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J Repro > Breasts > Flashcards

Breasts Flashcards

1
Q

most common cause of breast lump <30yo

A

fibroadenoma

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2
Q

most common cause of breast lump 30-50yo

A

cyst

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3
Q

most common cause of breast lump >50yo

A

cancer :(

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4
Q

what are the lumps made of in a breast with fibrocystic changes

A

small cysts with fibrosis

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5
Q

presentation of fibrocystic changes

A

small lumps

pain

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6
Q

who are fibrocystic changes of the breast most common in (age group)

A

20-50yo

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7
Q

management of fibrocystic changes in the breast

A

nothing

reassurance

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8
Q

investigations for any breast lump

A

triple assessment;

clinical - history and examination
radiography - mammogram/US
pathology - core needle biopsy/vacuum assisted biopsy

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9
Q

% of lumps seen in breast clinic that are cancer

A

10% of lumps

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10
Q

most common benign mass in breast

A

fibroadenoma

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11
Q

who get fibroadenomas (age)

A

young women

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12
Q

management of fibroadenoma of the breast

A

nothing

reassurance

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13
Q

presentation of fibroadenoma

A

painless lump - bc benign tumour = slow growing

mobile

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14
Q

which benign breast condition mimics breast cancer on mammogram

what do you need to do to distinguish

A

radical scar/complex sclerosing lesion

need biopsy to distinguish

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15
Q

what size is a radical scar

what size if a complex sclerosing lesion

A

radical scar 1-9mm

complex sclerosing lesion >10mm

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16
Q

mastalgia definition

what causes it

A

breast pain associated with menstruation - normal

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17
Q

what is a cyst

A

fluid filled cavity

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18
Q

who gets cysts in the breast (age)

A

older women

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19
Q

management of cysts

A

FNA - drainage

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20
Q

bloody nipple discharge

A

papilloma

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21
Q

‘cauliflower’ like extension of duct/cyst

A

papilloma

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22
Q

scaly/eczematous nipple/areola

A

pagets disease of the nipple

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23
Q

causes of fat necrosis in breast (2)

A

seatbelt injury

warfarin therapy

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24
Q

how does fat necrosis occur

A

damage to adipocytes (fat eg from seatbelt injury) = acute inflammation = fibrosis and scarring = lump formation

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25
Q

seatbelt injury 2 weeks ago

new lump in breast

A

fat necrosis

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26
Q

what risk factor is associated with duct ectasia

A

smoking

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27
Q

what is duct ectasia

A

sub areolar duct clogging = dilatation = inflammation = fibrosis and scarring = lump formation

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28
Q

what % of papillomas are premalignant

A

10%

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29
Q

red inflamed breasts
not painful
during breast feeding

A

mastitis

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30
Q

management of mastitis

A

continue breast feeding

1g flucloxacillin QDS

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31
Q

what microorganism causes mastitis if it is associated with breast feeding

A

staph aureus from skin

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32
Q

complication of untreated mastitis

A

abscess/sepsis

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33
Q

painful swelling of breasts during breast feeding

no redness/inflammation

A

engorgement

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34
Q

engorgement management

A

continue breast feeding

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35
Q

presentation of duct ectasia

A

sub areola lump
pain
green discharge

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36
Q

what BMI is a risk factor for breast cancer

why

A

high BMI

increased adipose = increase oestrogens

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37
Q

early/late menarche/menopause is a risk factor for breast cancer

why

A 
early menarche (<12) 
late menopause (>55)

bc increased time menstruating = increased ostrogen production

38
Q

high …. hormone is the basis for most of the risk factors of breast cancer

A

high oestrogen

oestrogen ‘feeds’ the tumour

39
Q

what type of contraception if a risk factor for breast cancer

A

any hormonal one!

40
Q

what type of contraception should you give someone w

A

copper coil (isn’t hormonal)

41
Q

which gene mutation is a risk factor for breast cancer

A

BRCA1/2

42
Q

does breast feeding increase or decrease you risk of breast cancer

A

decreases risk of breast cancer

43
Q

what screening is in place for breast cancer

A

mammogram every 3 years between 50-70yo

44
Q

is breast cancer more common in older or younger people

can it occur in the other group

A

more common in older people

don’t rule out breast cancer just bc <50yo

45
Q

does screening for breast cancer prevent it from happening or just pick it up earlier

A

just picks it up earlier

46
Q

which part of the breast does breast cancers arise from

A

terminal duct lobular unit (TDLU)

47
Q

what happens to collagen in breast cancer

A

collagen becomes more dense

48
Q

what are the 2 types of breast cancer

which is more common

A

ductal - 90%

lobular - 10%

49
Q

how does ductal carcinoma in situ differ from invasive ductal carcinoma

A

ductal carcinoma in situ (DCIS) is contained within the basement membrane

50
Q

what is ductal carcinoma in situ a precursor to

A

invasive ductal carcinoma (50% will progress)

51
Q

what is it called when DCIS spreads to the nipple

A

pagets disease of the nipple

52
Q

is pagets disease of the nipple classed as DCIS or invasive ductal carcinoma

A

DCIS - bc still confined to basement membrane, has just spread far

53
Q

presentation of pagets disease of the nipple

A

scaly/eczematous nipple/areola

weeping nipple discharge

54
Q

what type of breast cancer are 75% of them

A

invasive ductal carcinoma

55
Q

how does invasive ductal carcinoma differ from ductal carcinoma in situ

A

in invasive ductal carcinoma the malignant cells have breached the basement membrane

56
Q

why is immunocytochemistry important for invasive ductal carcinomas

A

important for treatment

57
Q

what are 3 types of receptor that may be found in an invasive ductal carcinoma, and hence could be a target for treatment

what is it called if the tumour doesn’t have any of the receptors

A 
oestrogen receptor (ER)
progesterone receptor (PgR)
HER2 (human epidermal growth factor receptor 2)

triple negative breast cancer - doesn’t have any of the above receptors

58
Q

the presence of which receptor (ER, PgR, HER2) indicates poor prognosis

A

HER2

59
Q

what can lobular carcinoma in situ progress to (not always)

A

invasive lobular carcinoma

60
Q

presentation of breast cancer

A

dimpled/depressed skin
breast lump
nipple changes
nipple discharge

61
Q

mobile breast lump

A

probs benign

62
Q

which quadrant of the breast do most breast cancers present in

A

upper outer quadrant

63
Q

what is the triple assessment for investigating breast lumps

A

clinical - history, examination
radiography - mammogram/US
pathology - core needle biopsy (GOLD standard)/vacuum assisted biopsy/FNA

64
Q

what type of radiology technique is mammogram

A

xray

65
Q

when do you use mammogram over US

why

A

> 40yo

better than US if there is lots of fat (in older people)

66
Q

when do yo use US over mammogram

why

A

<40yo

breast is usually too dense (gets fattier as you get older) to see any calcification on mammogram

67
Q

what changes are you looking for mammogram

A

calcification

68
Q

which type of radiology is used in breast cancer screening

A

mammogram

69
Q

what does DCIS look like on mammogram

A

calcification in a line (in a duct not invasive)

70
Q

if mammogram/US comes back saying theres calcification, what do you do next

A

biopsy and test pathology - to distinguish types of cancer

71
Q

GOLD standard biopsy technique

A

core needle biopsy

72
Q

when is vacuum assisted biopsy used over core needle biopsy

A

if calcification is too small for core needle biopsy

73
Q

what other collection method used to be used for sampling a breast mass for pathology report, but is no longer used

A

FNA

74
Q

if invasive ductal carcinoma is diagnosed by pathology, what investigation do you want to do next

A

immunohistochemistry - to find out what receptors it has for treatment

75
Q

surgical management options for breast cancer

A

breast conserving surgery - ‘lumpectomy’
mastectomy

ultimately patients decision!

76
Q

if youre doing breast conserving surgery (wide local excision/lumpectomy) what adjuvant therapy MUST you give (even if you get it all out)

A

adjuvant radiotherapy

high chance of recurrence if not

77
Q

if doing mastectomy, do you need radiotherapy

A

no - bc removing entire breast

78
Q

does mastectomy alone or wide local excision with radiotherapy have a lower recurrence rate

A

both same

people often pick mastectomy thinking lower recurrence, but reassure them otherwise! is more psychologically distress having entire breast removed

79
Q

if doing mastectomy for invasive carcinoma, which lymph nodes do you also remove

A

axillary nodes

80
Q

do you need to remove axillary nodes if DCIS

A

no

bc in situ = not spread to nodes

81
Q

before removing axillary nodes in invasive carcinoma, how do you tell which one you need to remove

what is this node called

A

inject dye into breast tumour = see where the dye ends up first

called the sentinel node

82
Q

why do you go to the hassle of finding the sentinel node and not just remove al axillary nodes
the removal of which nodes is associated with higher risk of lymphoedema

A

if you remove them all = risk of arm lymphoedema

removing levels II and III = higher risk than level I

83
Q

adjuvant therapy for triple negative tumours

A

chemotherapy

84
Q

adjuvant therapy for oestrogen receptor positive tumours

A

tamoxifen - antioestorgen therapy

85
Q

adjuvant therapy for HER2 positive tumours

A

trastuzumab (Herceptin) - monoclonal antibody

86
Q

which type of tumour is adjuvant/neoadjuvant therapy used for

when is it used

A

invasive carcinoma (not in situ)

before surgery (to debulk tumour) or after

87
Q

what is it called when you used additional therapies to surgery BEFORE the surgery has taken place

A

neoadjuvant therapy (as opposed to Adjuvant = After)

88
Q

side effect of chemo

A

neutropaenia

89
Q

if someone with breast cancer is on the mirena coil, what do you want to do

A

change to copper coil

90
Q

where do breast cancers usually metastasise

A

bone (spine)

91
Q

is prognosis good or bad for breast cancers

A

good if not metastatic!

92
Q

what type of breast cancer is caused by breast radiotherapy

A

angiosarcoma

J Repro (28 decks)

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