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Year 3 - Repro and Sexual Health > Breast Week - General > Flashcards

Breast Week - General Flashcards

1
Q

Give examples of risk factors for breast cancer

A 
Precursor lesions 
Age
Firth child after 30
Nulliparous 
Post-menopausal obesity 
Early menarche 
Genetics
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2
Q

What is the most common type of breast cancer?

A

Ductal

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3
Q

How does invasive and in situ carcinoma present normally?

A

Through screening or patient presents to GP with a lump

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4
Q

How may a breast lump be investigated in a young woman?

A

Ultrasound and mammography

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5
Q

Which type of breast cancer present with an “Indian file” appearance?

A

Invasive lobular carcinoma

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6
Q

How is radiotherapy given for breast cancer?

A

4500-5000 centigrays 5 days per week for 6 weeks

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7
Q

What does a radical mastectomy remove?

A

Entire breast, overlying skin and lymph nodes

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8
Q

How can breast reconstruction be achieved?

A

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

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9
Q

What are the indications for post-mastectomy radiotherapy?

A

Involvement of >3 nodes
Positive surgical margins
Tumour >5cm

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10
Q

Which drug is used to block oestrogen receptors on breast cancer cells?

A

Tamoxifen

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11
Q

Which drug is used to block HER2 receptors in breast cancer?

A

Herceptin/trastuzumab
Bevacizumab
Lapatinib

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12
Q

How does lapatinib work?

A

Dual inhibtion of epidermal growth factor receptor and HER-2 receptor

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13
Q

What is lapatinib used in combination with for advanced breast cancer?

A

Capecitabine

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14
Q

How does a fibroadenoma in the breast present?

A

Palpable mass 1-3cm on breast in early reproductive years

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15
Q

How does a fibroadenoma in the breast feel on examination?

A 
Rubbery-firm
Mobile
Smooth
Distinct borders
Non-tender
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16
Q

How is a fibroadenoma treated?

A

Can be excised for cosmetic reasons but not necessary

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17
Q

Compare a phyllode tumour and a fibroadenoma

A

Phyllode tumour is larger (3-6cm); age 35-45 and grow

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18
Q

Which drug can be used for mastalgia?

A

Tamoxifen

Topical NSAID

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19
Q

How does a breast cyst feel on examination?

A

Mobile
Smooth Well-defined
Soft

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20
Q

When should fluid from a cyst be sent for cytology?

A

If there is blood

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21
Q

What is suspected if there is bloody discharge from a cyst?

A

Intracystic carcinoma

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22
Q

Describe physiological nipple discharge

A

Watery
Clear
Yellow

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23
Q

How is nipple discharge investigated?

A

Mammography
Ultrasonography
Surgical excision of duct

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24
Q

How can Paget’s disease of the breast present?

A

Erythematous weeping lesion on surface of nipple and areola.
Can be dry and scaly
Often underlying palpable mass

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25
Q

How is mastitis caused by staph aureus treated?

A

Fluclox 500mg orally every 6 hours
or
Augmentin 625mg every 8 hours for 7 days

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26
Q

How does mastitis present?

A

Erythema
Fever
Tenderness
Swelling

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27
Q

How often should a patient with mastitis be examined?

A

Every 3 days

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28
Q

How does a breast abscess present?

A

Loose or bulging mass

In central area of mastitis

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29
Q

How is a breast abscess investigated?

A

Aspirated with 18-gauge needle under LA

Do every 3 days, esp if >10ml of pus aspirated

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30
Q

Which pathogens tend to cause non-puerperal or post menopausal mastitis?

A

Peptostrep magnus

Bacteroides fragilis

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31
Q

How is non-staph mastitis treated?

A

Augmentin 625mg every 8 hours for 7 days
or
Cephalexin 500mg every 6 hours for 7 days

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32
Q

What is associated with chronic mastitis?

A

Subareolar abscess

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33
Q

What should be considered if mastitis is unresponsive to any antibiotic therapy?

A

Inflammatory carcinoma

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34
Q

How does an adenolipoma classically present?

A

Smooth palpable mass

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35
Q

Which cells are associated with apocrine metaplasia of the epithelial cells?

A

Eosinophils

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36
Q

What is a galactocoele?

A

Palpable milk-filled cyst a/w pregnancy or lactation

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37
Q

How is a galactocoele diagnosed and drained?

A

FNA

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38
Q

Which type of cells does a lipoma contain?

A

Adipose

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39
Q

What is Mondor’s disease?

A

Phlebitis and then clot formation in the superficial veins of breast

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40
Q

How does Mondor’s disease present?

A

Firm, vertical cord-like structure

a/w history of trauma

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41
Q

How is Mondor’s disease managed?

A

Usually not, should resolve itself in 8-12 weeks

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42
Q

How is a mammogram carried out?

A

X-Ray used in low dose

Breasts compressed to keep tissue immobile and thickness consistent as exposure time is long

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43
Q

How does breast density affect cancer risk?

A

More dense = higher risk

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44
Q

What are the advantages of mammography?

A

Images whole breasts

High sensitivity for DCIS and invasive cancer

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45
Q

What is the false positive rate in mammography?

A

1 in 5

46
Q

What is tomosynthesis?

A

3D mammogram
Taken from multiple angles
Slides reconstructed

47
Q

When would an ultrasound be preferred over a mammogram?

A

Younger women
Inflammation/infection
Breast problems during pregnancy

48
Q

What does strain elastography measure?

A

“Stiffness of lumps”

Produces a colour map of the stiffness

49
Q

What colour is normal breast tissue on shear wave elastography?

A

Blue

50
Q

Why may contrast enhanced ultrasound be used in breast cancer assessment?

A

Assess response to chemo

Look at nodes

51
Q

How does the stroma aid tumour growth?

A

Allows neovascularisation
Can dissolve “good” collagen
May produce some nutrients for cancer

52
Q

What is the downside of using MRI to assess breast cancer?

A

Pick up tiny bits of cancer that would have been dealt with by chemo/radiotherapy causing mastectomy rates to go up

53
Q

What is a breast lump in a woman under 30 most likely to be?

A

Fibroadenoma

54
Q

What is a breast lump in a woman 30-50 most likely to be?

A

Cyst

55
Q

What is a breast lump in a woman over 50 most likely to be?

A

Cancer

56
Q

How are abnormal lymph nodes identified on ultrasound?

A

Cortical thickness

Shape

57
Q

What are the main types of surgery used in breast cancer?

A 
Breast conserving (wide local excision)
Mastectomy
58
Q

How is impalpable disease biopsied?

A

Image guided wire insertion to mark location of abnormality

Can image specimen removed before sending to pathology to ensure got a good specimen

59
Q

Why is a pedicle flap preferred to be used on breast reconstruction?

A

To allow tissue used to keep its own blood supply

60
Q

What are the advantages of getting breast implants?

A

Short surgery

Only 1 scar

61
Q

What complications may occur when using breast implants?

A 
Infection
Migration
Loss
Capsular contracture
Tear
62
Q

Describe the two-stage reconstruction done with breast implants

A

1 - Mastectomy and creation of submuscular pocket. Expander inserted into this

2 - expander exchanged for permanent implant

63
Q

What are the advantages of using animal collagen mesh implant in the breast?

A

One surgery
Better pole expansion
Reduced post-op pain
Improved aesthetics

64
Q

What treatment is given following wide local excision?

A

Radiotherapy

65
Q

Why is chemo done before breast surgery?

A

To shrink tumour and make surgery easier

66
Q

How is trastuzumab given?

A

S/c mostly

Sometimes IV

67
Q

What follow up is done after breast cancer treatment?

A

Review in a year

Mammograms annually for 3 years

68
Q

What systemic palliative treatment can be given in wide-spread disease?

A

ER-blockade

Chemo

69
Q

When is radiotherapy given in palliative care in breast cancer?

A

Bone mets

Fungating disease

70
Q

What haematological complication may occur with chemo?

A

Neutropenia

71
Q

What complications may occur with tamoxifen?

A

Polyps
Endometrial cancer
Hot flushes

72
Q

In what situation may skin problems be experienced in breast cancer treatment?

A

Radiotherapy

Bigger breasts

73
Q

What is a new lump immediately following breast cancer treatment likely to be?

A

Fat necrosis

74
Q

Which group of drugs should you try to avoid with tamoxifen?

A

Anti-depressants

75
Q

What may be a cause of blurred vision with breast cancer?

A

Retinal mets

76
Q

Which tumour markers may be checked in breast cancers?

A

CEA

CA15-3

77
Q

What is the triple assessment of a breast lump?

A

Clinical
Radiological
Pathological

78
Q

How is a mammogram carried out?

A

Breast compressed to keep immobile and keep thickness consistent

79
Q

The radiation dose of a mammogram is low/high ?

A

Low

80
Q

What is the first sign of DCIS?

A

Calcification

81
Q

Where do most breast cancers occur?

A

Upper lateral quadrant

82
Q

Having a higher density breast s a risk factor for breast cancer true/false

A

True

76-100th centile density have 5x risk of 1-10th

83
Q

What are the adv of using mammography?

A

Whole breast imaged

High sensitivity

84
Q

What are the disadv of using mammography?

A

1 in 5 false positive
10% cancers found are very low risk
Radiation exposure
Uncomfortable

85
Q

What is tomosynthesis?

A

3D mammogram

Multiple pictures from various angles

86
Q

Tomosynthesis is less sensitive than mammogram for cancer true/false

A

False

Is more sensitive and potentially leads to over treatment

87
Q

When in USS performed in breast lump?

A

Palpable mass
Infection/inflame
Younger women
Image guided biopsy

88
Q

What are the adv of USS over mammogram?

A 
Quick
No radiation
Not uncomfortable 
Good sensitivity
Differentiate between solid and cystic lumps
89
Q

What does strain elastography measure?

A

Stiffness of breast lumbs

90
Q

What colour is normal breast tissue on shear wave assessment?

A

Blue

91
Q

Why might contrast enhanced ultrasound be used in breast cancer treated?

A

Assess response to chemo

Look at lymph nodes

92
Q

How does the stroma of tumours promote malignancy?

A

Allows neovascularisation
Dissolves good collagen
Allows invasion
Produces nutrients for cancer

93
Q

What is used in breast cancer screening of high risk women?

A

MRI

94
Q

Most common cause of a breast lump in <30

A

Fibroadenoma

95
Q

Most common cause of a breast lump in 30-50s

A

Cyst

96
Q

Most common cause of a breast lump in >50

A

cancer

97
Q

What are spiculate masses indicative of?

A

Malignancy

98
Q

Where does breast cancer commonly metastasise?

A 
Bones
lungs
Pleura
Liver 
brain
99
Q

What is a capsular contracture seen in breast implant?

A

When the implant is recognised as foreign and scar tissue is formed around it

100
Q

What are the complications of breast implant?

A 
Loss of implant
Implant tear
Implant migration
infection
Capsular contracture
101
Q

Describe a pedicle flap

A

Uses nearby tissue to allow tissue to keep its own blood supply

102
Q

Describe a free flap in breast reconstruction

A

Tissue moved to breast area

103
Q

How is a two stage breast reconstruction performed?

A

Mastectomy and creation of submuscular pocket and expander insertion
Fortnightly appointment to expand

104
Q

Which serious condition is a two stage reconstruction associated with?

A

Lymphoma

105
Q

What are the advantages of one stage reconstruction?

A

Better pole expansion
Red post op pain
Better appearance
Only one op

106
Q

Which drug is more effect in breast cancer - tamoxifen or aromatase inhibitor

A

Aromatase inhibitor

107
Q

What does an aromatase inhibitor do?

A

Converts androgen to oestrogen

108
Q

How is trastuzamab given?

A

subcut

109
Q

What is the treatment regime of trastuzumab?

A

3 weekly for a year

110
Q

What are the main side effects of trastuzumab?

A

Allergic reactions

Cardiac failure

111
Q

What is the follow up to breast cancer after treatment?

A

Mammograms for 3 years

112
Q

Which anti-depressant should be avoided with tamoxifen therapy?

A

Paroxetine/fluoxetine

Year 3 - Repro and Sexual Health (23 decks)

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