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Phase 3a > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

How long is a typical menstrual cycle?

A

23-35 days

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2
Q

What is the structure of the ovarian menstrual cycle?

A

Follicular (d1-13), ovulation (d14), luteal phase (d15-28)

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3
Q

What is the structure of the uterine menstrual cycle?

A

menses (d1-5, proliferative (d6-14), secretory (d15-28)

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4
Q

What happens in the follicular phase?

A
  • Folliculogenesis
  • Follicle maturation
  • Thickening of the uterine lining
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5
Q

What happens in the luteal phase?

A
  • Corpus luteum forms
  • Increased progesterone
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6
Q

During the menses and follicular phase are the levels of oestrogen and progesterone high or low?

A

Low

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7
Q

During the proliferative phase and ovulation are the levels of oestrogen and progesterone high or low?

A

High oestrogen

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8
Q

What causes high oestrogen during ovulation?

A

LH surge on day 12-13, 36 hours pre-ovulation

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9
Q

During the luteal and secretory phase are oestrogen levels high or low?

A

high progesterone

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10
Q

What is the best marker of ovulation?

A

Mid-luteal progesterone levels (cycle length minus 7 days e.g. day 21)

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11
Q

What hormones are involved in the menstrual cycle and released by the pituitary?

A

LH, FSH

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12
Q

What is the role of oestrogen?

A
  • Female body composition
  • Builds up endometrium
  • Improves bone mineral density
  • Increases spiral arterioles
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13
Q

What is the role of progesterone?

A
  • increase uterine mucus secretion
  • maintains endometrial lining
  • myometrium smooth muscle relaxation
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14
Q

What is the role of LH?

A

Acts on theca cells to produce oestrogen

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15
Q

What is the role of FSH?

A

Acts on granulosa cells for folliculogenesis

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16
Q

What needs to happen for the LH surge to occur?

A

An isolated raised oestrogen

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17
Q

What is primary amenorrhoea?

A

When a pt has never had a period either >13 with no primary sexual characteristics or >15 with no secondary sexual development

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18
Q

What is hypergonadotrophic amenorrhoea?

A
  • Raised LH and FSH
  • primarily in TURNERS (45X)
  • Can be ovarian dysgenesis/agenesis
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19
Q

What is hypogonadotrophic amenorrhoea?

A
  • Decreased LH and FSH
  • primarily in Kallmann’s syndrome (+anosmia)
  • Failure to thrive
  • Androgen insensitivity syndrome
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20
Q

What is secondary amenorrhoea?

A

> 6 months of no periods in a normally menstruating female

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21
Q

What can cause secondary amenorrhoea?

A
  • Sheehan’s syndrome (pituitary necrosis after PPH)
  • Asherman’s syndrome (uterine adhesions post surgery)
  • Eating disorders
  • Hyperthyroid
  • Hyperprolactinaemia
  • PCOS
  • Pregnant?
  • Pre menopause?
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22
Q

How is amenorrhoea diagnosed?

A
  • History and examination
  • Bloods- oest, prog, test, FSH, LH, prolactin, SHBG, TPT, IGF1
  • HbA1C (PCOS)
  • Urine bHCG (pregnant?)
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23
Q

How is amenorrhoea treated?

A
  • Hypogonadotrophic = COCP
  • Hypergonadotrophic = GnRH analogue
  • Refer to secondary care to treat underlying cause
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24
Q

What is a bicornate uterus?

A

Congenital defect, heart shaped uterus
- Increases risk of miscarriage + intra uterine growth restriction

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25
Q

What is transverse vaginal septum?

A

Sheath of tissue across vaginal opening
- Perforate (bleed) or imperforate (no bleed)
- Increased risk of infertility and endometriosis

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26
Q

What chromosome abnormality is Mullerian agenesis?

A

46XX

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27
Q

What is menorrhagia?

A

Subjectively heavy menses (normal 30-80ml)

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28
Q

What are the causes of menorrhagia?

A
  • dysfunctional uterine bleeding - mc idiopathic
  • uterine fibroids
  • copper coil (IUD)
  • hypothyroidism
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29
Q

What are the investigations for menorrhagia?

A
  • Bloods - FBC, clotting screen, ferritin, TFT
  • Trans vaginal ultrasound
  • History and exam
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30
Q

What are fibroids?

A

Uterine leiomyomas
Typically 30-50 years old

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31
Q

What are the types of fibroids?

A
  • Pedunculated
  • Subserosal
  • Submucosal
  • Intramural
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32
Q

What are the risk factors for fibroids?

A
  • Increased oestrogen
  • nulliparity
  • obesity
  • early menarche
  • late menopause
  • afrocaribbean
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33
Q

What are the symptoms of fibroids?

A
  • Menorrhagia
  • bloating
  • pelvic pressure
  • subfertility
    (+ risk of IUGR and abnormal foetal lie
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34
Q

How are fibroids diagnosed?

A
  • Bimanual - large, irregular, non tender uterus
  • Transvaginal ultrasound - mass
  • MRI can be used
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35
Q

What is the treatment for fibroids?

A
  • First line - IUS - CI if uterus distorted
  • Second line - COCP
  • If they don’t want contraception give tranexamic acid
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36
Q

What is the best treatment for a subfertile female with fibroids who wants a child?

A

Myomectomy

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37
Q

What are the complications of fibroids?

A
  • Red degeneration - low fever, lower abdo pain, N+V
  • Calcification
  • Subfertility/infertility
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38
Q

What is dysmenorrhoea?

A

A subjectively painful period

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39
Q

What are the causes of dysmenorrhoea?

A
  • Endometriosis
  • Adenomyosis
  • PID?
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40
Q

What is endometriosis?

A

Ectopic endometrial tissue that is displaced
Typically 20-40 yr old (mean 28)
1/10 Females UK

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41
Q

Where can you get endometriosis?

A
  • Ovaries
  • Bladder
  • Bowel (incl pouch of douglas)
  • Abdomen
  • Thorax (thoracic endometrial syndrome)
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42
Q

What are the theories behind endometriosis?

A
  • Halberns - Haematogenous and lymphatic spread
  • Samsons - retrograde menstruation
  • Meyers - Metaplasia
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43
Q

What are the risk factors for endometriosis?

A
  • Nulliparity
  • autoimmune disease
  • early menarche
  • late menopause
  • FH
  • vaginal outflow obstruction
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44
Q

What are the symptoms of endometriosis?

A
  • dysmenorrhoea
  • menorrhagia
  • subfertility
  • deep dyspareunia
  • dysuria
  • dyschezia
  • haemoptysis
  • fatigue
  • SOB
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45
Q

How is endometriosis diagnosed?

A
  • First line - TVUSS
  • Gold standard - laparoscopy
  • Bimanual - adnexal motion tenderness + fixed retroverted uterus
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46
Q

How is endometriosis treated?

A
  1. NSAIDS
  2. COCP
  3. Surgery - fertility preserving - ablation
    no saving fertility - hysterectomy
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47
Q

What is adenomyosis?

A

Endometrial invasion into the myometrium
35-45 yrs old w history of uterine surgery

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48
Q

What are the risk factors for adenomyosis?

A
  • uterine surgery
  • early menarche
  • late menopause
  • nulliparity
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49
Q

What are the types of adenomyosis?

A
  • Focal (one site)
  • Diffuse (throughout)
  • Adenomyoma (benign focal mass)
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50
Q

What are the symptoms of adenomyosis?

A
  • dysmenorrhoea
  • cyclical pain
  • deep dyspareunia
  • menorrhagia
  • subfertility
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51
Q

How is adenomyosis diagnosed?

A
  • Bimanual - BOGGY uterus
  • TVUSS
  • GS - post excisional biopsy
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52
Q

What is PCOS?

A

2/3 Rotterdam criteria
- hirsutism + signs of hyperandrogenism
- menstrual disturbance (oligo or anovulation)
- polycystic ovaries on TVUSS

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53
Q

What are the risk factors for PCOS?

A
  • FH
  • obese
  • insulin resistance (T2DM)
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54
Q

What are the symptoms of PCOS?

A
  • hirsutism (acne, facial hair)
  • mood swings
  • amenorrhoea/oligomenorrhoea
  • subfertility
  • hyperpigmentation of neck folds and armpit folds
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55
Q

How is PCOS diagnosed?

A
  • 2/3 Rotterdam criteria (can be clinical)
  • Bloods - FBC, U+E, TFT, LFT, Test, Oest, Prog, SHBG
  • Ratio of LH:FSH = 2:1
  • TVUSS - >12 polycystic ovaries arranged like beads on a string
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56
Q

How is PCOS treated?

A

Not fertility planning:
- lose weight and exercise
- COCP
- consider metformin
Fertility planning:
- consider clomifene (induce ovulation)

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57
Q

What are the possible complications of PCOS?

A
  • Infertility
  • metabolic syndromes
  • T2DM
  • endometrial hyperplasia and endometrial cancer!!!
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58
Q

How are gynae malignancies staged?

A

FIGO 1-4 staging

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59
Q

What are the main gynae malignancies?

A
  • endometrial
  • ovarian
  • cervical
  • vulval
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60
Q

What are the types of endometrial cancer?

A

Adenocarcinoma - 80%
- Type 1 - more common, better prognosis, raised oestrogen
- Type 2 - atrophic, p53 mutations

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61
Q

What are the risk factors for endometrial cancer?

A

Unopposed oestrogen:
- Oestrogen only HRT!!!
- PCOS
- T2DM
- Tamoxifen use
- nulliparity
- obese
- early menarche
- late menopause
Genetics:
- Lynch syndrome (HNPCC)
- KRAS mutation
- p53 mutation
-PTEN mutation

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62
Q

What are protective factors for endometrial cancer?

A
  • COCP
  • IUS
  • breast feeding
  • multiparity
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63
Q

What are the symptoms of endometrial cancer?

A

50+ postmenopausal bleeding

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64
Q

How is endometrial cancer diagnosed?

A
  • Bimanual - large + irregular
    First line - TVUSS - thick uterine lining
    Gold standard - hysteroscopy + biopsy
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65
Q

How is endometrial cancer staged?

A
  1. Confined to the uterus
    • cervix
    • pelvis
    • extrapelvic e.g. bladder, lungs, liver
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66
Q

How is endometrial cancer treated?

A

Stage 1 or 2 - hysterectomy with bilateral salpingoopherectomy
Stage 3+4 - debulking surgery and adjuvant chemotherapy

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67
Q

What are the types of ovarian cancer?

A
  • Epithelial (70%) - serous (mc) and mucinous
  • Germ cell (20%) - teratoma and dysgerminoma
  • Sex cord (10%)
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68
Q

What are the risk factors for ovarian cancer?

A
  • BRCA 1+2
  • nulliparity
  • obese
  • early menarche
  • late menopause
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69
Q

What are protective factors for ovarian cancer?

A
  • COCP
  • breast feeding
  • multiparity
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70
Q

What are the symptoms of ovarian cancer?

A
  • 50+ postmenopausal female with new onset IBS/GI/urinary symptoms
  • bloating
  • severe constipation
  • indigestion
  • abdominal pain
  • jaundice if metastasised
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71
Q

How is ovarian cancer diagnosed?

A

First line - TVUSS - multiloculated bilateral free fluid containing heterogeneous and blood test - CA125
Gold standard - pipelle biopsy
RMI - menopausal status + CA125 + USS findings >250 needs specialist referral for biopsy

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72
Q

What can cause a raised CA125?

A
  • ovarian cancer
  • menstruation
  • PID
  • benign cysts
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73
Q

What is the FIGO staging for ovarian cancer?

A
  1. ovaries
    • pelvis
    • peritoneum/ lymph nodes
    • distant mets - liver, brain, bowel
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74
Q

What is the treatment for ovarian cancer?

A

Stage 1 - hysterectomy + B/L S.O
Stages 2-4 - optimal debulking adjuvant chemo

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75
Q

What needs to be done before any gynae surgery?

A
  • FBC
  • U+E
  • clotting screen
  • crossmatch group and save
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76
Q

What are the possible complications of ovarian cancer?

A
  • struma ovarii - ovarian tumour releasing T4
  • meigs syndrome
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77
Q

Who is most affected by cervical cancer?

A

sexually active 30-45 yrs old

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78
Q

What are the types of cervical cancer?

A
  • Squamous cell (90%)
  • adenocarcinoma (10%)
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79
Q

What are the risk factors for cervical cancer?

A
  • high risk HPV strains (16+18, 31, 45)
  • unprotected sexual intercourse
  • people who don’t screen
  • HIV
  • COCP use
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80
Q

Which conditions should a PAP smear be avoided?

A
  • menstruating
  • PID
  • within 12 weeks of giving birth/ termination/ miscarriage
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81
Q

What are symptoms of cervical cancer?

A
  • Caught early - asymptomatic
  • post-coital bleeding
  • intermenstrual bleeding
  • abnormal vaginal discharge
  • vaginal discomfort
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82
Q

How is cervical cancer diagnosed?

A
  • Speculum exam - erosions, masses, ulcers
  • Colposcopy + biopsy
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83
Q

What is the FIGO staging for cervical cancer?

A
  1. cervix (a. microscopic b. visible)
    • upper 2/3 vagina
    • lower 1/3 vagina or pelvic wall
    • bladder/ rectum/ extrapelvic
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84
Q

How is cervical cancer treated?

A

CIN - LLETZ
1-2a - hysterectomy + LN removal
2b-4a - chemo + radiotherapy
4b - palliative chemo

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85
Q

What are the types of vulval cancer?

A
  • Squamous - 90%
  • melanoma - 10%
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86
Q

Who is most affected by vulval cancer?

A

35-55 yrs

87
Q

What are the risk factors for vulval cancer?

A

Younger female - HPV association
Older female - lichen sclerosis

88
Q

What are the symptoms of vulval cancer?

A
  • vulvodynia
  • superficial dyspareunia
  • ulcers
  • inguinal lymphadenopathy
89
Q

What is the diagnosis for vulval cancer?

A

2 ww for biopsy

90
Q

What is the treatment for vulval cancer?

A

wide local excision + LN removal

91
Q

Who is most affected by ovarian cysts?

A

Pre-menopausal women

92
Q

What are the types of ovarian cysts?

A
  • follicular cyst
  • corpus luteum cyst
  • neoplastic
  • non-functional cyst- PCOS
93
Q

What are the symptoms of ovarian cysts?

A
  • bloating
  • painful periods
  • dysuria
  • decreased fertility
94
Q

What is the most common type of ovarian cyst?

A

Teratoma

95
Q

What are the possible complications of ovarian cysts?

A
  • Meigs syndrome
  • cyst rupture
  • cyst haemorrhage
  • ovarian torsion
  • progression to ovarian cancer
96
Q

What is ovarian torsion?

A

When an ovary twists around itself on a longitudinal axis

97
Q

Who is most affected by ovarian torsion?

A

15-45 yrs

98
Q

What are the risk factors for ovarian torsion?

A
  • cysts
  • IVF
  • pelvic surgery
99
Q

What are the symptoms of ovarian torsion?

A
  • Severe unilateral RIF/LIF pain
  • N+V
  • Painful walk
100
Q

How is ovarian torsion diagnosed?

A
  • Urine bHCG -ve
  • colour doppler TVUSS - whirlpool sign + free fluid around ovary
101
Q

How is ovarian torsion treated?

A

surgical detorsion

102
Q

What is cervical ectropion?

A

Cervical glandular columnar epithelium around the external os

103
Q

What are the symptoms of cervical ectropion?

A
  • post-coital bleeding
  • increased discharge
104
Q

How is cervical ectropion diagnosed?

A

Speculum - red ring around cervical os

105
Q

What is the treatment for cervical ectropion?

A

Reassurance:
- consider stopping COCP
- consider ablative surgery - last line

106
Q

What are the types of pelvic organ prolapse?

A
  • Cystocele
  • urethrocystocele
  • rectocele
  • vault prolapse
107
Q

What are the risk factors for pelvic organ prolapse?

A
  • multiparity
  • uterine surgery
  • obesity
  • aging
  • strenuous activity
108
Q

What are the symptoms of pelvic organ prolapse?

A

Cystocele - urinary retention, incontinence, urinary symptoms
Rectocele - constipation, diarrhoea, faecal symptoms

109
Q

How is pelvic organ prolapse diagnosed?

A

Speculum exam and bimanual

110
Q

What are the grades of pelvic organ prolapse?

A
  1. > 1cm from hymen
  2. <1cm from hymen
  3. > 1cm outside hymen
  4. total uterine prolapse
111
Q

What is the treatment for pelvic organ prolapse?

A

Conservative - weight loss, keigel exercises
Med - ring pessary
Surgical - pelvic floor repair or hysterectomy

112
Q

Who is most affected by premenstrual syndrome?

A

Menstruating females, typically 20-45 yrs

113
Q

What is premenstrual syndrome?

A

Behavioural and psychological symptoms associated with the luteal phase

114
Q

What are the risk factors for premenstrual syndrome?

A
  • FH depression
  • personal history depression
  • smoking
  • alcohol
  • mood disorders
115
Q

What are the symptoms of premenstrual syndrome?

A

Hormonal - bloating, tired, hot flushes
Low serotonin - depressed, anxious, irritable, fatigue, constipation

116
Q

How is premenopausal syndrome diagnosed?

A
  • clinical diagnosis
  • > 2 cycles like this associated with the luteal phase
  • Gold standard = GnRH analogue for 3 months - +ve test = complete resolution of symptoms
117
Q

What is the treatment for premenstrual syndrome?

A

Conservative - regular sleep, stop alcohol + smoking
Meds - NSAIDs, COCP, CBT +SSRI

118
Q

What are the possible complications of premenstrual syndrome?

A

Premenstrual dysphoric disorder - severe mood swings, agitation, +/- psychosis

119
Q

What is menopause?

A

The cessation of the menstrual cycle >12months in 45-55yrs or post hysterectomy

120
Q

What is perimenopause?

A

1-11 months of amenorrhoea in 45-55 yr old female with vasomotor symptoms

121
Q

What is classed as early menopause?

A

40-45 yrs

122
Q

What is premature ovarian insufficiency?

A

Abnormal cessation of the menstrual cycle in a female younger than 40

123
Q

How is premature ovarian insufficiency measured?

A

High FSH levels

124
Q

What are the risk factors for premature ovarian insufficiency?

A
  • Cancer
  • severe infection
  • chemo
  • PCOS
  • Raised T4
  • Family history
  • Fragile X syndrome
125
Q

How is premature ovarian insufficiency treated?

A

Give HRT at least until age 51

126
Q

What can be causes of menopause?

A
  • idiopathic
  • hysterectomy
  • PCOS
  • eating disorders
  • sheehan’s + asherman’s
127
Q

What are the symptoms of menopause?

A

Vasomotor - flushing + night sweats
General - mood swings, brain fog, fatigue, decreased libido, increased urination, bloated

128
Q

How is menopause diagnosed?

A
  • Clinical - amenorrhoea >12months
  • uncertainty - FHS serum levels
129
Q

How is menopause treated?

A
  • unproblematic - don’t treat
  • problematic:
    • oest+prog transdermal continuous combined HRT
    • oest only if post hysterectomy (endometrial cancer risk)
130
Q

How is atrophic vaginitis treated?

A

Consider topical oestrogen

131
Q

What are the positives of HRT?

A
  • decreased bowel cancer risk
  • decreased risk of endometrial and ovarian cancer
  • improve quality of life
  • decrease the risk of osteoporosis
132
Q

What are the negatives of HRT?

A
  • increased risk of breast cancer (if taken for > 5 years)
  • increased risk of VTE
133
Q

What can cause post-menopausal bleeding?

A
  • Atrophic vaginitis - most common
  • Endometrial cancer - most serious
134
Q

What can cause post-coital bleeding?

A
  • Cervical ectropion - mc young pts
  • Atrophic vaginitis - mc older pts
135
Q

What can cause superficial dyspareunia?

A
  • Vulvodynia
  • Vulval cancer
  • Lichen sclerosis
  • Atrophic vaginitis
136
Q

What can cause deep dyspareanunia?

A
  • Endometriosis
  • Adenomyosis
  • PID
  • Cervical cancer
137
Q

What are the types of urine incontinence?

A
  • Urge - 2nd
  • Stress - mc
  • Overflow
138
Q

What is a differential for urge incontinence?

A

Overactive bladder

139
Q

What is urge incontinence?

A

A sudden and intense urge to pass urine that cannot be controlled or delayed

140
Q

Where is urge incontinence most commonly seen?

A
  • Younger females
  • UTIs
  • DM
  • Pregnancy
141
Q

What are the symptoms of urge incontinence?

A
  • nocturnal symptoms
  • detrusor overactivity
  • key in door syndrome
  • handwashing trigger
142
Q

How is urge incontinence diagnosed?

A
  • urine dip + mc/s
  • bladder diary - nocturnal symptoms
  • urodynamic studies
143
Q

How is urge incontinence treated?

A
  • bladder training 6w
  • then try oxybutynin
  • then cystoplasty and botox injections
144
Q

When is stress incontinence most commonly seen?

A
  • Older pts
  • surgery history
  • multiple births
  • weight lifts
  • obese
145
Q

What are the symptoms of stress incontinence?

A
  • incontinence with Valsalva manoeuvre
  • no nocturnal symptoms
146
Q

How is stress incontinence diagnosed?

A
  • urine dip and mc/s
  • bladder diary
  • urodynamic studies
  • +ve q-tip test
147
Q

What is the treatment for stress incontinence?

A
  • kegel exercises first
  • then try duloxetine
  • surgery last line - mesh sling etc.
148
Q

What is overflow incontinence?

A

Nocturnal leakage with total detrusor voluntary control loss

149
Q

What are the symptoms of overflow incontinence?

A
  • poor stream
  • incomplete emptying
150
Q

How is overflow incontinence diagnosed?

A
  • Urine dip + mc/s
  • bladder diary
  • urodynamic studies - high post residual volume of urine
151
Q

What is the treatment for overflow incontinence?

A

Catheterise

152
Q

What is Asherman’s syndrome?

A

Uterine adhesions after surgery causing secondary amenorrhoea

153
Q

What are the risk factors for Asherman’s syndrome?

A
  • C-section
  • PID
  • Endometriosis
154
Q

What are the symptoms of Asherman’s?

A
  • Secondary amenorrhoea
  • infertility
155
Q

How is Asherman’s diagnosed?

A

1st line - TVUSS
GS - laparoscopy

156
Q

How is Asherman’s syndrome?

A

Surgical - adhesionolysis

157
Q

What is a Bartholin cyst?

A

An internal blockage of a bartholin gland resulting in a build-up of mucus and secretions at labia majora

158
Q

How are Bartholin cysts treated?

A

Incision + drainage

159
Q

Where is the most common site of lumps in the breast?

A

The upper outer quadrants and the tail of spence

160
Q

What are suspicious signs of breast cancer in the nipples?

A
  • Dimpling
  • Deviation
  • Depression
  • Discolouration
  • Discharge
  • Tethering
  • Nipple eczema persisting with treatment
161
Q

What is the breast screening programme?

A

A 3 yearly mammogram for 47-73yr olds
A form of secondary prevention

162
Q

Who is high risk for breast cancer?

A

BRCA gene carriers - screened 25-60

163
Q

Is the BRCA gene autosomal dominant or recessive?

A

Autosomal dominant

164
Q

Which chromosome does BRCA 1 affect?

A

C17

165
Q

What is the most common inherited cause of breast cancer?

A

BRCA 1

166
Q

How can patients with the BRCA1 gene be treated?

A
  • prophylactic mastectomy
  • tamoxifen
167
Q

What chromosome does BRCA2 affect?

A

C13

168
Q

What is there an increased risk of with BRCA2 gene?

A
  • male breast cancer
  • ovarian cancer
  • pancreatic cancer
169
Q

What is the triple assessment for breast cancer?

A
  • History and exam
  • Imaging (USS, XR, mammogram, MRI)
  • Cytology analysis
170
Q

For breast cancer imaging when is an USS and mammogram used?

A

USS - <40 in young dense breast
Mammogram - >40

171
Q

When is a mammogram not useful for breast imaging?

A

Not good at picking up in younger dense breast or in females with increased HRT

172
Q

Why is MRI increasingly used for breast imaging?

A

Increasingly used for females with breast implants

173
Q

What are the methods of cytology analysis for breast?

A
  • Fine needle aspiration biopsy (FNAC)
  • Core biopsy
174
Q

What are the positives and negatives of FNAC?

A

Positives:
- Less invasive
- detects cancer
Negatives:
- No receptor status

175
Q

What are the positives and negatives of a core biopsy?

A

Positives:
- detects cancer
- can tell receptor status
Negatives:
- less invasive
- painful

176
Q

What is the lifetime risk of breast cancer in females?

A

1 in 8, median age 62

177
Q

What family history can increase the risk of breast cancer?

A

Primary relative:
- Female <50 bilateral breast cancer
- Female <40 unilateral breast cancer
- Male any age

177
Q

What are the risk factors for breast cancer?

A
  • Nulliparous
  • early menarche
  • late menopause
  • obesity
  • smoking
  • alcohol
  • HRT for 5+ years
  • BRCA
  • Lifraumeni gene
178
Q

What is a protective factor for breast cancer?

A

exercise

179
Q

What are the types of breast cancer?

A
  • Mostly adenocarcinoma (99%) - ductal (90%) or lobular (10%)
  • tubular
  • mucinous
  • medullary
180
Q

How well are grades of breast cancer differentiated?

A

Grade 1 - well differentiated
Grade 3 - poorly differentiated

181
Q

When are patients sent on an urgent 2wk wait referral for breast malignancy?

A

> 30+ with unexplained breast lump
50+ with unilateral suspicious nipple changes

182
Q

How is breast cancer staged?

A

TNM staging (tumour, nodes, metastases)
1. T1 N0 M0
2. T2/3 N1 M0
3. T4 N>1 M0
4. T4 N>1 M1

183
Q

What can be used to measure breast cancer response to treatment?

A

B15-3

184
Q

What is the receptor status for breast cancers?

A
  • 75% are oestrogen +ve
  • 10-15% HER-2 +ve
185
Q

How do you treat a breast cancer that is oestrogen positive?

A

Pre menopause - tamoxifen
Post menopause - anastrozole/ letrozole

186
Q

What are the side effects of tamoxifen treating breast cancer?

A
  • Hot flushes
  • VTE
  • Endo cancer
187
Q

What are the side effects of anastrozole/ letrozole treating breast cancer?

A
  • Osteoporosis (give vit D + Calcium)
  • vaginal dryness
  • hot flushes
188
Q

How do you treat breast cancer that is HER-2 positive?

A

Trastuzumab (herceptin)

189
Q

What are the side effects of trastuzumab when treating breast cancer?

A

Cardiotoxicity - baseline ECHO needed

190
Q

How is breast cancer treated surgically?

A
  • Mastectomy (1/3)
  • Lumpectomy + adjuvant radiotherapy(1/3)
  • Lymph node clearance with both surgeries
191
Q

When will a mastectomy be used to treat breast cancer?

A
  • If the pt opts for it
  • If more than 20% of the breast is affected
  • If radiotherapy is contraindicated
192
Q

When is a lumpectomy used to treat breast cancer?

A
  • If the pt opts for it
  • If less than 20% of the breast is affected
  • If radiotherapy is an option
193
Q

How can a pregnant woman with breast cancer be treated?

A
  • Surgically
  • Chemo in the 2nd and 3rd trimester
194
Q

How is the prognosis of breast cancer measured?

A
  • Nottingham prognosis index
  • NHS predict
195
Q

What is a fibroadenoma?

A

30 with a mobile unilateral benign breast lump

196
Q

How are fibroadenomas diagnosed?

A

Routine triple assessment

197
Q

What is the treatment for fibroadenoma?

A

lumpectomy

198
Q

What is mammary dysplasia?

A

40-45 with with lumpy grain of rice breasts

199
Q

What is the treatment for mammary dysplasia?

A

Supportive bra, NSAIDS, COCP?

200
Q

What is a phyllodes tumour?

A

30-40 with a rapidly growing fibroadenoma - not cancerous initially but 10% may develop into a sarcoma

201
Q

What is intraductal papilloma?

A

35-55 with bloody-watery nipple discharge

202
Q

How is intraductal papilloma diagnosed?

A

Triple assessment

203
Q

How is intraductal papilloma treated?

A

Surgery

204
Q

What is mastitis +/- abscess

A

Inflammation of the milk glands in the breast, wedge shaped distribution +/- fever

205
Q

How is mastitis +/- abscess treated?

A
  • Lactating - fluclox
  • Not lactating - fluclox + metronidazole
206
Q

Should women with mastitis continue breast feeding?

A

Yes

207
Q

What is mammary duct ectasia?

A

Sticky brown-green nipple discharge due to clogged ducts

208
Q

What are the types of breast cyst?

A
  • Galactocele
  • simple
  • blood
209
Q

What is pagets disease?

A

Unrelenting nipple eczema persisting after 2 or more weeks of steroid/antifungal

210
Q

What are the symptoms of pagets disease?

A
  • Nipple and areola eczema, then rest of breast
  • +/- straw colour DC
  • Nipple inversion
211
Q

How is pagets disease diagnosed?

A
  • Triple assessment
  • +ve for paget cells (90% HER2 +ve)
212
Q

How is pagets disease treated?

A

Mastectomy or lumpectomy or wide local excision

213
Q

What are silicone breast implant complications?

A
  • Ruptures
  • Capsular contractures
  • Breast implant associated large cell lymphoma

Phase 3a (6 decks)

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