questions Flashcards
criteria if which present warrants treatment for mastitis
- systemically unwell
- nipple fissure present
- symptoms not improving after 12-24 hours of effective milk removed
- culture indicates infection
Breast cancer referral for a woman over 30?
have an unexplained breast lump (with or without pain)
Breast cancer referral for a woman over 50? with what symptoms in a single nipple?
- discharge
- retraction
any other concerning changes
pattern of eczematous skin changes occuring in
a) pagets disease
b) eczema
in Pagets: involves the nipple primarily and only latterly spreads to the areolar
opposite in eczema
how is diagnosis of pagets disease of breast made?
- punch biopsy
- mammogram
- USS
prior to surgery what is the management in presence & absence of palpable axillary lymphadenopathy?
- palpable: axillary node clearance at primary surgery
- non palpable: pre-operative axillary ultrasound
management if woman with no palpable axillary lymphadenopathy has pre-operative axillary ultrasound
- if positive
?
positive: sentinel node biopsy?
4 types of breast cancer features that make wide local excision the choice of surgery over mastectomy?
- solitary lesion
- peripheral tumour
- small lesion in large breast
- DCIS < 4cm
4 types of breast cancer features that make mastectomy the choice of surgery over wide local excision?
- multifocal tumour
- central tumour
- large lesion in small breast
- DCIS > 4 cm
what treatment should always be offered following wide local excision & why?
radiotherapy
as this may reduce the recurrence by 2/3rds.
which women require radiotherapy following mastectomy?
for T3-T4 tumours
and those with 4 or more positive axillary lymph nodes
hormonal therapy of choice for post menopausal women with oestrogen receptor positive tumours?
Aromatase inhibitors = anastrozole or letrozole
important side effects of tamoxifen?
- VTE
- Menopausal symptoms
- increased risk of endometrial cancer
who is contraindicated for trastuzumab?
- patients with a hx of heart disorders
when can neoadjuvant chemo be used?
either prior or after surgery in a number of criteria e.g. if have axillary node disease
marker used to montor response to breast cancer treatment & disease recurrence
CA 15-3
apearance of breast in inflammatory breast cancer
progressive, erythema and oedema of the breast
typical symptoms of duct ectasia?
- greenish nipple discharge
- peri-areolar lump
- around menopause
- slit like retraction of nipple
- cheese like discahrge
why does duct ectasia occur?
reflects a shortening and widening of the terminal breast ducts around th enipple
discrete soft fluctuant areas in UOQ & mammogram halo sign
breast cyst
what is the major adverse effect of aromatase inhibitors?
osteoporosis
episode of clear nipple discharge which has blood when tested & originates from a single duct
intraductal papilloma
comedo necrosis
feature of high nuclear grade ductal carcinoma in situ
grey gelatinious surface when lump is sliced apart
mucinous carcinoma
Most common in middle-aged women
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
Fibroadenosis
fibrocystic disease, benign mammary dysplasia
whos given trastuzumab?
HER2 positive
blood stained discharge is most likely associated with:
duct papilloma
what does ‘snowstorm’ sign on ultrasound of axillary lymph nodes indicate?
extracapsular breast implant rupture?
fibroadenoma > 3 cm and causing patient moderate discomfort?
surgical excision
side effects of tamoxifen (4)
- post menopausal symptoms (vaginal dryness, nausea, low libido, hot flushes)
- cataracts
- DVT
- endometrial thickening
when other than breast ca may tamoxifen or danazol be indicated?
severe, prolonged cyclical breast pain which hasn’t improved with standard treatment
risk factors for non breastfeeding breast abscess
- smoking
- diabetes
- nipple piervcing
- immunocomprimised
tramline’ appearance of breast arterial calcification
associated with increasing age, diabetes, CVD
what drug can be used for chemoprevention in women with BRCA gene mutation
tamoxifen
