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Medicine, Year 3, GI and Surgery > Clinical Topic 11: Breast Disease > Flashcards

Clinical Topic 11: Breast Disease Flashcards

1
Q

Where do accessory nipples and accessory breasts commonly develop?

A

Along the milk line
Accessory nipples: Below the breast
Accessory breasts: Axilla

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2
Q 
Breast Cyst:
How common is it?
What age can it occur?
Does it change with anything?
How does it feel?
How is it treated?
A
  • Most common cause of breast mass
  • Occur any age, but uncommon post-menopausal
  • Can fluctuate with menstrual cycle
  • Well demarcated, firm and mobile
  • Treated by Aspiration
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3
Q 
Fibroadenoma
How common is it?
What age can it occur?
Does it change with anything?
How does it feel?
How is it treated?
A
  • 2nd most common cause of breast mass
  • Occur from age 15-35 years old
  • Changes with pregnancy and oestrogen therapy
  • Feels like a breast mouse
  • Treated by Excision if >3cm,
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4
Q

What are the three types of Fibroadenomas?

A

Simple, Giant (>10cm), Juvenile

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5
Q 
Phylloides tumour:
Size? Growth?
What age can it occur?
Do they have metastatic potential?
How is it treated?
A
  • A large fast growing tumour
  • Common in ages 40-50 years old
  • 25% are malignant, 10% are metastatic
  • Treated by WIDE EXCISION
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6
Q

Fat Necrosis:
What is caused by?
How does it look and feel?
How is it treated?

A
  • Caused by trauma
  • Tender, ill-defined with skin retraction
  • Treated by biopsy and clinical follow up
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7
Q

Galactocele:
What is it?
Where are the commonly found?
How is it treated?

A
  • Milk filled cysts caused by lactiferous duct distention
  • Commonly found in upper quadrant above Areola
  • Treated by aspiration
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8
Q 
Duct Ectasia:
What is it?
How common is it?
What symptoms are classic?
How is it treated?
A
  • Blockage of Lactiferous ducts
  • Common in older women
  • Green-brown nipple discharge are classic
  • Treated by biopsy / excision
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9
Q 
Gynaecomastia:
What is it?
What is pseudogynaecomastia
How common is it?
What is caused by?
How is it treated?
A
  • Benign growth of glandular tissue of male breast
  • Common in infancy, adolescence, adulthood
  • Pseudogynaecomastia in obese individuals
  • Caused by imbalance of oestrogen / androgens
  • Treated by treating underlying cause, Tamoxifen, or surgery
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10
Q

What are red flags of nipple discharge?

A

If it is unilateral, spontaneous or bloody (think Intraduct Papilloma, DCIS, invasive cancer)

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11
Q 
Mastitis:
How common is it?
What is caused by?
What are the symptoms?
How is it treated?
A
  • Common in lactating female
  • Caused by staph / streptococcus
  • Dry, cracked areola, erythematous breast, breast pain
  • Treated by heat, continuing breast feeding, ABX for 10-14 days
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12
Q

Breast Abscess:
What are the symptoms?
How is it treated?

A
  • Breast swelling, tenderness, fever, purulent discharge

- Treated by USS guided aspiration and ABX

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13
Q

What are some risk factors for Breast Cancer?

A
  • Increasing age
  • Family History - BRCA1, BRCA2, TP53, ERBB2
  • Duration of Oestrogen exposure (endo / exogenous)
  • Early periods, late menopause
  • Lack of breast-feeding
  • HRT (doubled risk after 10 years)
  • Obesity
  • Alcohol
  • Ionising radiation
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14
Q

What kind of mutations of BRCA1 and BRCA2?

A

Autosomonal dominant

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15
Q

What is Fibroadenosis? When is it most common?

A

‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
Most common in middle-aged women

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16
Q

What are the three major types of breast cancer based on Hormone Receptors? Which is most common?

A

ER+ / HER2- (most common)
ER- / HER2-
HER2+ / ER+ or ER-

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17
Q

Outline Breast Cancer Screening

A
  • Offered to all women aged 50-70 (47-73 in some areas)
  • Women over 70 are encouraged to make own appointments
  • Mammography every 3 years
18
Q

What conditions present with:

  • Green nipple discharge
  • Blood stained nipple discharge
A
  • Duct ectasia

- Duct papilloma

19
Q

What does a “snowstorm” sign suggest on ultrasound?

A

Extra-capsular rupture of breast implant

20
Q

What is the TNM staging for breast cancer?

A 
T0: No evidence of primary
T1: <2cm 
T2: 2-5cm
T3: >5cm
T4: Extension into chest wall, skin, or is inflammatory

N0: No nodal involvement
N1: Mobile nodes
N2: Fixed, matted nodes
N3: Internal mammary nodes

M0: No metastasis
M1: Metastasis

21
Q

What are the “No Special Type” and “Special Type” breast cancers?

A

No Special Type:
- Invasive ductal carcinoma

Special Type:

  • Invasive lobar carcinoma
  • DCIS
  • LCIS
22
Q

What is the most common breast cancer?

A

Invasive Ductal Carcinoma

23
Q

How is Paget’s Disease different to Nipple Eczema?

A

In Paget’s disease, nipple affected first -> then areola

In Nipple Eczema, areola affected first -> then nipple

24
Q

Why might a patient have a Mastectomy over a Wide Local Excision?

A
  • Multifocal tumour
  • Central tumour
  • Large lesion
  • DCIS >4cm
25
Q

Why might a patient a Wide Local Excision instead of a Mastectomy?

A
  • Solitary tumour
  • Peripheral tumour
  • Small lesion
  • DCIS <4cm
26
Q

What are the recommendations for Radiotherapy in patients with Breast Cancer?

A

If Wide Local Excision -> offer radiotherapy

If Mastectomy -> offer radiotherapy if T3/T4, or 4 or greater lymph node involvement

27
Q

What are the recommendations for Hormonal (Oestrogen) therapy in patients with Breast Cancer?

A

If ER+ and pre/peri menopausal -> Tamoxifen

If ER+ and post-menopausal -> Aromatase

28
Q

What are the recommendations for Biological therapy in patients with Breast Cancer?

A

Only if HER2+

Trastuzumab (only if they do not have heart conditions)

29
Q

What are the adverse side-effects of Tamoxifen?

A

Increased risk of endometrial cancer, VTE, menopausal symptoms

30
Q

What screening tool is used to assess Prognosis of Breast Cancer?

A

Nottingham Prognostic Index

31
Q

If hormonal therapy is indicated following surgery for breast cancer, how long should Tamoxifen be given for?

A

5 years

32
Q

What are the recommendations for Chemotherapy in patients with Breast Cancer?

A

If node involvement -> FEC-D chemotherapy

If no node involvement -> FEC chemotherapy

33
Q

If Herceptin is being given as adjuvant treatment for breast cancer, how long should it be given for?

A

Every 3 weeks for 1 year

34
Q

Radiotherapy following surgery for breast cancer is usually given for how long?

A

5 days a week for 3 weeks

35
Q

Mutations in a BRCA gene are responsible for what percentage of all breast cancers?

A

2%

36
Q

Lobar in situ neoplasmas are commonly _focal, _lateral, and _crease after menopause

A

Multi-focal, bilateral and decrease after menopause

37
Q

Hot flushes, moodswings, fatigue and headache are all side effects of which therapy for breast cancer?

A

Tamoxifen

38
Q

Following discharge from oncology and surgical services after breast cancer treatment, patients should receive yearly mammograms for how long?

A

For 3 years. After 3 years, re-join National Breast Screening Programme

39
Q

Intraductal papilloma produces what coloured discharge? Does it come from one duct, or multiple ducts?

A

Clear or bloody discharge

One duct

40
Q

Periductal mastitis is common in which group of patients specifically?

A

Smokers

41
Q

What is the “halo sign” on a mammogram associated with?

A

Breast Cyst

Medicine, Year 3, GI and Surgery (12 decks)

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