L24: Benign And Malignant Breast Disease Flashcards by selcan icli

What are the common symptoms of breast disease

Lump
Change in skin
Nipple change 
Nipple discharge 
Pain
Infection

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In the drug history what should you specifically ask for

HRT

OCP

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In the family history what should you ask for

Ovarian and breast cancer

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What is a triple assessment

Physical examination
Radiological imaging
Biopsy

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What are the benign lumps in the breast

Fibroadenoma
Cyst
Traumatic fat necrosis
Phyllodes tumour

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What hormonal changes can occur in the breast

Gynaecomastia

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What infection can occur in the breast

Periductal mastitis
Acute bacterial mastitis
Abscess

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What is a fibroadenoma

Commonest breast lump in women

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What are the features of fibroadenoma

Rubbery 
Firm
Painless
Oval and smooth defined border
Mobile i.e not attached to the skin

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What is the diagnosis of fibroadenoma by

Tripple assessment

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What is the treatment of fibroadenoma

Reassurance
Monitor
Excision

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What are cysts

Fluid filled lobules

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In which group of females are cyst common in

Perimenopausal

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What is the diagnosis of cysts by

Triple assessment

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What is the presentation of cysts

Single of multiple smooth lumps
Short history
Pain and tenderness
Can become big or painful before menstruation

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What is the treatment of cysts

Reassurance

Aspiration

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What is traumatic fat necrosis

Traumatic necrosis

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What is traumatic fat necrosis due to

seat belt injury

Elbow injury

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What happens in traumatic fat necrosis

Adipose tissue (fat) breaks downs

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What are the presentation of traumatic fat necrosis

Painless, irregular and firm lump
Skin changes
With or without bruising

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What is the assessment of traumatic fat necrosis

Triple assessment

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Why is the biopsy in traumatic fat necrosis important

Because it can rememble cancer

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What is the management of traumatic fat necrosis

Should resolve on its own

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What is phyllodes tumour

A rare tumour that occurs in women around menopause

Which cells does phyllodes tumour arise from

Stromal cells

What is the presentation of phyllodes tumour

``` Firm Mobile Well circumscribed Non tender Similar to fibroadenoma ```

What is the diagnosis of phyllodes tumour by

Triple assessment

What is the management of phyllodes tumour

Triple assessment

What is the management of phyllodes tumour

Wide excision | Follow up with imaging

What is gynacomastia and who does it occur in

Proliferation of breast tissue in males

What are the causes of gynacomastia

``` Liver cirrhosis Testicular tumour Hypogonadism Idiopathic Drugs; osteogen and androgen ```

What is the treatment of gynaecomastia

Reassurance Manage the cause Liposuction or cosmetic surgery

What is periductal mastitis

Inflammation around the dilated milk ducts

What is the presentation of periductal mastitis

Pain Nipple discharge Cellulitis Subareolar mass

What is the diagnosis of periductal mastitis by

Ultrasound

What is the treatment of periductal mastitis

Antibiotics | Surgery- if recurrent

What is acute bacterial mastitis usually associated with

Breast feeding

Which organism is likely to cause acute bacterial mastitis

Staphylococcus Auerus

What is the presentation of acute bacterial mastitis

Breast inflammation: redness, swelling, tenderness and warmth Localised to small area Fluctuant mass Systemic signs of inflammation

What is the diagnosis of acute bacterial mastitis by

Ultrasound

What is the treatment of acute bacterial mastitis

Antibiotics Continue breastfeeding Aspirate the abscess

What are the types of breast carcinoma dependent on

The location

What are the types of breast carcinoma

``` Ductal Lobular Tubular Medulla Mucinous ```

What are the subtypes of ductal breast carcinoma

Ductal carcinoma in situ | Invasive ductal carcinoma

Where can spread of breast carcinoma to

Local: skin, muscle and chest wall Lymphatic: axillary and internal thoracic nodes Haematological: lungs, liver, bone and brain

What are the risk factors for breast cancer

``` Age Family history BRCA gene mutations Oestrogen exposure: early menarache, late menopause, OCP, HRT Chest radiation Alcohol Overweight ```

What are the protective factors against breast cancer

Breastfeeding Having children Physical activity

What are the features of breast cancer

``` Lumps: firm and irregular Nipple retraction and inversion Blood stained nipple discharge Skin tethering Peau de orange appearance Change in breast shape Palpable axillary lymph nodes ```

What is the diagnosis of breast cancer by

Triple assessment: examination, imaging and biopsy

What are the treatment options in breast cancer

Surgery: - wide local excision: removal of the lump and some healthy margin - mastectomy: removal of the whole breast - surgery to the axilla: also used as prognosis Adjuvant therapy Hormonal therapy Biological therapy

What is adjuvant therapy

Therapy given before or after the surgery

Name examples of adjuvant therapy

Chemotherapy | Radiotherapy

When is hormonal therapy used

If the tumour is postive for oestrogen receptors (ER)

What can hormonal therapy be

Selective oestrogen receptor modulator e.g tamoxifen Aromatase inhibitors e.g anastrozole Ovarian ablation

Who uses Aromatase inhibitors

Post menopausal women who make oestrogen from fatty tissue and do not have oestrogen production from the ovary

Who has ovarian ablation

Pre-menopausal women

If there is a HER2 over expressing tumour what biological therapy can be used

Herceptin

What is herceptin

Monoclonal antibody for HER2 receptor