Exam 6- breast Flashcards
Smooth discrete lumps, sometimes painful, often seen in pre-menopausal women
Fibrocystic change
Painless, highly mobile mass which is the commonest breast lump in younger women
Fibroadenoma
Triple assessment of a breast lump (3)
Clinical exam
Imaging (US/MRI/mammogram)
Biopsy (core needle)
Caused by trauma to adipose tissue, usually in obese women?
Fat necrosis
Tender lump + green discharge
Mammary duct ectasia
Red, hot, tender mass in lactating woman
Breast abscess
Young female smoker + tender discharging lump
Periductal mastitis
Lump with blood-stained discharge
Duct papilloma
? breast cancer
Two main types of sclerosing breast lesions
Sclerosing adenosis
Radial scar
Treatment of duct papilloma
Microdochectomy or total duct excision
Bilateral pain in the outer half of the breast, usually in relationship to menstrual cycle
Cyclical mastalgia
Main types of breast cancer; which is commonest?
Ductal and lobular. Ductal is more common
Most common presenting symptom of breast cancer. Other symptoms? (4)
Lump which may or may not be painful.
Nipple changes (Paget's, inversion) Skin changes (peau d'orange) Lymphoedema of the arm Nipple discharge
Tumour marker for breast cancer?
CA 15-3
When is a mastectomy preferred over wide local excision?
Big tumour (>4cm) or multifocal
Guidelines for radiotherapy use in breast cancer (2)
After WLE
After mastecomy if axillary nodes are positive
Hormonal therapy for ER+ breast cancers? (2)
Pre-menopause: tamoxifen
Post-menopause: aromatase inhibitors
What is the clinical significance of HER+ status?
Tamoxifen is less effective; trastuzumab (herceptin) can be used
Specific breast ca. risk factors (4)
Family Hx (BRCA)
Nulliparity, early menarche, late menopause
HRT
Combined oral contraceptive
Which subtype of breast cancer carries the worst prognosis?
Triple negative
What is the Nottingham prognostic index?
A scoring system which accounts for diameter, grade and lymph node status
In WLE what distance of margins are aimed for?
1cm
Sources of autologous material for breast reconstruction? (4)
Lat dorsi Transversus rectus abdominus Inferior gluteal (IGAP) flap Deep inferior epigrastric (DIEP) flap
Options for detecting axillary node status? (2) Treatment options for positive nodes?
Ultrasound + core biopsy
Sentinel node biopsy
Treatment- axillary clearance, radiotherapy
Acute side effects of radiotherapy (3)
Skin erythema, moist desquamation
Tiredness
Dysphagia (supraclavicular fossa)
What is comedo necrosis and what is it associated with?
Cancer cells “plug” the duct and become necrosed. Its a feature of high grade ductal carcinoma
Nerves frequently injured during axillary dissection?
Intercostobrachial
Painless breast lumps secondary to protein plugs blocking the outlet of the mammary glands?
Galactocele
