Obs + Gynae - Breast Flashcards by Hugh Brookes

Name 5 risk factors for breast cancer

Previous Hx
Age
Family history
Genetic factors (BRCA1 - chromosome 17, BRCA2 - chromosome 13 and TP53 mutations carry very high risk)
Nulliparity (or first child after age 30)
Not having breast-fed (breast-feeding is protective)
Early menarche/late menopause
Radiation to chest
Obesity and the consumption of alcohol
HRT
Combined oral contraception

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What chromosome is BRCA1 on?

chromosome 17

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What chromosome is BRCA2 on?

chromosome 13

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Name 3 staging investigations for breast cancer

ER/Epidermal growth factor/progesterone receptor (PR) status
Blood tests (LFTs)
CXR (CT if metastases)
Bone scintigraphy
Positron Emission Tomography (PET)

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Name a diagnostic investigation for breast cancer

Core needle/open/excision/incisional biopsy, Fine needle aspiration

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What do T, N and M mean in context of breast cancer staging?

T = primary tumour, N = regional lymph nodes, M = (presence of metastases)

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Name the 4 principal treatment modalities for breast cancer?

Surgery, Chemotherapy, Radiotherapy, Hormonal therapy

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How do aromatase inhibitors work?

They block conversion of androgens to oestrogen in peripheral tissues.
(Anastrozole and letrozole are non-steroidal aromatase inhibitors. Exemestane is a steroidal aromatase inhibitor)
(Aromatase inhibitors are prescribed as initial adjuvant therapy in postmenopausal women with oestrogen-receptor-positive tumours)

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Name the most commonly used ER blocker drug used for ER positive tumours

Tamoxifen

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Name the most commonly used monoclonal antibody used for HER2 positive tumours

Trastuzumab

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How often is breast cancer screening and for what age?

The NHS breast cancer screening program offers a mammogram every 3 years to women aged 50 – 70 years

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NICE guidelines (Jan 21) recommend a two week wait referral for suspected breast cancer for what symptoms?

An unexplained breast lump in patients aged 30 or above
Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)

(also consider for lump in axilla or skin changes suggestive of breast ca)

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Triple diagnostic assessment for breast cancer?

Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Biopsy (fine needle aspiration or core biopsy)

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Which scan is more useful in younger and which more useful in older women?

Ultrasound scans are typically used to assess lumps in younger women (e.g., under 30 years). They are helpful in distinguishing solid lumps (e.g., fibroadenoma or cancer) from cystic (fluid-filled) lumps.
Mammograms are generally more effective in older women. They can pick up calcifications missed by ultrasound.
MRI scans may be used:
For screening in women at higher risk of developing breast cancer (e.g., strong family history)
To further assess the size and features of a tumour

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2 Ls and 2 Bs of breast cancer metastasis

L – Lungs
L – Liver
B – Bones
B – Brain

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First-line hormone treatment for premenopausal vs postmenopausal women with oestrogen-receptor positive tumours?
(+ how long is it given?)

Tamoxifen for premenopausal women
Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)
(+ for 5 – 10 years)

Tamoxifen increases risk of which cancer?

Endometrial cancer

What is a breast mouse?

Fibroadenoma

Fibroadenoma features

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

When are fibrocystic breast changes most likely to occur?

Symptoms often occur prior to menstruating (within 10 days) and resolve once menstruation begins. Symptoms usually improve or resolve after menopause.

Management of Fibrocystic breast changes

Wearing a supportive bra
Non-steroidal anti-inflammatory drugs (NSAIDs) (ibuprofen)
Avoiding caffeine is commonly recommended
Applying heat to the area
Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance

Fat necrosis features in breast

Painless
Firm
Irregular
Fixed in local structures
There may be skin dimpling or nipple inversion

(It may resolve spontaneously with time. Surgical excision may be used if required for symptoms)

What does a breast cyst feel like?

+ what age most commonly?

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

(+ most often between ages 30 and 50, more so in the perimenopausal period. They can be painful and may fluctuate in size over the menstrual cycle)

What duct is blocked in a Galactocele?

Lactiferous duct

Phyllodes tumour management

Treatment involves surgical removal of the tumour and the surrounding tissue (“wide excision”). They can reoccur after removal. Chemotherapy may be used in malignant or metastatic tumours.

The most common causative organism of breast abscess?

Staph aureus also: Streptococcal species Enterococcal species Anaerobic bacteria (such as Bacteroides species and anaerobic streptococci) (Penicillins (Flucloxacillin) are effective against gram + (S aureus, Strep, Enterococcal) (Co-amoxiclav covers anaerobes) ( Metronidazole gives excellent anaerobic cover so can also be added to the mix)

Mastitis with infection in the breast tissue presents with what breast changes?

- Nipple changes - Purulent nipple discharge (pus from the nipple) - Localised pain - Tenderness - Warmth - Erythema (redness) - Hardening of the skin or breast tissue - Swelling

Management of lactational vs non-lactational mastitis

Lactational mastitis (caused by blockage of lactiferous ducts) - managed conservatively - continue breastfeeding / expressing milk - breast massage - Heat packs, warm showers and simple analgesia - Antibiotics (flucloxacillin or erythromycin/clarithromycin where there is penicillin allergy) are required where infection is suspected or symptoms do not improve. Non-lactational mastitis - Analgesia - Antibiotics (broad spectrum - Co-amoxiclav or Erythromycin + metronidazole) - Treatment for the underlying cause (e.g., eczema or candidal infection)

Breast Abscess management

- Referral to the surgical team - Antibiotics - Ultrasound (confirm the diagnosis and exclude other pathology) - Drainage (needle aspiration or surgical incision and drainage) - Microscopy, culture and sensitivities of the drained fluid (Women who are breastfeeding are advised to continue breastfeeding when they have mastitis or breast abscesses. They should regularly express breast milk if feeding is too painful, then resume feeding when possible. This is not harmful to the baby and is important in helping resolve the mastitis or abscess)

What are women told about breastfeeding if they present with a breast abscess or mastitis?

Women who are breastfeeding are advised to continue breastfeeding when they have mastitis or breast abscesses. They should regularly express breast milk if feeding is too painful, then resume feeding when possible. This is not harmful to the baby and is important in helping resolve the mastitis or abscess.