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PHASE 3A > WOMEN'S HEALTH - BREAST > Flashcards

WOMEN'S HEALTH - BREAST Flashcards

1
Q

define carcinoma

A

cancer that begins in the skin or tissues that line/cover internal organs

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2
Q

6 types of breast cancer

A
  1. ductal carcinoma in situ (DCIS)
  2. lobular carcinoma in situ (LCIS)
  3. invasive ductal carcinoma (NST)
  4. invasive lobular carcinoma (ILC)
  5. inflammatory breast cancer
  6. Paget’s disease of the nipple
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3
Q

what is the most common BC type?

A

invasive ductal carcinoma

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4
Q

what is DCIS? prognosis?

A

precancerous/cancerous epithelial cells of the breast ducts, localised to that area

good prognosis if fully excised/adjuvant tx used

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5
Q

what is LCIS? who does it commonly present in?

A

precancerous condition typically occurring in postmenopausal women

often asymptomatic

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6
Q

where does invasive ductal carcinoma originate?

A

in cells from breast ducts

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7
Q

define invasive

A

cancer that’s spread beyond the layer of tissue in which it developed and is growing into surrounding healthy tissue

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8
Q

what does inflammatory breast cancer present similarly to? prognosis?

A

presents similarly to breast abscess/mastitis BUT won’t respond to abx

worse prognosis than other BCs

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9
Q

which women are those considered ‘high risk’ and so can receive annual BC screening? (from what age)?

A

from age 30 if..

  1. 1st degree relative with BC under 40
  2. 1st degree male relative with BC
  3. 1st degree relative with bilateral BC, first diagnosed under 50
  4. two 1st degree relatives with BC
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10
Q

presentation of inflammatory BC

A
  • peau d’orange
  • inversion
  • warm, tender breast
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11
Q

presentation of Paget’s disease of the nipple

A
  • scaly
  • red
  • dry
  • eczema-like
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12
Q

what are the 4 NICE criteria for a two week wait referral for BC?

A
  1. unexplained breast lump in women >30
  2. unilateral nipple change in patients >50
  3. unexplained axilla lump in >30
  4. skin changes suggestive of BC
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13
Q

what referral type should be considered in women under 30 presenting with an unexplained breast lump

A

non-urgent referral

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14
Q

BC imaging assessment choice in women <40

A

USS

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15
Q

BC imaging assessment choice in women >40

A

mammogram

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16
Q

once a pt is diagnosed with BC following the triple assessment, what investigations should be offered? (2)

A
  1. USS of axilla
  2. ultrasound-guided biopsy of any abnormal nodes
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17
Q

what biopsy can be performed during BC surgery to assess for spread of cancer?

A

sentinel lymph node biopsy (biopsy of first lymph node to which cancer cells are likely to spread to)

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18
Q

surgical management for women with BC who are sentinel node +ve

A

axillary surgery

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19
Q

what reconstructive surgery options are available after breast-conserving surgery?

A
  1. partial reconstruction

OR

  1. reduction and reshaping
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20
Q

what reconstructive surgery options are available after mastectomy? (2)

A
  1. breast implants
  2. flap reconstruction
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21
Q

breast implants
a) advantages
b) disadvantages
c) SEs

A

a) simple, acceptable appearance
b) feels less natural, cold, less mobile, static
c) scar tissue distorting implant, leakage, breast pain, infection, sensation changes, implant position changing

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22
Q

what is there a risk of if the rectus abdominus muscle is used in breast reconstruction?

A

abdominal hernia

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23
Q

chemo uses alongside BC surgery
a) neoadjuvant
b) adjuvant

A

a) pre surgery to shrink tumour

b) post-surgery to prevent recurrence

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24
Q

which BC receptor type is hormonal tx indicated in?

what are the options in pre and postmenopausal women?

A

oestrogen receptor +ve

tamoxifen if premeno

anastrozole if postmeno

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25
Q

which BC receptor type is targeted tx indicated in? what are the options?

A

for HER2 +ve cancer

trastuzumab, pertuzumab, neratinib

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26
Q

when is radiotherapy used in BC? what are some SEs?

A

usually in pts who have had breast-conserving surgery to reduce risk of recurrence

SEs = fatigue, local skin and tissue irritation/swelling, fibrosis, shrinking of breast tissue

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27
Q

surgical tx for:
a) carcinoma in situ

b) invasive carcinoma

c) Paget’s

A

a) wide local excision or mastectomy

b) wide local excision or chemo, consider chemo if later stage

c) central excision (nipple and areola) or mastectomy

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28
Q

what are fibroadenomas and who are they common in

A

common benign tumours of stromal/epithelial breast duct tissue

common between 20-40yo

29
Q

what do fibroadenomas respond to? therefore when do they tend to regress?

A

respond to oestrogen and progesterone… regress after menopause

30
Q

typical presentation of a fibroadenoma

A

mobile, small, firm breast lump
painless
well-defined
round
up to 3cm

31
Q

a) typical management of fibroadenoma
b) what if >3cm/painful/worried about malignancy?

A

a) doesn’t need removal

b) surgical excision

32
Q

what is the most common cause of breast lumps?

A

breast cyst

33
Q

what is a breast cyst and when do they most commonly occur?

A

benign, individual fluid-filled lumps

perimenpause - 30-50

34
Q

presentation of a breast cyst

A
  1. smooth, well-defined borders, mobile
  2. painful
  3. fluctuate in size over menstrual cycle
35
Q

investigations for breast cyst

A

exclude cancer - mammogram or USS then biopsy

36
Q

fine needle aspiration of a breast cyst - what colour should it be?

A

straw coloured

37
Q

what should be done if fine needle aspiration of a breast cyst is ‘straw-coloured’ and not bloody?

A

no further testing or tx required

38
Q

management of breast cyst if it persistently refills/is bloody after fine needle aspiration

A

biopsy/excise

39
Q

which benign breast lump puts women at a slightly higher risk of BC

A

breast cyst

40
Q

what is fat necrosis?

A

benign breasts ump formed by localised degeneration and scarring of fat tissue

41
Q

RFs for fat necrosis breast lump

A
  1. obesity
  2. trauma
  3. radiotherapy
  4. surgery
42
Q

presentation of fat necrosis breast lump

A
  1. painless, firm, irregular
  2. may be skin dimpling/nipple inversion
43
Q

investigations for fat necrosis breast lump and which is diagnostic

A
  1. USS/mammogram (may look similar to BC)
  2. fine needle aspiration/core biopsy and histology is diagnostic
44
Q

management of breast lump caused by fat necrosis

A

conservative - resolves spontaneously over time

IF sx persist, surgical excision

45
Q

what is a lipoma?

A

benign tumours of fat (adipose) tissue in any area of body > can be in breast

46
Q

presentation of lipoma of the breast

A

soft, painless, mobile, NO skin changes

47
Q

management of a breast lipoma

A

conservative and reassurance

48
Q

what is a galactocele?

A

breast-milk-filled cysts in the breast

49
Q

which women may get galactoceles?

A

lactating women, normally after stopping breastfeeding

50
Q

cause of galactoceles

A

lactiferous duct is blocked > prevents gland from draining milk > milk builds up

51
Q

signs and symptoms of a galactocele

A

in a woman who has recently stopped breastfeeding…
- firm, painless lump
- under areola

52
Q

management of a galactocele

what if gets infected?

A

normally resolves without tx

if infected - abx

53
Q

what is a duct/breast papilloma?

A

papilloma = growth (like wart)

can grow inside the ducts of the breast, often near the nipple

54
Q

what age are duct/breast papillomas common in?

A

35-55yo

55
Q

signs and symptoms of a breast/duct papilloma

A
  1. clear/blood-stained discharge from nipple (normally from single duct)
  2. breast lump IF duct large enough

pain and discomfort not common

56
Q

diagnostic investigation for a duct/breast papilloma

A

ductogram

57
Q

management of a duct/breast papilloma if
a) cells normal under microscope
b) cells abnormal under microscope

A

REMOVAL

a) vacuum assisted excision (VAE)
b) surgical excision

58
Q

which BC types can duct/breast papillomas rarely be associated with?

A

DICS/invasive papillary cancer

59
Q

what is duct ectasia?

A

dilatation and shortening of the terminal breast ducts within 3cm of the nipple

60
Q

RF for duct ectasia

A

increased age

61
Q

presentation of duct ectasia

A
  • nipple retraction
  • creamy nipple discharge
62
Q

management of duct ectasia (troublesome discharge) if

a) young
b) old

A

a) microdochectomy
b) total duct excision

63
Q

who is typically affected by periductal mastitis?

A

young women, smokers

64
Q

how does periductal mastitis present?

A

recurrent periareolar/subareolar infections

65
Q

what does Paget’s disease of the nipple indicate?

A

underlying breast malignancy

66
Q

which BC is Paget’s disease of the nipple most commonly associated with?

A

invasive carcinoma

67
Q

investigations for Paget’s disease of the nipple (2)

A
  1. mammography/USS
  2. punch biopsy
68
Q

marker for BC monitoring

A

CA153

PHASE 3A (18 decks)

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