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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
Q

What is mastalgia?

A

Pain in the breast; most common breast symptom for women during reproductive years

26
Q

Describe cyclical mastalgia?

A

Diffuse pain
Most intense during immediate premenstrual phase of cycle
Usually bilateral

27
Q

Describe non cyclical mastalgia?

A

Usually localized
Persistent
Less responsive to tx than cyclical

28
Q

What are non breast aetiologies of anterior chest wall pain?

A 
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
Q

What are effective therapies for mastalgia?

A 
Well-fitting firm bra
Regular exercise
Evening primrose oil
Tamoxifen 
Topical NSAIDs
30
Q

Can you do a MMG in women <35?

A

No; can’t see anything as breast tissue is too dense

31
Q

When will palpable breast cysts tend to occur?

A

Late reproductive years

32
Q

On examination, what will a breast cyst feel like?

A 
Typically palpable 
Clearly defined 
Soft
Mobile 
Smooth
Distinct borders 
Can be tender; esp before menstruation 
Can be multiple and/or bilateral
33
Q

What is the method for diagnosing and treating a cyst?

A

FNA

34
Q

Does the fluid extracted from a breast cyst FNA need to be sent for cytological eval?

A

No; only if grossly bloody

35
Q

What is a papilloma of a cyst?

A

Benign intracystic papillary proliferation that occurs within a cyst

36
Q

What will occur if there is a papilloma within a cyst?

A

Creates bloody cyst fluid

37
Q

When is an intracystic carcinoma suspected?

A

Fluid is grossly bloody

Residual mass after aspiration

38
Q

What is recommended for any intracystic solid lesion of irregular cystic wall?

A

USS guided core biopsy for histological diagnosis

39
Q

Is nipple discharge normal?

A

Yes; clear, yellow and watery discharge is physiological for women of reproductive age

40
Q

When does nipple discharge become pathological?

A

Bloody discharge from a single duct

41
Q

What is the most common etiology of spontaneous nipple discharge?

A

Intraductal papilloma

42
Q

Is nipple discharge commonly a sign of malignancy?

A

No; unless assoc with a palpable mass

43
Q

What investigations are recommended for pathological nipple discharge?

A

MMG
USS
Surgical excision of discharging ducts

44
Q

How can paget’s disease of the nipple present?

A

Erythematous weeping lesion on the surface of nipple and areola
More commonly presents as a dry, scaly, eczematous lesion

45
Q

How is paget’s disease of the nipple be diagnosed?

A

Histologic tissue biopsy (incisional or punch)

Often underlying palpable mass or a radiological abnormality

46
Q

What are signs of mastitis?

A 
Fever
Erythema
Induration 
Tenderness
Swelling
47
Q

How will a breast abscess present?

A

Flocculent sometimes bulging mass usually located in central area of mastitis

48
Q

How can a breast abscess be diagnosed?

A

Focused USS; determines a fluid filled (pus) center

Aspiration with 18-gauge needle using LA is diagnostic and therapeutic

49
Q

When is excision and drainage required in breast abscesses?

A

If repeated aspirations are not effective

50
Q

What is chronic mastitis assoc with?

A

Subareolar abscess

Periareolar fistula can occur

51
Q

What should be suspected in a case of mastitis that is unresponsive to antibiotic therapy that has spread over entre breast?

A

Inflammatory carcinoma

52
Q

Describe an adenolipoma?

A

Smooth palpable mass

Characteristic MMG pattern

53
Q

What is ductal hyperplasia?

A

Benign histologic process
BUT
When hyperplasia is atypical, it is assoc with an increased risk of carcinoma

54
Q

What is a galactocele?

A

Palpable milk-filled cyst most commonly associated with pregnancy or lactation
FNA can diagnose and drain

55
Q

What is mondor’s disease?

A

Phlebitis (inflammation of vein) and subsequent clot formation in superficial veins of breast

56
Q

How will mondor’s disease present?

A

Firm
Vertical
Cord like structure usually assoc with hx of trauma to breast

57
Q

Describe the triple assessment in breast pathology?

A

Clinical breast examination and history
MMG
USS
Core-needle biopsy

58
Q

What will histology tell you in breast ca?

A

Invasive or not
Ductal or lobular
Degree of differentiation
Receptor status

59
Q

What does chemotherapy target?

A

Any cells in the M phase of cell replication

60
Q

Non-invasive forms of hormonal therapy?

A

SERMs (tamoxifen)
AIs
GnRH

Repro and Sexual Health (77 decks)

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