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Reproduction/Sexual Health > Week 7 > Flashcards

Week 7 Flashcards

1
Q

US vs mammogram in breast lump assessment

A

US >40 years or targetted lump
Mammogram >40 years or screening 50-70

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2
Q

When would you offer excision in fibroadenoma?

A

Rapidly growing (consider phyllodes tumour - may be benign/borderline/malig)
Discomfort to patient

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3
Q

Where does fibroadenoma arise from?

A

Overgrowth of epithelium and stroma of breast
(overdevelopment of normal breast tissue)

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4
Q

Management of breast abscess

A

Continue breast feeding/expressing
Aspiration and Flucloxacillin
Prevent cracked nipples

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5
Q

What are you lookig for in mammogram?

A

Microcalcifications ≤100nm with high inherent contrast

Soft tissue abnormalities with lower intrinsic contrast

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6
Q

Two views of mammogram

A

Mediolateral oblique
Craniocaudal CC

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7
Q

Inidcations for mammography

A

Symptomatic assessment > 40 years

Screening (50 – 70yrs)
Higher risk ‘family history’ screening > 40 years

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8
Q

Benign calificiations on mammogram

A

Vascular calcification
Oil cyst eggshell calcification
Plasma cell mastitis (long, bilat, points to nipple)
Dystrophic calicification in scar

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9
Q

Features of DCIS on mammogram

A

Shape: Linear or branching
Distribution: Cluster or segmental
Pleomorphic (varying) size and density

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10
Q

Use of US in breast imaging

A

Targetted breast imaging
E.g. known lesion, suspicion on mamm.
Axilla lymphadenopathy

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11
Q

Tall mass on US suggests

A

Masss breaking through tissue layers, indicates malignancy

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12
Q

Anechoic mass on US?

A

Cyst

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13
Q

Features of concerning lymph nodes on US

A

Round shape
Absence of the fatty hilum
Increased concentric or focal cortical thickness

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14
Q

Imaging pathway in one stop breast clinic

A

Under 40 (or pregnant / breast-feeding)
- Ultrasound first
- Mammogram only if concerning finding requiring biopsy
40 years and over
- Mammogram first
- Targeted ultrasound

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15
Q

Types of image-guided biopsy in breast assessment

A

US or mammographic

Core 14G
- diagnostic, mass lesions, nodes
Vacuum assisted
- diagnostic, microcalcification
Vacuum assisted excision
- 2nd line, instead of surgery for B3

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16
Q

Function of radioopaque clips

A

Confirm position
Neoadjuvant chemotherapy
Localisation

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17
Q

Follow-up post surgery in breast cancer

A

5 year annual mammography

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18
Q

Most sensitive assessment of breast cancer

A

MRI
- IV gadolinium
- Lie prone with MRI scanner
- used for locoregional staging
- not highly specific

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19
Q

Indications for staging for distant mets

A
  1. T3 and T4 primary cancers (≥5cm or locally invasive)
  2. ≥4 abnormal nodes at axillary ultrasound or ≥4 macrometastatic nodes at axillary surgery
  3. If symptoms raise the suspicion of metastatic disease.
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20
Q

ANDIs include…

A

Fibroadenoma
Cysts (happens in run up to period, most common >40)
Papilloma (essentially skin tag inside cyst)
Pain (usually chest wall or hormonal)

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21
Q

When should nipple discharge be investgated?

A

Blood stained or associated with other red flag features
- Normal otherwise

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22
Q

Inflammatory conditions of breast

A

Mastitis
Fistula
Abscess

23
Q

Why is HER2 status important in breast cancer?

A

ER vs PR positive
Triple neg is worst prognosis
PR is prognosticator and determines likelihood of chemo response
HER2 pos can determine type of hormonal/chemo needed

24
Q

Types of chemo in breast cancer

A

Anthracyclines and Taxanes
- anti-HER2 as well
6-8 cycles, 3 weekly

25
Q

Side effects of anthracyclcines

A

Heart effects
Small leukaemia risk

26
Q

How can neutropenic sepsis be prevented in chemo pts?

A

GCSF
– stimulates bone marrow to differentiate and release stem cells
Give 1st dose tazocin

27
Q

Chemo treatment reg in triple negative breast cacer

A

EC (3 weekly) followed by 12 continous weeks of weekly Carboplatin+Paclitaxel.

28
Q

Indications for neoadjuvant chemo NACT

A

Inflammatory breast cancer
Downstaging required e.g. nodal burden
T2 +HER2 or triple neg
Tany N>1

29
Q

What drugs can be used in adjuvant chemo?

A

Carboplatin and Pembrolizumab

30
Q

What treatments follow adjuvant chemo?

A

Radiotherapy and endocrine therapy
- 3-4 weeks after

31
Q

Use of anti herceptin antibodies in adj chemo

A

Given for 1 year
- herceptin if node neg
- herceptin/pertuzumab if node pos
- regular echos

32
Q

How is endocrine treatment used in breast cancer?

A

5 years, 10 if high risk

Determine if pre/post menopausal

Tamoxifen - pre/perimenomausal
Letrozole - postmenopausal or in induced ovarian suppression

33
Q

Mechanism of tamoxifen

A

ANTAgnosies the oestrogen receptors around breast tissue
AGONISTIC around Uterus, hence small risk of uterine cancer

Flushes, mood change, tiredness

34
Q

Mechanism of letrozole

A

Stops fat and other peripheral cells producing estrogen
Flushes, tiredness and joint pain
Watch for bone density changes with DEXA scans!

35
Q

Contraindications in hormone treatment of breast cancer

A

HRT
- also in ER cancers
Hormonal contraception
- copper coil is fine

36
Q

Use of radiotherapy in breast cancer

A

Local treatment of breast and lymph nodes
No survival benefit, not used if theres been mastctomy unless 4 or more nodes involved
Blasts left behind cells

37
Q

Side effects of radiotherapy

A

Warm/Red breast, tiredness
Lymphoedema (less compared to node clearance)
Skin changes/fibrosis
Rib fracture, stiffness of shoulder, sarcoma, lung fibrosis

38
Q

Define high risk of breast cancer

A

Lifetime risk of developing breast cancer of 30% or more

39
Q

Define moderate risk of breast cancer

A

Lifetime risk of breast cancer of greater than 17% but less than 30%
(just higher than 12% population risk)

40
Q

Define low risk of breast cancer

A

17% or less lifetime risk

41
Q

Screening for moderate risk of breast cancer

A

Annual mammogram 40-50y then join population screening

42
Q

High risk screening for breast cancer

A

Biennial mammograms from 35 – 39
Annual mammograms from 40 – 59
18 monthly mammograms from 60 – 70
Think ab prophylactic chemoprevention
(or 5 years earlier than youngest cancer onset)

43
Q

Management of very high risk of breast cancer

A

Extra breast screening with annual mammograms from 30 till 70 and annual breast MRI from 30 till 50
Options for double mastectomy and BSO
No routine prostate screening

44
Q

Define lead time in screening

A

Difference in time between cancer diagnosed and screening and cancer diagnosed symptomatically

45
Q

Scottish breast screening programme

A

Three yearly screening 50-70
Bilateral 2 view mammogram
3 in 1000 detection rate
If abnormality detected = triple assessment at one-stop clinic

46
Q

Use of tomosynthesis

A

Takes several images in similar sense to CT
Used to assess abnormalities on mammogram to ensure it’s nt breast tissue pushed together in weird ways

47
Q

What is normal size of an axillary node?

A

<3mm cortex

48
Q

Radial scar indicates slightly higher risk of which cancer?

A

DCIS

49
Q

Childhood subdiaphragmatic radiotherapy as a child incr risk of which type of cancer?

A

Breast
- incr screening, MRI

50
Q

Mammogram contraindicated in which breast cancer mutation?

A

TP53

51
Q

BRCA1 features

A

More commonly triple neg
More rapid growth
Look benign on imaging

52
Q

BRCA2 features

A

Look more like sporadic
More DCIS

53
Q
A

Reproduction/Sexual Health (9 decks)

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