Women's Health 1 (Gynae/Breast) Flashcards

Question

What is the management for adenomyosis?

Answer 1

same as the treatment for heavy menstrual bleeding for women who do not want contraception: - tranexamic acid (if no associated pain) = antifibrinolytic - mefenamic acid (with associated pain) = NSAID for women who want or are happy to have contraceptives: - mirena coil (1st line) - COCP - cyclical oral progestogens

Answer 2

Infertility Miscarriage Preterm birth Small for gestational age Preterm premature rupture of membranes Malpresentation Need for caesarean section Postpartum haemorrhage

Answer 3

where adhesions (sometimes called synechiae) form within the uterus, following damage to the uterus these adhesions form physical obstructions and distort the pelvic organs, resulting in menstruation abnormalities, infertility and recurrent miscarriages

Answer 4

it usually occurs after a pregnancy-related dilatation and curettage (scraping) procedure, e.g. in the treatment of retained products of conception (removing placental tissue left behind after birth) can also occur after uterine surgery or several pelvic infections the adhesions can bind the uterine walls together, or within the endocervix, sealing it shut

Answer 5

secondary amenorrhoea significantly lighter periods dysmenorrhoea infertility

Answer 6

hysteroscopy (GS) also the treatment as adhesions can be dissected during this procedure hysterosalpingography (XR imaging of the uterus with contrast) sonohysterography (uterus is filled with fluid before pelvic USS) MRI scan

Answer 7

a chronic inflammatory skin condition which presents with patches of shiny, 'porcelain-white' skin and commonly affects the labia, perineum and perianal skin in women lichen refers to a flat eruption that spreads

Answer 8

itching soreness and pain (possibly worse at night) skin tightness superficial dyspareunia erosions fissures

Answer 9

occurs in lichen sclerosus when the signs and symptoms are made worse by friction to the skin

Answer 10

porcelain-white colour shiny tight thin slightly raised may be papules or plaques

Answer 11

cannot be cured but symptoms can be effectively managed long term strong topical steroids like clobetasol propionate emollients

Answer 12

5% risk of squamous cell carcinoma of the vulva sexual dysfunction narrowing of the vaginal or urethral openings bleeding, pain, discomfort

Answer 13

a condition where there is ectopic endometrial tissue outside the uterus endometrioma = a lump of endometrial tissue outside the uterus

Answer 14

no clear cause seems to be a genetic element - retrograde menstruation where the endometrial lining flows backwards through the fallopian tubes during menstruation, into the pelvis and peritoneum where it seeds itself - embryonic cells destined to become endometrial tissue remain in areas outside the uterus during foetal development and then develop into ectopic endometrial tissue - spread of endometrial cells through the lymphatic system (similar to cancer spread) - metaplasia of cells outside the uterus into endometrial cells

Answer 15

can be asymptomatic cyclical abdominal or pelvic pain deep dypareunia dysmenorrhoea infertility cyclical bleeding from other site e.g. haematuria

Answer 16

pelvic USS - may reveal endometriomas and chocolate cysts but more commonly unremarkable laparoscopic surgery (GS) with biopsy and potential to removed deposits for symptom relief

Answer 17

important parts of initial management are education, analgesia and partnership with patient to establish their ICEs hormonal management: COCP, progesterone pill, depo injection, nexplanon implant, mirena coil, GnRH agonists Surgical management: laparoscopic surgery to excise or ablate the endometrial tissue and remove adhesions, hysterectomy

Answer 18

pelvic inflammatory disease ectopic pregnancy torsion of an ovarian cyst appendicitis primary dymenorrhoea IBS uterine fibroids UTI

Answer 19

a premalignant condition affecting the squamous epithelium of the skin which can precede vulval cancer High grade squamous intraepithelial lesions are a type of VIN associated with HPV infection which typically occur in younger women aged 35-50 Differentiated VIN is an alternative type of VIN associated with lichen sclerosus and typically occurs in older women (50-60 yrs)

Answer 20

lichen sclerosus (5% get vulval cancer) advanced age (75+) immunosuppression HPV infection

Answer 21

watch and wait wide local excision to remove the lesion imiquimod cream laser ablation

Answer 22

vulval lump ulceration bleeding pain itching lymphadenopathy of the groin

Answer 23

irregular mass fungating lesion ulceration bleeding most commonly affect the labia majora

Answer 24

Biopsy of the lesion Sentinel node biopsy to demonstrate lymph node spread Further imaging for staging (e.g. CT abdomen and pelvis)

Answer 25

Wide local excision to remove the cancer Groin lymph node dissection Chemotherapy Radiotherapy

Answer 26

a viral STI associated with anal, vulval, penis, mouth and throat cancers important strains are type 16 and 18 which are responsible for around 70% of cervical cancers and also the strains targeted with the HPV vaccine HPV produces two proteins (E6 and E7) which inhibit the tumour suppressor genes, P53 and pRb respectively, promoting cancer development as a result

Answer 27

HPV - early sexual activity, multiple sexual partners, not using condoms not having cervical screening smoking HIV COCP for 5+ years family history exposure to diethylstilbestrol during foetal development

Answer 28

abnormal vaginal bleeding vaginal discharge pelvic pain dyspareunia

Answer 29

a grading system for the level of dysplasia in the cells of the cervix CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated CIN III: severe dysplasia, very likely to progress to cancer if untreated

Answer 30

Stage 1: Confined to the cervix Stage 2: Invades the uterus or upper 2/3 of the vagina Stage 3: Invades the pelvic wall or lower 1/3 of the vagina Stage 4: Invades the bladder, rectum or beyond the pelvis

Answer 31

Cervical intraepithelial neoplasia and early-stage 1A: LLETZ or cone biopsy Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy Stage 2B – 4A: Chemotherapy and radiotherapy Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

Answer 32

a procedure where the epithelial lining of the cervix is examined in detail and stains such as acetic acid and iodine solution are used to identify abnormal areas

Answer 33

also known as a loop biopsy and can be performed with local anaesthetic during a colposcopy procedure uses a loop of wire with electrical current to remove abnormal epithelial tissue on the cervix

Answer 34

a treatment for CIN and very early-stage cervical cancer an operation performed under general anaesthetic where the surgeon removes a cone-shaped piece of the cervix using a scalpel which is then sent for histology to assess for malignancy risks: - pain - bleeding - infection - scar formation with stenosis of the cervix - increased risk of miscarriage and premature labour

Answer 35

an operation which can be used in advanced cervical cancer and involves removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum

Answer 36

a monoclonal antibody that may be used in combination with other chemotherapies in the treatment of metastatic or recurrent cervical cancer targets vascular endothelial growth factor A which is responsible for the development of new blood vessels also used to treat wet age-related macular degeneration

Answer 37

80% are squamous cell carcinomas adenocarcinoma rarely small cell cancer

Answer 38

A smear test is offered to all women between the ages of 25-64 years 25-49 years: 3-yearly screening 50-64 years: 5-yearly screening cervical screening cannot be offered to women over 64 (unlike breast screening, where patients can self-refer once past screening age)

Answer 39

inadequate normal borderline changes low-grade dyskaryosis high-grade dyskaryosis (moderate/severe) possible invasive squamous cell carcinoma possible glandular neoplasia can also identify bacterial vaginosis, cadididasis and trichomoniasis

Answer 40

Inadequate sample – repeat the smear after at least three months HPV negative – continue routine screening HPV positive with normal cytology – repeat the HPV test after 12 months HPV positive with abnormal cytology – refer for colposcopy

Answer 41

a precancerous condition involving thickening of the endometrium most cases return to normal over time less than 5% will progress to endometrial cancer 2 types: hyperplasia without atypia and atypical hyperplasia

Answer 42

intrauterine system e.g. mirena coil continuous oral progestogens e.g. medroxyprogesterone

Answer 43

Increased age Earlier onset of menstruation Late menopause Oestrogen only hormone replacement therapy No or fewer pregnancies Obesity (adipose tissue is a source of oestrogen) Polycystic ovarian syndrome Tamoxifen (oestrogenic effect on the endometrium)

Answer 44

it lead to increased exposure to unopposed oestrogen due to a lack of ovulation when ovulation occurs a corpus luteum is formed in the ovaries from the ruptured follicle that released the egg and its the corpus luteum which produces progesterone and provide endometrial protection during the luteal phase of the menstrual cycle women with PCOS are less likely to ovulate and form a corpus luteum so progesterone is not produced and the endometrial lining has more exposure to unopposed oestrogen

Answer 45

COCP intrauterine system like mirena coil cyclical progestogens to induce a withdrawal bleed

Answer 46

COCP mirena coil increased pregnancies cigarette smoking (due to anti-oestrogenic effect)

Answer 47

Postcoital bleeding Intermenstrual bleeding Unusually heavy menstrual bleeding Abnormal vaginal discharge Haematuria Anaemia Raised platelet count

Answer 48

postmenopausal bleeding (12+ months after last menstrual period)

Answer 49

unexplained vaginal discharge visible haematuria (with raised platelets, anaemia or raised blood glucose)

Answer 50

Transvaginal ultrasound for endometrial thickness (normal is less than 4mm post-menopause) Pipelle biopsy, which is highly sensitive for endometrial cancer making it useful for excluding cancer Hysteroscopy with endometrial biopsy

Answer 51

Stage 1: Confined to the uterus Stage 2: Invades the cervix Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes Stage 4: Invades bladder, rectum or beyond the pelvis

Answer 52

For stage 1 and 2 usually a total abdominal hysterectomy with bilateral salpingo-oopherectomy (TAH and BSO) where the uterus, cervix and adnexa are removed A radical hysterectomy involves also removing the pelvic lymph nodes, surrounding tissues and top of the vagina Radiotherapy Chemotherapy Progesterone may be used as a hormonal treatment to slow the progression of the cancer

Answer 53

epithelial cell tumours (serous tumours (MC), endometrioid carcinomas, clear cell, mucinous tumours, undifferentiated tumours) dermoid cysts/ germ cell tumours - teratomas (can contain other tissue types e.g. skin, teeth, hair and bone), particularly associated with ovarian torsion sex cord-stromal tumours - rare and can be benign or malignant, arise from the stroma or sex cords, include sertoli-leydig cell tumours, granulosa cell tumours metastasis - krukenberg tumour is a common type of metastasis in the ovary usually from the GI tract and these have characteristic signet ring cells on histology

Answer 54

age (peak age 60) BRCA1 and BRCA2 genes increased number of ovulations obesity smoking recurrent use of clomifene

Answer 55

COCP breastfeeding pregnancy

Answer 56

abdo bloating early satiety loss of appetite pelvic pain urinary symptoms weight loss abdo pain or pelvic mass ascites

Answer 57

ascites pelvic mass abdo mass

Answer 58

CA1245 blood test pelvic USS CT scan histology using a CT guided biopsy, laparoscopy or laparotomy paracentesis

Answer 59

menopausal status USS findings CA125 level

Answer 60

Alpha-fetoprotein (α-FP) Human chorionic gonadotropin (HCG)

Answer 61

Endometriosis Fibroids Adenomyosis Pelvic infection Liver disease Pregnancy

Answer 62

Stage 1: Confined to the ovary Stage 2: Spread past the ovary but inside the pelvis Stage 3: Spread past the pelvis but inside the abdomen Stage 4: Spread outside the abdomen (distant metastasis)

Answer 63

a squamous cell carcinoma involving the posterior wall of the upper third of the vagina. It may directly invade the bladder or rectum. Lesions may be ulcerative or exophytic. 80% of vaginal cancers are metastatic spread i.e. from the urethra, bladder, rectum etc. vaginal bleeding/bloody discharge

Answer 64

colposcopy biopsy, cervical cytology, endometrial biopsy CT scan fluorodeoxyglucose-positron emission tomography CXR cytoscopy, sigmoidoscopy

Answer 65

Stage 0 - squamous cell carcinoma in situ; this disease is usually multifocal and commonly occurs at the vaginal vault. Stage I - the disease is limited to the vaginal wall mucosa. Stage II - the disease involves the subvaginal tissue, but not the pelvic wall. Stage III - the disease extends to pelvic wall. Stage IV - the disease either extends beyond the true pelvis or involves the bladder or rectal mucosa: Stage IVA - the disease has spread to adjacent organs. Stage IVB - the disease has spread to distant organs.

Answer 66

dependent on tumour stage surgery and radiotherapy are very effective in early-stage disease radiation therapy is the treatment of choice in most patient with vaginal cancer, particularly in later-stage disease chemoradiation therapy (cisplatin, 5-fluorouracil)

Answer 67

also known as a molar pregnancy where a mass of tissue grows inside the womb which will not develop into a baby a complete mole occurs when two sperm cells fertilise an ovum which contains no genetic material and so the genetic material of the sperm combine and divide a partial mole is when 2 sperm cells fertilise a normal ovum at the same time so that it has 3 sets of chromosomes and then divides and multiplies into a tumour called a partial mole (some foetal material may develop)

Answer 68

molar pregnancies generally behave like a normal pregnancy - more severe morning sickness - vaginal bleeding - increased enlargement of the uterus - abnormally high hCG - thyrotoxicosis (hCG can mimic TSH and stimulate the thyroid to produce excess T3/T4)`

Answer 69

snowstorm appearance (created by the presence of many hydropic villi which give the appearance of a central heterogenous mass filling the entire uterine cavity)

Answer 70

evacuation of the uterus to remove the mole the products of conception need to be sent for histological examination to confirm a molar pregnancy patients should be referred to the gestational trophoblastic disease centre for management and follow up hCG levels should be monitored until they return to normal occasionally the mole can metastasise and the patient may need systemic chemotherapy

Answer 71

a group of pregnancy-related tumours which develop from the cells which surround the fertilised egg or embryo e.g. hydatidiform mole, choriocarcinoma, placental site trophoblastic tumour, epithelioid trophoblastic tumours

Answer 72

primary amenorrhoea = when the patient has never developed periods abnormal functioning of the hypothalamus or pituitary gland (hypogonadotropic hypogonadism) abnormal functioning of the gonads (hypergonadotropic hypogonadism) imperforate hymen or other structural pathology

Answer 73

pregnancy (MC) menopause physiological stress due to excessive exercise, low body weight, chronic disease or psychosocial factors polycystic ovarian syndrome medications, such as hormonal contraceptives premature ovarian insufficiency (menopause before 40yrs) thyroid hormone abnormalities (hypo or hyperthyroid) excessive prolactin e.g. from a prolactinoma Cushing's disease

Answer 74

also known as uterine polyps a fleshy tag of tissue which can appear on the neck or in the cavity of the uterus usually benign but some can be cancerous or precancerous

Answer 75

vaginal bleeding post-menopause intermenstrual bleeding frequent, unpredictable periods with varying length/heaviness infertility

Answer 76

being peri or post menopausal obesity tamoxifen (drug therapy for breast cancer) HRT

Answer 77

transvaginal USS hysterosonography hysteroscopy endometrial biopsy

Answer 78

watch and wait progestins or gonadotropin-releasing hormone agonists to relieve symptoms polypectomy during hysteroscopy

Answer 79

benign tumours of the smooth muscle of the uterus also known as uterine leiomyomas

Answer 80

intramural (within the myometrium) - they change the shape of the uterus as they grow subserosal (just below the outer layer of the uterus) - the grow outwards and can be very large submucosal (just below the lining of the uterus) pendunculated (on a stalk)

Answer 81

often asymptomatic heavy menstrual bleeding (menorrhagia) prolonged menstruation abdo pain bloating or feeling full in the abdomen urinary or bowel symptoms (due to pelvic pressure or fullness) deep dyspareunia reduced fertility

Answer 82

hysteroscopy pelvic USS MRI scanning

Answer 83

for fibroids less than 3cm (same as management for heavy menstrual bleeding): mirena coil symptomatic management combined oral contraceptive cyclical oral progestogens e.g. medroxyprogesterone acetate endometrial ablation resection of submucosal fibroids during hysterectomy hysterectomy

Answer 84

for fibroids more than 3cm referral to gynaecology needed symptomatic management with NSAIDs and tranexamic acid mirena coil combined oral contraceptive cyclical oral protestogens uterine artery embolisation myomectomy hysterectomy

Answer 85

myomectomy = surgical removal of the fibroid via laparoscopic surgery or laparotomy endometrial ablation = destruction of the endometrium by inserting a specially designed balloon into the endometrial cavity and filling it with high-temperature fluid which burn the endometrial lining of the uterus hysterectomy = removal of the uterus and fibroids which can be laparoscopy (keyhole), laparotomy (open) or vaginal approach

Answer 86

menorrhagia (+/- anaemia) reduced fertility pregnancy complications e.g. miscarriages, premature labour, and obstructive delivery constipation urinary outflow obstruction and UTIs red degeneration of the fibroid torsion of the fibroid malignant change to a leiomyosarcoma (very rare)

Answer 87

ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply more likely to occur in larger fibroids (5cm+) in the 2nd or 3rd trimester of pregnancy may occur as the fibroid rapidly enlarges during pregnancy, outgrowing its blood supply and becoming ischaemic may also occur due to kinking in the blood vessels as the uterus changes shape and expands during pregnancy

Answer 88

severe abdo pain low-grade fever tachycardia vomiting management = supportive - rest, fluids and analgesia

Answer 89

a fluid-filled sac in the ovary majority benign in premenopausal women but more concerning for malignancy in postmenopausal women

Answer 90

anovulation hyperandrogenism polycystic ovaries on USS

Answer 91

mostly asymptomatic pelvic pain bloating fullness in the abdomen palpable pelvic mass

Answer 92

follicular cysts - occur when the developing follicle fails to rupture and release the egg but a cyst persists corpus luteum cysts - occur when the corpus luteum fails to break down and instead fills with fluid

Answer 93

less than 5cm - almost always resolve within 3 cycles and do not require a follow up scan 5-7cm - require routine referral to gynaecology and yearly USS monitoring 7+cm - consider an MRI scan or surgical evaluation persistent or enlarging cysts may require laparoscopy or ovarian cystectomy or oophorectomy

Answer 94

torsion haemorrhage into the cyst rupture with peritoneal bleeding

Answer 95

triad of: ovarian fibroma pleural effusion ascites typically occurs in older women and removal of the tumour results in complete resolution of the effusion and ascites

Answer 96

where the ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply usually due to an ovarian mass >5cm e.g. cyst or tumour twisting of the adnexa and blood supply to the ovary leads to ischaemia so if the torsion persists, necrosis occurs and the function of the ovary will be lost therefore ovarian torsion is an emergency requiring prompt diagnosis and management

Answer 97

sudden onset severe unilateral pelvic pain the pain is constant, gets progressively worse and is associated with nausea and vomiting can take a milder and more prolonged course in some cases with less severe pain occasionally the ovary can twist and untwist intermittently resulting in pain which comes and goes localised tenderness and potentially a palpable mass in the pelvis on examination

Answer 98

pelvic USS which may show a whirlpool sign, free fluid in pelvis and oedema of the ovary laparoscopic surgery is used to make a definitive diagnosis and treat it detorsion or oophorectomy may be performed during laparoscopic surgery

Answer 99

oligoovulation or anovulation (irregular or absent menstrual periods) hyperandrogenism (characterised by hirsutism and acne) polycystic ovaries on USS diagnosis requires 2 or 3 of these features

Answer 100

oligomenorrhoea or amenorrhoea infertility obesity (~70% patients) hirsutism acne hair loss in a male pattern

Answer 101

insulin resistance and diabetes acanthosis nigricans (due to insulin resistance) cardiovascular disease hypercholesterolaemia endometrial hyperplasia and cancer obstructive sleep apnoea depression and anxiety sexual problems

Answer 102

PCOS medications e.g. phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids ovarian or adrenal tumours secreting androgens Cushing's syndrome congenital adrenal hyperplasia

Answer 103

testosterone sex hormone-binding globulin luteinizing hormone follicle-stimulating hormone prolactin thyroid-stimulating hormone LH, LH:FSH ratio, testosterone, insulin and sometimes oestrogen are all typically raised in PCOS

Answer 104

string of pearls appearance where the follicles are arranged around the periphery of the ovary ovarian volume of >10cm3

Answer 105

weight reduction if appropriate risk management for risks associated with diabetes, cardiovascular disease, endometrial cancer e.g. smoking cessation, antihypertensive medications, COCP, mirena coil (continuous endometrial protection)

Answer 106

COCP (1st line for acne) topical adapalene (retinoid), antibiotics (clindamycin with benzoyl peroxide) or azelaic acid for acne topical elflornithine (for facial hirsutism) spironolactone (mineralocorticoid antagonist with anti-androgen effects), flutamide (non-steroidal anti-androgen) and finasteride (5a-reductase inhibitor which decreases testosterone production)

Answer 107

weight reduction if applicable metformin, clomifene or a combination to stimulate ovulation (ongoing efficacy debate) gonadotrophins ovarian drilling (puncturing holes into the ovaries to improve the woman's hormonal profile and result in regular ovulation and fertility)

Answer 108

a type of pituitary adenoma size classification: microprolactinoma = <1cm and macroprolactinoma = >1cm hormonal status classification: secretory/functioning adenoma produces an excess of a particular hormone and a non-secretory/functioning adenoma does not produce excess hormone

Answer 109

amenorrhoea infertility galactorrhoea osteoporosis

Answer 110

impotence loss of libido galactorrhoea gynaecomastia

Answer 111

headache visual disturbances e.g. bitemporal hemianopia or upper temporal quadrantanopia symptoms and signs of hypopituitarism (lethargy, anorexia, decreased muscle strength and bone density, impotency)

Answer 112

diagnosis = MRI management: - dopamine agonists e.g. cabergoline, bromocriptine which inhibit the release of prolactin from the pituitary gland - trans-sphenoidal surgery to remove the tumour (when medical therapy failed) - radiation therapy

Answer 113

<25 yrs - histology or cytology only. No imaging if clinically feels benign. USS if clinically indeterminate or suspicious. Risk of malignancy negligible in this age group. 25-40 years: breast USS plus histology or cytology. Triple assessment over 40 yrs: mammography and USS and either histology or cytology: Triple assessment

Answer 114

In younger women the breast tissue is dense and predominately glandular. With age it becomes less dense and dominated by fatty tissue. Mammograms struggle to differentiate between fluid-filled cysts and solid masses in dense breasts so are less useful diagnostically in younger women

Answer 115

benign, individual, fluid-filled lumps *most common cause of breast lumps* on examination: smooth well-circumscribed mobile possibly fluctuant

Answer 116

P1 - Normal P2 - Benign P3 - Indeterminate P4 - Suspicious P5 - malignant

Answer 117

breast cyst

Answer 118

localised degeneration and scarring of fat tissue in the breast which causes a benign lump O/E: painless firm irregular fixed in local structures may be skin dimpling or nipple inversion may be associated with an oil cyst containing liquid fat commonly triggered by localised trauma, radiotherapy or surgery --> an inflammatory reaction resulting in fibrosis and necrosis of the fat tissue can appear similar to breast cancer on mammogram so biopsy may be required to rule this out conservative management as can resolve spontaneously over time surgical excision may be used if required for symptoms

Answer 119

benign tumour of adipose tissue which commonly occurs in the breast O/E: soft painless mobile do not cause skin changes typically treated conservatively with reassurance, in some cases can be surgically removed

Answer 120

breast milk filled cysts which occur when the lactiferous duct is blocked, preventing the gland from draining milk O/E: firm mobile painless usually beneath the areola usually resolve without treatment is possible to drain them with a needle small risk of infection

Answer 121

rare tumour of the connective tissue of the breast which occur most often in 40-50yr old women large and fast growing can be benign (50%) or malignant (25%) treatment involves surgical removal of the tumour and the surrounding tissue (wide excision) can reoccur after removal chemotherapy may be used in malignant or metastatic tumours

Answer 122

common benign tumours of stromal/epithelial breast duct tissue typically small and mobile within the breast tissue more common in younger women between 20-40yrs O/E: painless smooth round well circumscribed (well-defined borders) firm mobile usually up to 3cm diameter usually not treated, in some cases surgical removal is indicated

Answer 123

female increased oestrogen exposure (earlier onset of periods and later menopause) more dense breast tissue (more glandular tissue) obesity smoking family history (1st deg relative) HRT (particularly combined) *COCP --> small increase in breast cancer risk but it returns to normal ten years after stopping the pill

Answer 124

BRCA1 on chromosome 17 BRCA2 on chromosome 13

Answer 125

Invasive ductal carcinoma (MC) also known as 'No Special Type' while other rarer types are known as 'Special type' Invasive lobular carcinoma Ductal carcinoma-in-situ Lobular carcinoma-in-situ Inflammatory Breast Cancer Paget's disease of the nipple

Answer 126

medullary breast cancer mucinous breast cancer tubular breast cancer multiple others

Answer 127

an eczematoid change of the nipple associated with an underlying breast malignancy and is present in 1-2% of patients with breast cancer

Answer 128

where cancerous cells block the lymph drainage resulting in an inflamed appearance of the breast accounts for around 1 in 10,000 cases of breast cancer

Answer 129

to offer a mammogram every 3 years to women aged 47-73yrs old annual mammogram screening is offered to women with increased risk between specific age ranges, depending on their level of risk

Answer 130

anxiety and stress exposure to radiation, with a very small risk of causing breast cancer missing cancer, leading to false reassurance unnecessary further tests or treatment where findings would not have otherwise caused harm

Answer 131

tamoxifen if premenopausal anastrozole if postmenopausal (except with severe osteoporosis)

Answer 132

hard, irregular, painless or fixed lumps lumps tethered to the skin or chest wall nipple retraction skin dimpling or oedema lymphadenopathy (especially in the axilla)

Answer 133

an unexplained breast lump in patients aged 30 or above unilateral nipple changes in patients aged 50 or above (discharge, retraction, other changes) consider 2 week wait referral for: an unexplained lump in the axilla in patients aged 30 or above skin changes suggestive of breast cancer

Answer 134

clinical assessment imaging (USS or mammography) biopsy (fine needle aspiration or core biopsy) Important to ensure concordance i.e. a clinically suspicious mass should have suspicious imaging and cytology before a decision is made to remove a woman’s breast. If there is discordance it may mean that the biopsy has missed the lesions and that further biopsies should be taken

Answer 135

USS typically used to assess lumps in younger women (breasts are more dense and glandular), helpful in distinguishing solid lumps from cystic lumps Mammograms are generally more effective in older women and can pick up calcifications not seen on USS MRI scans can be used in women at higher risk of developing breast cancer, also to assess size and features of a tumour in more detail

Answer 136

performed during breast surgery for cancer an isotope contrast and a blue dye are injected into the tumour area and travel through the lymphatics to the first lymph node (the sentinel node) this will show up blue on the isotope scanner and a biopsy can be performed to assess if cancer cells are present

Answer 137

oestrogen receptors progesterone receptors human epidermal growth factor (HER2)

Answer 138

where the breast cancer cells do not express any of the breast cancer receptors resulting a worse prognosis due to limited treatment options

Answer 139

Lungs Liver Bones Brain Can spread to anywhere though!

Answer 140

surgery (mastectomy or wide local excision) radiotherapy hormone therapy biological therapy chemotherapy

Answer 141

multifocal tumour central tumour large lesion in small breast DCIS >4cm

Answer 142

solitary lesion peripheral tumour small lesion in large breast DCIS <4cm

Answer 143

whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around 2/3's radiotherapy is also offered to women who've had a mastectomy for T3-T4 tumours and for those with 4+ positive lymph nodes

Answer 144

if tumours are positive for hormone receptors tamoxifen - a selective oestrogen receptor modulator whic either blocks or stimulates oestrogen receptors depending on the site of action (block in breast, stimulates in uterus and bone) aromatase inhibitors (e.g. letrozole, anastrozole or exemestane) block the creation of oestrogen in fat tissue

Answer 145

trastuzumab = monoclonal antibody which targets the HER2 receptor, may be used in patients with HER2 positive breast cancer pertuzumab = monoclonal antibody which targets the HER2 receptor neratinib = tyrosine kinase inhibitor, reducing the growth of breast cancers, may be used in HER2 positive breast cancer

Answer 146

a first-degree relative with breast cancer under 40 yrs a first-degree male relative with breast cancer a first-degree relative with bilateral breast cancer, first diagnosed under 50 yrs two first-degree relatives with breast cancer

Answer 147

- always given to the remaining breast after wide local excision - after some mastectomies for poor prognosis, high-risk tumours - as palliation for large or inoperable primary cancers - to treat symptomatic bone mets - to treat the axilla in women who cannot have axillary clearance surgery - to reduce local recurrence rates (usually around 2/3rds)

Answer 148

all women with oestrogen sensitive breast cancer are offered 5 or more year of anti-oestrogen therapy

Answer 149

Pre-menopausal women: - tamoxifen (30% increase in survival rate) (selective oestrogen receptor modulator which acts on oestrogen receptors throughout the body) Post-menopausal women: - aromatase inhibitors e.g. exemestane, letrozole, anastrozole (prevent the peripheral conversion of adrenal androgens to oestrogens by the aromatase enzyme in fatty tissues)

Answer 150

a mammogram every year for 5 years

Answer 151

*Reassurance that they do not have breast cancer is sufficient for 85% of women* Cyclical pain 1. simple explanation, reassurance and occasional simple analgesia 2. Danazol - weak androgen and mild inhibitor of gonadal function by inhibition of LH and FSH (significant side effects to breast) 3. Tamoxifen - can't be given long term due to risk of endometrial cancer 4. Goserelin - agonist of LH and FSH which causes stimulation of these receptors followed by a block Non-cyclical pain - NSAIDs

Answer 152

a benign condition where there is dilation of the large ducts in the breasts leading to intermittent discharge from the nipple which can be white, grey or green. occurs most frequently in perimenopausal women ectasia = dilation

Answer 153

nipple discharge tenderness of pain nipple retraction or inversion a breast lump

Answer 154

Clinical assessment (history and examination) Imaging (ultrasound, mammography and MRI) Histology (fine needle aspiration or core biopsy) *Microcalcifications are a key finding on mammogram Ductography Nipple discharge cytology Ductoscopy

Answer 155

can resolve without any treatment symptomatic management of mastalgia (breast pain) antibiotics if infection is suspected or present surgical excision of the affected duct in problematic cases

Answer 156

a warty lesion which grows within one of the ducts in the breast as a result of epithelial cell proliferation

Answer 157

can occur at any age often asymptomatic nipple discharge (clear or blood stained) tenderness or pain palpable lump

Answer 158

in ductography contrast is injected into the abnormal duct and a mammogram is then performed to visualise the duct the papilloma will be seen as an area that does not fill with contrast

Answer 159

they require complete surgical excision

Answer 160

Implants Flap reconstruction The breast can be reconstructed using a portion of the latissimus dorsi and the associated skin and fat tissue. Transverse Rectus Abdominis Flap (TRAM Flap) Deep Inferior Epigastric Perforator Flap (DIEP Flap) The breast can be reconstructed using skin and subcutaneous fat from the abdomen (no muscle) as a free flap. The deep inferior epigastric artery, with the associated fat, skin and veins, is transplanted from the abdomen to the breast.

Answer 161

ascites pelvic mass (unless clearly due to fibroids) abdominal mass

Answer 162

menopausal status USS findings CA125 level

Answer 163

endometriosis fibroids adenomyosis pelvic infection liver disease pregnancy

Women's Health 1 (Gynae/Breast) Flashcards

(188 cards)