impalpable disease biopsied?
Image guided wire insertion to mark location of abnormality
Can image specimen removed before sending to pathology to ensure got a good specimen
Why is a pedicle flap preferred to be used on breast reconstruction?
To allow tissue used to keep its own blood supply
What are the advantages of getting breast implants?
Short surgery
Only 1 scar
What complications may occur when using breast implants?
Infection Migration Loss Capsular contracture Tear
Describe the two-stage reconstruction done with breast implants
1 - Mastectomy and creation of submuscular pocket. Expander inserted into this
2 - expander exchanged for permanent implant
What are the advantages of using animal collagen mesh implant in the breast?
One surgery
Better pole expansion
Reduced post-op pain
Improved aesthetics
What treatment is given following wide local excision?
Radiotherapy
Why is chemo done before breast surgery?
To shrink tumour and make surgery easier
How is trastuzumab given?
S/c mostly
Sometimes IV
What follow up is done after breast cancer treatment?
Review in a year
Mammograms annually for 3 years
What systemic palliative treatment can be given in wide-spread disease?
ER-blockade
Chemo
When is radiotherapy given in palliative care in breast cancer?
Bone mets
Fungating disease
What haematological complication may occur with chemo?
Neutropenia
What complications may occur with tamoxifen?
Polyps
Endometrial cancer
Hot flushes
In what situation may skin problems be experienced in breast cancer treatment?
Radiotherapy
Bigger breasts
What is a new lump immediately following breast cancer treatment likely to be?
Fat necrosis
Which group of drugs should you try to avoid with tamoxifen?
Anti-depressants
What may be a cause of blurred vision with breast cancer?
Retinal mets
Which tumour markers may be checked in breast cancers?
CEA
CA15-3
What is the triple assessment of a breast lump?
Clinical
Radiological
Pathological
How is a mammogram carried out?
Breast compressed to keep immobile and keep thickness consistent
The radiation dose of a mammogram is low/high ?
Low
What is the first sign of DCIS?
Calcification
Where do most breast cancers occur?
Upper lateral quadrant
Having a higher density breast s a risk factor for breast cancer true/false
True
76-100th centile density have 5x risk of 1-10th
What are the adv of using mammography?
Whole breast imaged
High sensitivity
What are the disadv of using mammography?
1 in 5 false positive
10% cancers found are very low risk
Radiation exposure
Uncomfortable
What is tomosynthesis?
3D mammogram
Multiple pictures from various angles
Tomosynthesis is less sensitive than mammogram for cancer true/false
False
Is more sensitive and potentially leads to over treatment
When in USS performed in breast lump?
Palpable mass
Infection/inflame
Younger women
Image guided biopsy
What are the adv of USS over mammogram?
Quick No radiation Not uncomfortable Good sensitivity Differentiate between solid and cystic lumps
What does strain elastography measure?
Stiffness of breast lumbs
What colour is normal breast tissue on shear wave assessment?
Blue
Why might contrast enhanced ultrasound be used in breast cancer treated?
Assess response to chemo
Look at lymph nodes
How does the stroma of tumours promote malignancy?
Allows neovascularisation
Dissolves good collagen
Allows invasion
Produces nutrients for cancer
What is used in breast cancer screening of high risk women?
MRI
Most common cause of a breast lump in <30
Fibroadenoma
Most common cause of a breast lump in 30-50s
Cyst
Most common cause of a breast lump in >50
cancer
What are spiculate masses indicative of?
Malignancy
Where does breast cancer commonly metastasise?
Bones lungs Pleura Liver brain
What is a capsular contracture seen in breast implant?
When the implant is recognised as foreign and scar tissue is formed around it
What are the complications of breast implant?
Loss of implant Implant tear Implant migration infection Capsular contracture
Describe a pedicle flap
Uses nearby tissue to allow tissue to keep its own blood supply
Describe a free flap in breast reconstruction
Tissue moved to breast area
How is a two stage breast reconstruction performed?
Mastectomy and creation of submuscular pocket and expander insertion
Fortnightly appointment to expand
Which serious condition is a two stage reconstruction associated with?
Lymphoma
What are the advantages of one stage reconstruction?
Better pole expansion
Red post op pain
Better appearance
Only one op
Which drug is more effect in breast cancer - tamoxifen or aromatase inhibitor
Aromatase inhibitor
What does an aromatase inhibitor do?
Converts androgen to oestrogen
How is trastuzamab given?
subcut
What is the treatment regime of trastuzumab?
3 weekly for a year
What are the main side effects of trastuzumab?
Allergic reactions
Cardiac failure
What is the follow up to breast cancer after treatment?
Mammograms for 3 years
Which anti-depressant should be avoided with tamoxifen therapy?
Paroxetine/fluoxetine
