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Gynaecology > BREASTS > Flashcards

BREASTS Flashcards

1
Q

What is involved in Triple Assessment?

A

Clinical Examination (P1-5)
Imaging (U1-5; M1-5)
Biopsy (B1-5)

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2
Q 
Breast screening
1-
2-
3-
4-
5-
What do they mean?
A 
1-normal
2-benign
3-indeterminate
4-suspicious
5-malignant
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3
Q

What is the wait when women with breast symptoms sent by GP to fast track clinic

A

2 wk wait

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4
Q

Out of 100 ladies breast screened, how many will need more tests, how many will have cancer?

A

4 need more tests

1 cancer

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5
Q

What kinds of imaging in triple assessment?

A

ultrasound

MAMMOGRAM

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6
Q

what are the two mammograms views?

A

cranio-caudal (squashed from top)

medio-lateral-oblique (squashed from side)

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7
Q

What kind of biopsy in triple assessment?

A

core biopsy
(with x ray guidance)
with local anaesthetic

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8
Q

Radiologist hooks wire on lesion on lesion to guide surgeon on day of surgery. Whats this called?

A

wire localisation

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9
Q

How many women get breast cancer?

A

1 in 8

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10
Q

What age group is NHS breast screening for?

A

47-73yrs

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11
Q

Name 4 risk factors for breast cancer.

A

age
FHx
uninterrupted oestrogen exposure
obesity

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12
Q

How many years after stopping COCP is breast cancer risk back to normal?

A

10yrs

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13
Q

What are the pre-malignant breast cancers

A

ductal carcinoma in situ (DCIS)

lobular carcinoma in situ

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14
Q

How frequent is NHS breast screening?

A

every 3 yrs

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15
Q

What imaging does NHS breast screening involve?

A

2view mammography

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16
Q

What is the most common invasive breast cancer?

A

invasive ductal carcinoma

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17
Q

70% of breast cancers are…

A

invasive ductal carcinoma

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18
Q

Why is invasive lobular carcinoma more difficult to identify?

A

stringy diffuse tissue thickening

not just lump

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19
Q

Which BC especially affects young women?

A

medullary

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20
Q

Which BC especially affects elderly women?

A

colloid / mucoid

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21
Q

If BC is oestrogen receptor positive, is that a better or worse prognosis?

A

better

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22
Q

If BC is HER2 receptor positive, is that a better or worse prognosis?

A

worse

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23
Q

What is HER2?

A

human epidermal growth factor receptor

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24
Q

What % of BCs are oestrogen receptor positive?

A

60%

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25
Q

What % of BCs are HER2 receptor positive?

A

30%

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26
Q

What are the four aspects of the breast examination?

A

inspection
palpation of breast
palpation of axilla
further Ex - spine, hepatomegaly

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27
Q

Apart from a breast lump, how else can breast cancer present?

A

change in size/shape of breast
skin changes e.g. peau d’orange, Paget’s change

bloody nipple discharge
nipple inversion

armpit lump

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28
Q

Red scaly itchy rash behind the nipple. Painful and bleeds when scratch. Sign of malignancy behind nipple. What’s this called?

A

Paget’s change

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29
Q

What scale is used to determine prognosis after surgery for breast cancer?

A

Nottingham prognostic index`

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30
Q

is it’s a CYSTIC lump, what kind of biopsy is better?

A

fine needle aspiraiton

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31
Q

if it’s a SOLID lump, what kind of biopsy is better?

A

core biopsy

32
Q

What is stage4 breast cancer?

A

mets, fixed to chest wall

33
Q

What is the treatment for stage 1-2 breast cancer?

A

surgery
radio
chemo
hormone therapy

34
Q

What is the treatment for stage 3-4 breast cancer?

A

radio / bisphosphonates for bone pain

chemo

35
Q

Name four types of hormone therapy for stage1-2 breast cancer.

A

tamoxifen
aromatase inhibitors
ovarian ablation
ovarian supppression

36
Q

What hormone therapy for PRE-menopausal ladies with stage 1-2 breast cancer?

A

ovarian ablation

to decrease oestrogen synthesis

37
Q

What hormone therapy for POST-menopausal ladies with stage 1-2 breast cancer?

A

aromatase inhibitors

to decrease oestrogen synthesis

38
Q

How long do you take tamoxifen?

A

5yrs post-op

oral once a day

39
Q

Targeted drug for HER2 positive?

A

TRASTUZUMAB (herceptin)

40
Q

You give radiotherapy after breast surgery. Whereabouts depending on which surgery?

A

to breast after wide local excision
to chest wall after mastectomy
to axillary lymph node if not cleared

41
Q

Talk me through breast cancer surgery.

A

can be :

  • wide local excision (breast-conserving), or
  • mastectomy +/- reconstruction

and!

  • sentinel node biopsy, or
  • axillary node sampling / clearance
42
Q

What can be a side effect from axillary lymph node radiotherapy?

A

lymphoedema in arm

43
Q

How might you locate breast lump for surgery if it’s impalpable?

A

radiological wire localisation

44
Q

Give me three reasons why you might advise a mastectomy over wide local excision?

A
  • > 25% breast vol
  • multifocal lumps
  • location e.g. cleavage area
45
Q

Give me four options for breast reconstruction.

A

tissue expanders
implants
lat dorsi flaps
TRAM flaps

46
Q

What is a TRAM flap in breast reconstruction?

A

transverse rectus abdominis muscle

47
Q

Give me three reasons why you might advise breast-conserving surgery (wide local excision) over mastectomy.

A

small lump
one specific area
can tolerate radio

48
Q

When do you give chemo in treatment of breast cancer?

A

neo-adjuvant for all

  • given before surgery to shrink the tumour
    e. g. cyclophosphamide
49
Q

Most common cause of breast lump in 15 to 30 yr olds?

A

fibroadenoma

50
Q

breast mice

A

a.k.a fibroadenoma

wiggle around with clear edges

51
Q

What actually is fibroademona?

A

benign overgrowth of conn tiss in lobule

52
Q

26 yr old presents with painless, firm mobile breast lump. Most likely diagnosis?

A

fibroadenoma

53
Q

what is the treatment for fibroadenoma?

A

observation and reassurance

excision if large

54
Q

23yr old presents with breast lump which is painless, firm and mobile with clear edges. What investigations do you carry out?

A

clinical Ex
ultrasound

(only biopsy if inconclusive)

55
Q

23yr old presents with breast lump which is painless, firm and mobile with clear edges. What investigations do you carry out?

A

clinical Ex
ultrasound

(only biopsy if inconclusive)

56
Q

Can you biopsy a cyst?

A

no. it’s not solid.

fine needle aspiration.

57
Q

40 yr old presents with round fluid filled breast lump, painless. Likely diagnosis?

A

breast cyst

58
Q

What is the treatment for breast cysts?

A

usually none

drainage with fine needle aspiration if v large or painful

59
Q

37 yr old presents with breast lump, which is causing her pain. On clinical Ex, you feel a round fluid filled lump. Ultrasound confirms it’s a large breast cyst. What is the treatment?

A

it’s large and painful, so drainage with fine needle aspiration

60
Q

In which group is breast abscess much worse at clearing up in ?

A

smokers

61
Q

What bacteria tends to cause infective mastitis during breastfeeding?

A

Staph aureus

62
Q

Apart from lactation, what else can cause infective mastitis?

A

skin infections

nipple piercings

63
Q

What is the treatment for a breast abscess / infective mastitis?

A

antibiotics +/- drainage.

64
Q

What is the most common cause of mastitis (inflammation of breast tissue)?

A

milk blockages

not always infectious so wouldnt need abx!

65
Q

What is duct ectasia?

A

ducts widen and fluid builds up - secretions stagnate - green/brown/bloody discharge

66
Q

Scarring of breast after injury. What’s this?

A

fat necrosis

67
Q

When is the typical time for duct ectasia?

A

around the menopause

68
Q

I banged my boob on the door handle. What might I get now.

A

fat necrosis

69
Q

Give me two types of intraductal papilloma.

A

central (near nipple)

peripheral

70
Q

What is the most common cause of bloody nipple discharge in women 20-40?

A

intraductal papilloma

71
Q

Small benign tumour that forms in milk duct of breast. What’s this?

A

intraductal papilloma

72
Q

What actually is intraductal papilloma?

A

small benign tumour that forms in milk duct of breast

73
Q

These very small lumps may not show up on mammography and commonly cause blood nipple discharge.

A

intraductal papilloma

74
Q

Often intraductal papilloma isn’t palpable on clinical Ex or visible on US / mammogram. What investigation might you need?

A

galactrogram to guide biopsy.

75
Q

Mulitple. Younger women. Increased malig risk. Which kind of intraductal papilloma is this?

A

peripheral

76
Q

Solitary. Near nipple. Around menopause. Which kind of intraductal papilloma is this?

A

central

77
Q

What treatment might be required for intraductal papilloma?

A

excision of duct

Gynaecology (8 decks)

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