Breasts Flashcards
1
Q
most common cause of breast lump <30yo
A
fibroadenoma
2
Q
most common cause of breast lump 30-50yo
A
cyst
3
Q
most common cause of breast lump >50yo
A
cancer :(
4
Q
what are the lumps made of in a breast with fibrocystic changes
A
small cysts with fibrosis
5
Q
presentation of fibrocystic changes
A
small lumps
pain
6
Q
who are fibrocystic changes of the breast most common in (age group)
A
20-50yo
7
Q
management of fibrocystic changes in the breast
A
nothing
reassurance
8
Q
investigations for any breast lump
A
triple assessment;
clinical - history and examination
radiography - mammogram/US
pathology - core needle biopsy/vacuum assisted biopsy
9
Q
% of lumps seen in breast clinic that are cancer
A
10% of lumps
10
Q
most common benign mass in breast
A
fibroadenoma
11
Q
who get fibroadenomas (age)
A
young women
12
Q
management of fibroadenoma of the breast
A
nothing
reassurance
13
Q
presentation of fibroadenoma
A
painless lump - bc benign tumour = slow growing
mobile
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
15
Q
what size is a radical scar
what size if a complex sclerosing lesion
A
radical scar 1-9mm
complex sclerosing lesion >10mm
16
Q
mastalgia definition
what causes it
A
breast pain associated with menstruation - normal
17
Q
what is a cyst
A
fluid filled cavity
18
Q
who gets cysts in the breast (age)
A
older women
19
Q
management of cysts
A
FNA - drainage
20
Q
bloody nipple discharge
A
papilloma
21
Q
‘cauliflower’ like extension of duct/cyst
A
papilloma
22
Q
scaly/eczematous nipple/areola
A
pagets disease of the nipple
23
Q
causes of fat necrosis in breast (2)
A
seatbelt injury
warfarin therapy
24
Q
how does fat necrosis occur
A
damage to adipocytes (fat eg from seatbelt injury) = acute inflammation = fibrosis and scarring = lump formation
25
seatbelt injury 2 weeks ago
| new lump in breast
fat necrosis
26
what risk factor is associated with duct ectasia
smoking
27
what is duct ectasia
sub areolar duct clogging = dilatation = inflammation = fibrosis and scarring = lump formation
28
what % of papillomas are premalignant
10%
29
red inflamed breasts
not painful
during breast feeding
mastitis
30
management of mastitis
continue breast feeding
| 1g flucloxacillin QDS
31
what microorganism causes mastitis if it is associated with breast feeding
staph aureus from skin
32
complication of untreated mastitis
abscess/sepsis
33
painful swelling of breasts during breast feeding
| no redness/inflammation
engorgement
34
engorgement management
continue breast feeding
35
presentation of duct ectasia
sub areola lump
pain
green discharge
36
what BMI is a risk factor for breast cancer
why
high BMI
increased adipose = increase oestrogens
37
early/late menarche/menopause is a risk factor for breast cancer
why
```
early menarche (<12)
late menopause (>55)
```
bc increased time menstruating = increased ostrogen production
38
high …. hormone is the basis for most of the risk factors of breast cancer
high oestrogen
oestrogen 'feeds' the tumour
39
what type of contraception if a risk factor for breast cancer
any hormonal one!
40
what type of contraception should you give someone w
copper coil (isn't hormonal)
41
which gene mutation is a risk factor for breast cancer
BRCA1/2
42
does breast feeding increase or decrease you risk of breast cancer
decreases risk of breast cancer
43
what screening is in place for breast cancer
mammogram every 3 years between 50-70yo
44
is breast cancer more common in older or younger people
| can it occur in the other group
more common in older people
don't rule out breast cancer just bc <50yo
45
does screening for breast cancer prevent it from happening or just pick it up earlier
just picks it up earlier
46
which part of the breast does breast cancers arise from
terminal duct lobular unit (TDLU)
47
what happens to collagen in breast cancer
collagen becomes more dense
48
what are the 2 types of breast cancer
which is more common
ductal - 90%
| lobular - 10%
49
how does ductal carcinoma in situ differ from invasive ductal carcinoma
ductal carcinoma in situ (DCIS) is contained within the basement membrane
50
what is ductal carcinoma in situ a precursor to
invasive ductal carcinoma (50% will progress)
51
what is it called when DCIS spreads to the nipple
pagets disease of the nipple
52
is pagets disease of the nipple classed as DCIS or invasive ductal carcinoma
DCIS - bc still confined to basement membrane, has just spread far
53
presentation of pagets disease of the nipple
scaly/eczematous nipple/areola
| weeping nipple discharge
54
what type of breast cancer are 75% of them
invasive ductal carcinoma
55
how does invasive ductal carcinoma differ from ductal carcinoma in situ
in invasive ductal carcinoma the malignant cells have breached the basement membrane
56
why is immunocytochemistry important for invasive ductal carcinomas
important for treatment
57
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
```
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
the presence of which receptor (ER, PgR, HER2) indicates poor prognosis
HER2
59
what can lobular carcinoma in situ progress to (not always)
invasive lobular carcinoma
60
presentation of breast cancer
dimpled/depressed skin
breast lump
nipple changes
nipple discharge
61
mobile breast lump
probs benign
62
which quadrant of the breast do most breast cancers present in
upper outer quadrant
63
what is the triple assessment for investigating breast lumps
clinical - history, examination
radiography - mammogram/US
pathology - core needle biopsy (GOLD standard)/vacuum assisted biopsy/FNA
64
what type of radiology technique is mammogram
xray
65
when do you use mammogram over US
why
>40yo
better than US if there is lots of fat (in older people)
66
when do yo use US over mammogram
why
<40yo
breast is usually too dense (gets fattier as you get older) to see any calcification on mammogram
67
what changes are you looking for mammogram
calcification
68
which type of radiology is used in breast cancer screening
mammogram
69
what does DCIS look like on mammogram
calcification in a line (in a duct not invasive)
70
if mammogram/US comes back saying theres calcification, what do you do next
biopsy and test pathology - to distinguish types of cancer
71
GOLD standard biopsy technique
core needle biopsy
72
when is vacuum assisted biopsy used over core needle biopsy
if calcification is too small for core needle biopsy
73
what other collection method used to be used for sampling a breast mass for pathology report, but is no longer used
FNA
74
if invasive ductal carcinoma is diagnosed by pathology, what investigation do you want to do next
immunohistochemistry - to find out what receptors it has for treatment
75
surgical management options for breast cancer
breast conserving surgery - 'lumpectomy'
mastectomy
ultimately patients decision!
76
if youre doing breast conserving surgery (wide local excision/lumpectomy) what adjuvant therapy MUST you give (even if you get it all out)
adjuvant radiotherapy
high chance of recurrence if not
77
if doing mastectomy, do you need radiotherapy
no - bc removing entire breast
78
does mastectomy alone or wide local excision with radiotherapy have a lower recurrence rate
both same
people often pick mastectomy thinking lower recurrence, but reassure them otherwise! is more psychologically distress having entire breast removed
79
if doing mastectomy for invasive carcinoma, which lymph nodes do you also remove
axillary nodes
80
do you need to remove axillary nodes if DCIS
no
bc in situ = not spread to nodes
81
before removing axillary nodes in invasive carcinoma, how do you tell which one you need to remove
what is this node called
inject dye into breast tumour = see where the dye ends up first
called the sentinel node
82
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
if you remove them all = risk of arm lymphoedema
removing levels II and III = higher risk than level I
83
adjuvant therapy for triple negative tumours
chemotherapy
84
adjuvant therapy for oestrogen receptor positive tumours
tamoxifen - antioestorgen therapy
85
adjuvant therapy for HER2 positive tumours
trastuzumab (Herceptin) - monoclonal antibody
86
which type of tumour is adjuvant/neoadjuvant therapy used for
when is it used
invasive carcinoma (not in situ)
before surgery (to debulk tumour) or after
87
what is it called when you used additional therapies to surgery BEFORE the surgery has taken place
neoadjuvant therapy (as opposed to Adjuvant = After)
88
side effect of chemo
neutropaenia
89
if someone with breast cancer is on the mirena coil, what do you want to do
change to copper coil
90
where do breast cancers usually metastasise
bone (spine)
91
is prognosis good or bad for breast cancers
good if not metastatic!
92
what type of breast cancer is caused by breast radiotherapy
angiosarcoma
