OBGY Flashcards
When is hormone therapy offered to women with breast cancer? Which drugs are used?
If tumours are positive for hormone receptors:
- Tamoxifen in pre/peri-menopausal women
- Anastrozole in post-menopausal women
When should you refer to the 2WW breast cancer pathway?
> 30 unexplained lump with or without pain
>50 in one nipple: discharge, retraction, other changes of concern
When should you consider a referral to 2WW breast cancer pathway?
Skin changes that suggest breast cancer
>30 lump in axilla
When should you complete a non-urgent referral to breast clinic?
<30 lump with or without pain
Which contraceptive is most associated with weight gain?
Depo-provera injections
What is the management of intrahepatic cholestasis of pregnancy?
- Ursodeoxycholic acid
2. Elective induction from 37 weeks
What is a fibroadenoma?
common benign tumours of stromal/epithelial breast duct tissue
What are the features of a fibroadenoma?
Painless
Smooth
Round
Well circumscribed (well-defined borders)
Firm
Mobile (moves freely under the skin and above the chest wall)
Usually up to 3cm diameter
Why are fibroadenomas more common in younger women?
They respond to the female hormones (oestrogen and progesterone), which is why they are more common in younger women and often regress after menopause.
Which breast lump fluctuates with the menstrual cycle?
Fibrocystic Breast Changes
What are the symptoms of fibrocystic breast changes?
10 days before period, resolve when period ends:
Lumpiness
Breast pain or tenderness (mastalgia)
Fluctuation of breast size
What is the management of fibrocystic breast changes?
exclude cancer
manage symptoms:
- Wearing a supportive bra
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
- Avoiding caffeine
- Applying heat to the area
- Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance
What is the most common cause of breast lumps?
Breast cysts
What are the features of breast cysts?
Smooth
Well-circumscribed
Mobile
Possibly fluctuant (change size around period)
What is fat necrosis of the breast?
an oil cyst, containing liquid fat. Fat necrosis is commonly triggered by localised trauma, radiotherapy or surgery, with an inflammatory reaction resulting in fibrosis and necrosis (death) of the fat tissue. It does not increase the risk of breast cancer.
What are the features of fat necrosis of the breast?
Painless Firm Irregular Fixed in local structures There may be skin dimpling or nipple inversion
What might look similar to breast cancer on US or mammogram?
Fat necrosis
What is the management for fat necrosis?
- exclude cancer
2. conservative (resection if symptoms)
What are the features of lipoma?
Soft
Painless
Mobile
Do not cause skin changes
What is the management of lipomas?
Reassurance
What is a galactocele?
breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk.
What are the features of a galactocele?
irm, mobile, painless lump, usually beneath the areola
benign - usually resolve without treatment
What is a Phyllodes tumour?
rare tumours of the connective tissue (stroma) of the breast, occurring most often between ages 40 and 50
surgical removal, wide-excision + chemo
What are the two types of mastalgia?
Cyclical
Non-cyclical
Name three causes of non-cyclical breast pain.
Medications (e.g., hormonal contraceptive medications)
Infection (e.g., mastitis)
Pregnancy
Give three differentials for breast pain
Cancer (perform a thorough history and examination)
Infection (mastitis)
Pregnancy (perform a pregnancy test)
What hormonal treatments can be used to treat breast pain?
danazol and tamoxifen (under specialist)
What are the risk factors for breast cancer?
Female (99% of breast cancers)
Increased oestrogen exposure (earlier onset of periods and later menopause)
More dense breast tissue (more glandular tissue)
Obesity
Smoking
Family history (first-degree relatives)
Which genes can predispose to breast cancer?
BRCA1 = CX17 BRCA2 = CX13
TP53
PTEN
Name 5 types of breast cancer
Ductal carcinoma in situ Lobular carcinoma in situ Invasive ductal carcinoma Invasive lobular carcinoma Inflammatory breast cancer Paget's disease of the Nipple
What is the management of lobular carcinoma in situ?
close monitoring (e.g., 6 monthly examination and yearly mammograms)
What is the most common type of invasive breast cancer?
Invasive ductal carcinoma
What should be considered if mastitis does not respond to antibiotics?
Inflammatory breast cancers
How does Paget’s disease of the nipple present?
Looks like eczema of the nipple/areolar
Erythematous, scaly rash
Describe the breast cancer screening programme in the UK
offers a mammogram every 3 years to women aged 50 – 70 years.
What are the risk factors for high-risk breast cancer?
A first-degree relative with breast cancer under 40 years
A first-degree male relative with breast cancer
A first-degree relative with bilateral breast cancer, first diagnosed under 50 years
Two first-degree relatives with breast cancer
What should be done before genetic testing for breast cancer?
Counselling
What can be offered to people who are high risk for breast cancer?
Annual MMG >30years
Tamoxifen if premenopausal
Anastrozole if postmenopausal (except with severe osteoporosis)
Risk-reducing bilateral mastectomy or bilateral oophorectomy
How does breast cancer present?
Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction
Skin dimpling or oedema (peau d’orange)
Lymphadenopathy, particularly in the axilla
What is the triple assessment?
Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Biopsy (fine needle aspiration or core biopsy)