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Repro and Sexual Health > Malignant and Benign Diseases of the Breast > Flashcards

Malignant and Benign Diseases of the Breast Flashcards

1
Q

What is the 5 year survival rate for breast ca?

A

All stages; 86%
97% localized cancer
75% cancer with regional involvement
23% for metastatic cancer

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2
Q

What are the clinically relevant risk factors for breast cancer?

A 
Gender; female
Age
Gene mutations
Atypical ductal or lobular hyperplasia
Lobular carcinoma in situ
Atypical epithelial hyperplasia
Birth of first child after 30 
Consumption of alcoholic beverage once or more a day 
Early menarche 
FMHx of breast ca
Previous history of breast ca
Nulliparity
Postmenopausal obesity
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3
Q

What are the most common breast cancer presentations?

A 
Dimpled or depressed skin
Visible lump
Nipple change including inversion 
Bloody discharge
Texture change
Colour change
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4
Q

What will the lump feel like in a ductal carcinoma?

A

Stellate solid mass

Pleomorphic casting microcalcifications

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5
Q

How is the definitive diagnosis of breast cancer made?

A

Image guided core-needle biopsy

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6
Q

How is DCIS caught on MMG?

A

Not palpable
Perceived on MMG as malignant calcifications
Usually pleomorphic
Casting type

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7
Q

How is the definitive diagnosis of DCIS made?

A

Stereotactic vacuum assisted core biopsy

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8
Q

How will invasive lobular carcinoma tend to spread?

A

Typical histological indian file pattern

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9
Q

What is breast conserving surgery (BCS)?

A

Wide local excision with or without oncoplastic procedure to shape breast

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10
Q

What is an essential component of breast conserving therapy?

A

Radiation therapy
Total dose of whole breast irradiation of 4500-5000 centigrays using opposed tangential fields
5 days a week for 3-6 weeks
Boost dose of irradiation to tumour bed increases dose

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11
Q

What is a modified (total) mastectomy?

A

Removes entire breast; incl overlying skin and axillary lymph nodes
Modification is perseverance of pectoralis major muscle

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12
Q

When can breast reconstruction occur?

A

Immediate (during same operation as modified radical mastectomy)
Or delayed

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13
Q

What are the different forms of breast reconstruction?

A

Prosthetic
Autologous tissue reconstruction; latissimus dorsi myocutaneous flap, deep inferior epigastric perforator free flap, transverse rectus abdominis myocutaneous flap or superior/ inferior gluteal artery perforator free flap

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14
Q

What is the downside to a non-skin sparing mastectomy?

A

Prominent scars on new breast

Paddle of skin that is of a different colour and texture

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15
Q

Why is a skin sparing mastectomy preferred?

A

Preserves most of overlying skin during an immediate breast reconstruction thus leading to a superior aesthetic outcome

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16
Q

What does the choice of breast reconstruction depend on?

A 
Patient's body habitus 
Co-morbs 
Smoking history 
Size and shape of breasts s
Her preference
Surgeon's experience
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17
Q

What are the indications for post mastectomy radiotherapy (RT)?

A

More than 3 nodes involved
Positive surgical margins
Tumour’s >5cm

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18
Q

What is the most commonly used hormonal therapy?

A

Tamoxifen

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19
Q

What is a fibroadenoma?

A

Most common benign neoplasm of breast

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20
Q

What will a fibroadenoma feel like by examination?

A 
Rubbery 
Firm
Mobile 
Smooth 
Circumscribed 
Non-tender
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21
Q

At what age are fibroadenomas usually diagnosed?

A

20-40

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22
Q

Do fibroadenomas require removal?

A

No; they tend to remain unchanged or decrease in size approaching menopause and usually become non palpable after menopause

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23
Q

If required, how are fibroadenomas removed?

A

Open lumpectomy

Percutaneous vacuum assisted core biopsy under LA

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24
Q

What is the difference in the management of a fibroadenoma and a phyllodes tumour?

A

Phyllodes tumours should be excised with wide (1cm), clear surgical margins
Carefully followed up

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25
What is mastalgia?
Pain in the breast; most common breast symptom for women during reproductive years
26
Describe cyclical mastalgia?
Diffuse pain Most intense during immediate premenstrual phase of cycle Usually bilateral
27
Describe non cyclical mastalgia?
Usually localized Persistent Less responsive to tx than cyclical
28
What are non breast aetiologies of anterior chest wall pain?
``` Achalasia Angina Cervical radiculitis Cholecystitis Cholelithiasis Coronary artery disease Costochondritis (Tietze syndrome) Fibromyositis Hiatal hernia Myalgia Neuralgia Osteomalacia Phantom pain Pleurisy Psychological PE Pulmonary infarct Rib # Sickle cell Trauma TB ```
29
What are effective therapies for mastalgia?
``` Well-fitting firm bra Regular exercise Evening primrose oil Tamoxifen Topical NSAIDs ```
30
Can you do a MMG in women <35?
No; can't see anything as breast tissue is too dense
31
When will palpable breast cysts tend to occur?
Late reproductive years
32
On examination, what will a breast cyst feel like?
``` Typically palpable Clearly defined Soft Mobile Smooth Distinct borders Can be tender; esp before menstruation Can be multiple and/or bilateral ```
33
What is the method for diagnosing and treating a cyst?
FNA
34
Does the fluid extracted from a breast cyst FNA need to be sent for cytological eval?
No; only if grossly bloody
35
What is a papilloma of a cyst?
Benign intracystic papillary proliferation that occurs within a cyst
36
What will occur if there is a papilloma within a cyst?
Creates bloody cyst fluid
37
When is an intracystic carcinoma suspected?
Fluid is grossly bloody | Residual mass after aspiration
38
What is recommended for any intracystic solid lesion of irregular cystic wall?
USS guided core biopsy for histological diagnosis
39
Is nipple discharge normal?
Yes; clear, yellow and watery discharge is physiological for women of reproductive age
40
When does nipple discharge become pathological?
Bloody discharge from a single duct
41
What is the most common etiology of spontaneous nipple discharge?
Intraductal papilloma
42
Is nipple discharge commonly a sign of malignancy?
No; unless assoc with a palpable mass
43
What investigations are recommended for pathological nipple discharge?
MMG USS Surgical excision of discharging ducts
44
How can paget's disease of the nipple present?
Erythematous weeping lesion on the surface of nipple and areola More commonly presents as a dry, scaly, eczematous lesion
45
How is paget's disease of the nipple be diagnosed?
Histologic tissue biopsy (incisional or punch) | Often underlying palpable mass or a radiological abnormality
46
What are signs of mastitis?
``` Fever Erythema Induration Tenderness Swelling ```
47
How will a breast abscess present?
Flocculent sometimes bulging mass usually located in central area of mastitis
48
How can a breast abscess be diagnosed?
Focused USS; determines a fluid filled (pus) center | Aspiration with 18-gauge needle using LA is diagnostic and therapeutic
49
When is excision and drainage required in breast abscesses?
If repeated aspirations are not effective
50
What is chronic mastitis assoc with?
Subareolar abscess | Periareolar fistula can occur
51
What should be suspected in a case of mastitis that is unresponsive to antibiotic therapy that has spread over entre breast?
Inflammatory carcinoma
52
Describe an adenolipoma?
Smooth palpable mass | Characteristic MMG pattern
53
What is ductal hyperplasia?
Benign histologic process BUT When hyperplasia is atypical, it is assoc with an increased risk of carcinoma
54
What is a galactocele?
Palpable milk-filled cyst most commonly associated with pregnancy or lactation FNA can diagnose and drain
55
What is mondor's disease?
Phlebitis (inflammation of vein) and subsequent clot formation in superficial veins of breast
56
How will mondor's disease present?
Firm Vertical Cord like structure usually assoc with hx of trauma to breast
57
Describe the triple assessment in breast pathology?
Clinical breast examination and history MMG USS Core-needle biopsy
58
What will histology tell you in breast ca?
Invasive or not Ductal or lobular Degree of differentiation Receptor status
59
What does chemotherapy target?
Any cells in the M phase of cell replication
60
Non-invasive forms of hormonal therapy?
SERMs (tamoxifen) AIs GnRH

Repro and Sexual Health (77 decks)

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