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3a > WH: Breast > Flashcards

WH: Breast Flashcards

1
Q

breast anatomical location

A

paired structures located on the anterior thoracic wall in the pectoral region (spans 2nd - 6th ICS)
- present in M + F but more prominent in females following puberty

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2
Q

what glands do breasts contain ? what are these similar to ?

A

breasts contain mamary glands (assessors gland of F reproductive system)
- modified sweat glands

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3
Q

describe the anatomy of breasts. describe

A

mammory glands surrounded by connective tissue storm
- at the centre is the nipple: made mostly of smooth muscle fibres
- Surrounding this is the areola (pigmented skin with sebaceous glands)

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4
Q

What is lactation ? (where does the milk go?

A

maternal physiological response where milk is secreted for mammory gland
- lobules => ducts => nipple

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5
Q

Describe breast dev. what hormones ?

A

at puberty, oestrogen causes ducts to sprout and the ends form alveoli
- with each menstrual cyst there are cyclic changes due to change in oestrogen + progesterone

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6
Q

describe breast changes during pregnancy ?

A

significant hypertrophy of ductular-lobular-alveolar system

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7
Q

what is the quantity of milk secretion like during pregnancy ? why is this ?

A

little milk secretion due to high progesterone:oestrogen ratio

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8
Q

What are the main constituents of breast milk ? (5) main bit ?

A
  • water (90%)
  • lactose
  • fat
  • protein
  • mins + vits
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9
Q

How does colosseum vary compared to normal breast milk ? how much per day

A

colosseum has more fat soluble vitamins + proteins (immunoglobulins)

  • 40 ml/day
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10
Q

What hormones are involved in milk production ? briefly describe what they do ?

A
  • prolactin: stimulate milk production
  • oxytocin: let-down reflex
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11
Q

where is prolactin released ? controlled by what ? what stimulates its production ?

A

prolactin (AP) controlled by dopamine (prolactin inhibiting hormone (hypo))
- suckling (neuro-endocrine reflex)

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12
Q

What hormone levels would stimulate prolactin release ? (2)

A
  • low dopamine secretion from hypo (from suckling)
  • low pregoesteron: oestrogen ration
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13
Q

How is oxytocin involved in lactation ? explain. where does it act on ?

A

in response to suckling, oxytocin is release => myoepitheaial ells surrounding alveoli contract => squeeze milk out of breast (let-down reflex)

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14
Q

What tissue is most breast tissue ?

A

adipose tissue

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15
Q

Name some causes of Breast lumps ? (7)

A
  • breast cancer
  • Fibroadenoma
  • Fibrocystic breast changes
  • Breast cysts
  • Fat necrosis
  • Lipoma
  • Galactocele
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16
Q

Describe the lumps associated with breast cancer ? concerning lump. and other breast features ?

A
  • lumps that are hard, painless, fixed in place, tethered to skin/chest wall
  • nipple retraction
  • skin dumpling or oedema (peu d’orange)
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17
Q

What is fibroadenoma ? what tissue involved ?

A

common, benign tumour of stromal/epithelial breast duct tissue

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18
Q

fibroadenoma Epi. how common? what age?

A

common young women (20-40)
- respond to oestrogen + progesterone (regress after menopause)

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19
Q

describe the lumps associated with fibroadenoma ? size ?

A

painless, smooth, round, well circumscribed, firm
- usually less than 3cm
- mobile (freely move under skin - “breast mouse”)

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20
Q

What are fibrocystic breast changes ? what tissue involved ? explain pathophys

A

connective tissue (stroma), ducts + lobules répond to oestrogen + progesterone => fibrous + cystic (fluctuate with menstrual cycle)

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21
Q

fibrocystic breast changes symptoms ? (3) how might symptoms fluctuate ?

A

lumpiness, mastalgia, fluctuation of breast size
- Sx often occur in days prior to menstruation (10 days)

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22
Q

managment of fibrocystic breast changes ? (4)

A
  • supportive bra
  • NSAIDs
  • avoid caffeine
  • hormonal treatment (danazol)
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23
Q

What are breast cysts ?

A

benign individual fluid filled lumps (most common cause of lumps)

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24
Q

what would be found OE of a breast cyst ? (4)

A

smooth, well circumscribed, mobile, fluctuant

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25
Q

Breast cyst managment ?

A

require further investigations (scan + potentially aspiration) to exclude cancer

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26
Q

What is fat necrosis of the breast ? pathophys

A

benign lump formed by localised degernation + scarring of breast fat tissue

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27
Q

what could cause fat necrosis ?

A

trauma/radiotherapy/surgery => inflam reaction => fibrosis + necrosis of fat tissue

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28
Q

what would be found OE of fat necrosis ?

A

similar to cancer
- painless, firm, irregular, fixed, skin dimpling, nipple inversion

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29
Q

Fat necrosis Ix ?

A

USS, mammogram, histology (diagnostic + exclude cancer)

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30
Q

What is lipoma ?

A

benign tumour of fat/adipose tissue (occur anywhere in body where there is fat)

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31
Q

what would be seen OE of lipoma ?

A

soft, painless, mobile, no skin changes

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32
Q

What is galactocele ? who does it affect

A

women who lactate, after stopping breast feeding

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33
Q

What is mastalgia ?

A

Breast pain

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34
Q

is breast pain a common sign of breast cancer

A

not common of breast cancer so if no lump of skin changes then patient can be reassured

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35
Q

is cyclical or non cyclical breast pain more common. what causes it to be cyclical ?

A

related to menstrual cycle
- cyclical breast pain is more common

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36
Q

When in the menstrual cycle does cyclical breast pain usually occur ? describe the pain associated

A

usually occurs 2 weeks before mensturaiton (luteal)
- bilateral + generalised apin, heaviness, aching

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37
Q

what could cause non-cyclical mastalgia ? (3) who more common in ?

A

more common 40-50 yrs
- medications (hormonal contraception)
- Infeciton
- pregnancy

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38
Q

mastalgia mamangement ? (5)

A
  • supportive bra
  • NSAIDs
  • Avoid caffien
  • Apply heat
  • Daniel (hormonal)
39
Q

what is Gynaecomastia ?

A

enlargement of glandular breast tissues in males (quite common)

40
Q

what pathophys causes Gynaecomastia ?

A

hormonal imbalance (high oestrogen + low androgens)
- high oestrogen => breast dev
- low androgens => lack of breast dev suppression

41
Q

what could cause Gynaecomastia ?

A
  • idiopathic
  • Leydig cell testicular tumours
  • drugs
42
Q

what drugs could cause Gynaecomastia ? (3)

A
  • anabolic steroids
  • spironolactone
  • antipsychotics (that decrease dopamine)
43
Q

Px present with Gynaecomastia, what other examination will you do ?

A

genital examination
- to check fo Leydig cell testicular tumour

44
Q

what is pseudogynaecomastisa ?

A

appearing large breast due to extra adipose tissue no glandular tissue (due to being obese)

45
Q

when would you do imagine in Gynaecomastia ?

A

only if cancer suspected

46
Q

what is the most common cause of cancer in the UK ? chance of developing in life ?

A

breast cancer (99% women)
- 1/8 women will develop

47
Q

Breast cancer RF ?

A
  • Female
  • high oestrogen exposure (early menarche, later menopause)
  • more dense breast tissue
  • obesity
  • smoking
  • FHx
  • COCP
  • HRT
48
Q

What genetic mutations are associated with breast cancer ? what other cancer does this increase risk of ?

A

BRCA (tumour suppressor genes): BRCA mutation => increase breast cancer risk (and ovarian cancer)

49
Q

What different types of Brest cancer are there ?

A
  • Ductal carcinoma in Situ (DCIS)
  • Lobular carcinoma in Situ (LCIS)
  • Incasive ductal carcinoma - NST (no specific type)
50
Q

what is ductal carcinoma in Situ (DCIS) ? what cells ?

A

pre canc/canc epithelial cells of breast duct localised to a single area

51
Q

DCIS prognosis ?

A

becomes invasive in around 30%
- good prognosis if fully excised

52
Q

What is lobular carcinoma in Situ (LCIS) ?

A

pre-canc condition in pre- menopausal women

53
Q

LCIS Mx ?

A

usually asymptomatic + managed with close monitoring

54
Q

what is pages dies of the nipple ? appearance ?

A

looks like eczema of areolar/nipple
- erythematous caly rash of nipple region
- can be itch, inflamed or ulcerated

55
Q

what could pages disease of nipple indicate ?

A

may indicate breast cancer involving the nipple (usually DCIS or invasive cancer)

56
Q

what is the most common invasive breast cancer ?

A

invasive ductal carcinoma - NST (no specific type)

57
Q

describe breast screening. to who ? how often ?

A

mammogram every 3 yrs (women aged 50-70)

58
Q

if you are a high risk breast cancer patient, what other screening/ prevention are you offered ? (3)§

A
  • offered genetic testing
  • chemoprevention (tamoxifen)
  • risk reducing bilateral mastectomy
59
Q

Breast cancer presentation ?

A
  • Lumps (hard, irregular, painless, fixed in place)
  • nipple retraction
  • skin dimpling or oedema (peu d’orange)
  • Lympadenpathy (axillary)
60
Q

what criteria would make a Px eligible for a two week wait referral for breast cancer ? (2)

A
  • unexplained breast lump >30 yrs
  • unilateral nipple changes > 50 yrs
61
Q

breast cancer initial investigations ?

A

triple diagnostic assessment
- Clinical assessment (H+E)
- imaging (US, Mammogram)
- Biopsy (fine needle)

62
Q

what determines what imaging is offered for triple assessment ? (3)

A
  • US < 30 yrs
  • Mammogram > 30 yrs
  • MRI: high risk
63
Q

what is a sentinel lymph node biopsy ?

A

during surgery
- isotope contract goes to first (sentinel) node

64
Q

what are the 3 important breast cancer receptors ? is it good to have these or bad ?

A
  • oestrogen receptors (ER)
  • progesterone receptors (PR)
  • HER2

triple -ve is where cancer does not express any of these receptors (worse prognosis)

65
Q

What are the common metastasis sites from breast cancer ? (4)

A

2Ls, 2 Bs
- Lungs
- Liver
- Bones
- Brain

(but can spread to anywhere tho)

66
Q

What is done to stage breast cancer ?

A
  • triple assessment
  • Lymph node assessment
  • CT (thorax, abdo, pelvis)

TNM (tumour, nodes, metastesis) staging

67
Q

what surgical options are there for breast cancer ?

A

rumor removal
- breast conserving (+radiotherapy)
- mastectomy

plus axillary clearance (if cancer cells found in nodes)

68
Q

What is chronic lymphedema ? Mx?

A

caused by impaired lymphatic drainage of an area
- manual lyphattic drainga
- compression bandages
- weight loss
(-do no take blood form this arm)

69
Q

when might chemo be used in breast cancer Mx ? (3)

A
  • neoadjuvant
  • adjuvant
  • treatment (of metastatic breast cancer)
70
Q

What hormone treatment could be used for breast cancer ? describe who given to and course ?

A

tamoxifen (premenopausal), aromatase inhibitors (PM women)
- given for 5 - 10 yrs for oestrogen receptor +ve breast cancer

71
Q

breast cancer follow up ?

A

surveillance mammograms yearly for 5 yrs

72
Q

What is galactorrhea ?

A

breast milk production not associated with pregnancy or breast feeding

73
Q

where is prolactin made ? (3) function ?

A

made maily in AP (but also prostate, breast)
- breast milk production, immune function + metabolism

74
Q

causes of hyperprolactinaemia ? (4)

A
  • idiopathic
  • prolactinoma
  • endocrine (hypothyroidism, PCOS)
  • medications (dopamine antagonists (anti psychotics))
75
Q

elevated prolactin effects on other hormones ?

A

prolactin surpasses GnRH => low LH + FSH => menstural abnormalities and low sex drive

76
Q

what are prolactinomas ? associated with what ?

A

tumours of AP that secrete excessive prolactin (associated with multiple endocrine neoplasia (MEN) type 1)
- and bilateral hemianopia

77
Q

what are causes of non-milk discharge ? (3)

A
  • mammary duct ectasia
  • duct papillomas
  • pus (form an abscess)
78
Q

Galactorhoea Ix ?

A
  • pregnancy test
  • serum prolactine
  • U+E
    = LFT
  • TFT
  • MRI (for AP tumours)
79
Q

Mx of galactohrea ?

A

depends on cuase
- dopamine agonists (cabergoline)
- transphenoidal surgical removal of pituitary tumour

80
Q

What is mammary duct ectasia ?

A

bening condition where there is dilation of the large ducts in the breasts
- inflam => intermittent discharge (white, grey, green)

81
Q

mammary duct ectasia presentaiton ? common among who ?

A

perimenopasual women, smoking (big RF)
- nipple discharge
- tenderness/pain
- nipple retraction/inversion
- breast lump

82
Q

mammary duct ectasia Ix ?

A

exclude cancer: tipple assessment (H&E, imaging, histology)

83
Q

mammary duct ectasia Mx ?

A

reassure, not cacnerous
- treat Sx (mastalgia => supportive bra)

84
Q

What is intraductal papilloma ? what causes it ?

A

warty lesion that grows within 1 of the ducts of the breast due to proliferation of epithelial cells that line the duct
(benign but associated with hyperplasia/cancer)

85
Q

intraductal papilloma presentation ? age ?

A

35-55
- often asympotmattic
- nipple discharge (clear of blood stained)
- pain
- palpable lump

86
Q

intraductal papilloma Ix ?

A

tripple assessment to exclude cancer

87
Q

intraductal papilloma Mx ?

A

require complete surgical excision
(then examine for atypical hyperplasia)

88
Q

What is a breast abscess ? 2 types ?

A

collection of pus within area of breast, usually caused by bacterial infection
- lactations (associated with breast feeding)
- non-lactational

89
Q

breast abscess RF ? (1)

A

smoking

90
Q

causative organisms of breast abscess ? most common ?

A

s. aureus (most common)
streptococcal
enterococcal

91
Q

Mastitis with infection Px ? (8)

A

acute (few days)
- nipple changes
- pus from nipple
- pain/tenderness
- warmth
- redness
- hardening
- swelling
- generalised Sx (muscle ache, fatigue, fever)

92
Q

lactational mastitis Mx ?

A

conservative
continue breast feeding
breast massage

93
Q

non-lactational mastitis Mx ? (2)

A
  • analgesia
  • Abx (broad spec: co-amoxiclav)
94
Q

breast abscess Mx ? (5)

A
  • hospital admission
  • Abx
  • US (rule out other pathology)
  • drainage (and microscopy, culture + sensitivity testing)
  • can continue to breast feed (if not to painful)

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