Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen Surgery > Malignant Breast Disease > Flashcards

Malignant Breast Disease Flashcards

1
Q

Major risk factors for breast cancer

A
  • female
  • advancing age
  • contra- lateral disease
  • family history
  • irradiation
  • BRCA 1
  • BRCA2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Patients have a high risk of developing breast cancer if they have a family history of___?

A
  • breast, ovarian cancer
  • bilateral disease
  • early age of onset
  • several family members
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which genes lead to an increased risk of cancer (breast and ovarian)

A
  • BRCA1 on long arm of chromosome 17

- BRCA 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Minor risk factors for breast cancer

A
  • wide oestrogen window
  • few/ no children
  • late birth of first child
  • hormone replacement therapy
  • oral contraceptive pill
  • smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Controversial risk factors for breast cancer

A
  • no lactation
  • alcohol
  • diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Symptoms of breast cancer

A
  • most common: painless lump
  • change in breast appearance
  • Nipple discharge (concern if bloody)
  • eczematous change of nipple (Paget’s)
  • extra- mammary metastasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What percentage of patients with breast cancer are asymptomatic and found on mammographic screening

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Signs of breast cancer

A
  • subclinical (mammographic) lesion/ nipple discharge
  • thickened area/ Ill- defined, shelving mass
  • overlying skin dimpling/ nipple retraction
  • visible mass/ fixity to underlying muscle
  • skin oedema/ palpable axillary nodes
  • skin fixity and ulceration/ supraclavicular glands
  • symptomatic metastases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Differentials for breast cancer in the early stages

A

Fibro adenomas, cyst or fat necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of malignancy on mammogram

A
  • microcalcification
  • density with surrounding speculation
  • distortion of beast architecture
  • tethering
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Indications for mammography in proven cancer

A
  • to exclude multi centric/ contra lateral disease
  • to exclude DCIS
  • follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Indications for mammogram based on clinical exam

A
  • discrete mass in women > 30
  • vague thickening in women > 30
  • single nipple discharge
  • focal mastalgia
  • unexplained nipple retraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Indications for screening with mammogram

A
  • positive family history ( start 10 years before 1st degree relative developed the disease)
  • > 55, 2 yearly (UK)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Uses of ultra sound in assessment of breast disease

A
  • detects whether palpable lesions are solid/ cystic

- biopsy took for impalpable lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Technique for fine needle aspiration cytology

A
  • Conventional 22G needle attached to syringe is used
  • aseptic technique, several aspiration passes are done through the mass in different directions
  • the material is then ejected and smeared onto slides for fixation and staining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Uses of a trucut/ core biopsy

A

If clinical findings, mammogram and cytology are not all unequivocally positive.
Good core biopsy can also yield important information regarding tumour type, biology and hormone receptor status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is excision biopsy done

A

Done in rare cases where doubt remains regarding malignancy but there is a high degree of suspicion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which three categories is primary breast cancer divided into?

A
  • non-invasive epithelial cancers (carcinoma in situ)
  • invasive epithelial cancers
  • mixed connective and epithelial (rare)
19
Q

Which invasive breast cancer is the most common?

A

Infiltrating ductal carcinoma

20
Q

Describe the four stages of breast cancer

A

0- cancer in situ
1- T1 without nodes
2- T1/2 with nodes or T3 (with or without nodes)
3- locally advanced in breast (t4) or locally advanced nodes (N2-3)
4 - distant metastases

21
Q

What metastatic screening is appropriate for breast cancer

A
  • All patient: CXR, liver function tests
  • if LFTs are abnormal or >T3: liver ultrasound
  • > T3: bone scan
  • selected cases: bone X-rays/ CT/ MRI
22
Q

What does Her-2-neu receptor positivity imply?

A

It implies that the patient has a very aggressive tumour and she may have significant benefit form the biological modifier Trastuzumab (Herceptin)

23
Q

Therapy options for breast cancer

A
  • surgery
  • radiotherapy
  • chemotherapy
  • endocrine manipulation
  • biological treatments
24
Q

Surgical options for the breast in breast cancer

A

Total mastectomy and wide local incision

25
Q

Patients are suitable for a wide local excision if:

A
  • tumour size < 5 cm. Single lesion
  • large breast
  • outer quadrants
  • no family history
  • no multifocal disease
  • willing to receive 6 weeks adjuvant radiotherapy
26
Q

Surgical options for the Axilla in treatment of breast cancer

A
  • axillary nodal clearance

- sentinel lymph node biopsy

27
Q

Which patients are suitable for a sentinel lymph node biopsy

A
  • T1/2 lesion
  • no palpable lymph nodes
  • no prior axillary surgery, irradiation or neo-adjuvant chemotherapy
28
Q

Most women will receive some form of adjuvant therapy, what may be the only exceptions?

A

Very small (<1cm) well differentiated lesions

29
Q

What are the types of adjuvant therapy

A
  • radiotherapy
  • chemotherapy
  • endocrine manipulation
  • biological modifiers
30
Q

When is a patient more likely to respond to endocrine manipulation/ hormonal manoeuvres

A

If the cancer cells express estrogen or progesterone receptors

31
Q

Endocrine manipulation in premenopausal women

A
  • Tamoxifen
  • LHRH agonists
  • progesterones
  • oopherectomy
32
Q

Endocrine manipulation in post menopausal women

A

Aromatase inhibitors
Tamoxifen
Progesterones

33
Q

Features of breast cancer in situ on mammogram

A

Pleomorphic micro calcifications +- a spiculated mass

34
Q

Treatment of stage 0 breast cancer

A
  • localized, focal lesions are suitable for a WLE

- multifocal disease without a mass, a mastectomy without an ANC is done

35
Q

Options for plastic reconstruction after surgery for breast cancer

A
  • tissue expanders, prosthesis or muscle flaps
36
Q

Adjuvant therapy for stage 1/2 disease

A
  • low risk (node negative, <2 cm, low grade ER +): nil/ tamoxifen
  • intermediate/ high risk: hormonal treatment and/or tamoxifen
37
Q

Treatment of stage 3 breast cancer

A
  • chemotherapy, surgery (mastectomy and ANC) and radiotherapy
  • hormone therapy may be added if receptor positive
  • neoadjuvant chemo is often used to downsize the tumour
38
Q

Where does breast cancer metastasize to?

A

Bone, lungs, liver and brain

39
Q

What is Paget’s disease of the nipple

A

Intra ductal carcinoma which invades the breast

40
Q

How does Paget’s present

A

It presents as nipple erythema, itching, crusting and rawness. It often mimics eczema but it always involves the nipple and then moves out to the areola. Tissue diagnosis is done by punch biopsy and mammogram may show an underlying invasive carcinoma

41
Q

How is Paget’s disease treated

A

Patients are treated with a mastectomy with excellent survival rates if no invasive component

42
Q

How do patients with inflammatory breast cancer present

A

Present with a red, hot, oedematous breast with a rapid course. There may be no palpable mass or mammographic features of malignancy

43
Q

Histological features of inflammatory breast cancer

A

Dermal lymphatic invasion is characteristic

44
Q

Treatment of inflammatory breast cancer

A

Neoadjuvant chemotherapy followed by mastectomy if it becomes resectable

Gen Surgery (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions