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MC > Breast Lump > Flashcards

Breast Lump Flashcards

1
Q

The genetic predisposition to breast cancer
continues to be delineated with the strong
predisposition from mutations in the genes ______ and _____

A

BRCA1

and BRCA2

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2
Q

The commonest lumps are those associated with

______

A

mammary dysplasia (32%)

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3
Q

_______ is also a common cause of

cysts, especially in the premenopause phase

A

Fibrocystic disease

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4
Q

Over________ of isolated breast lumps prove to be
benign but clinical identification of a malignant tumour
can only definitely be made following aspiration
biopsy or histological examination of the tumour

A

75%

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5
Q

What is the triple test for breast masses?

A

1 Clinical breast examination
2 Imaging—mammography and/or ultrasound ± MRI
3 Fine-needle aspiration cytology ± core biopsy

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6
Q

Breast cancer is the most common cancer in
females. The risk of developing breast cancer
before age 85 in Australian women is ______

A

1 in 8

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7
Q

The average age of diagnosis of breast CA is ____

A

60.7 years

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8
Q

About _____ of all new cancers in women are

breast neoplasms.

A

25%

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9
Q

Ddx for different types of dc

— intraduct papilloma (commonest)
— intraduct carcinoma
— fibrocystic disease

A

Bloodstained

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10
Q

What is the discharge?

— fibrocystic disease
— mammary duct ectasia

A

Green–grey

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11
Q

What is the dc?
— fibrocystic disease
— intraduct carcinoma (serous)
— breast abscess (pus)

A

Yellow:

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12
Q

What is the dc?

— lactation cysts
— lactation
— hyperprolactinaemia
— drugs (e.g. antipsychotic, cocaine)

A

Milky white (galactorrhoea):

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13
Q

Causes of periareolar inflammation

A

Causes may be

inverted nipple or mammary duct ectasia.

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14
Q

It starts as an eczematous-looking, dry
scabbing red rash of the nipple and then proceeds to
ulceration of the nipple and areola

A

Paget disease of the nippl

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15
Q

Time of examination for breast lumps: ideally,__________

A

4 days after the end

of the period

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16
Q

Red flag pointers for breast lumps

A
  • Hard and irregular lump
  • Skin dimpling and puckering
  • Skin oedema (‘peau d’orange’)
  • Nipple discharge
  • Nipple distortion
  • Nipple eczema
  • Postmenopausal women
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17
Q

What are the draining lymphatic nodes of the breast

A

The draining lymphatic nodes are in the axillae,

supraclavicular fossae and internal mammary chain

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18
Q

Most cancers occur in the ________

A

upper outer quadrant

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19
Q

Lumps that are usually benign and require no

immediate action are

A

tiny (<4 mm) nodules in
subcutaneous tissue (usually in the areolar margin);
elongated ridges, usually bilateral and in the lower
aspects of the breasts; and rounded soft nodules
(usually <6 mm) around the areolar margi

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20
Q

A hard mass is suspicious of malignancy but

cancer can be soft because of______

A

fat entrapment

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21
Q

The _________ which is usually found in

the heavier breast, is often nodular and firm to hard.

A

inframammary ridge,

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22
Q

Positive signs of malignancy on Xray mammography include an _________

A

irregular infiltrating mass with focal spotty microcalcification.

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23
Q

Xray Mammo for screening

• established benefit for women _______
• possible benefit for women in their ______
• follow-up in those with breast cancer, as 6%
develop in the opposite breast
• localisation of the lesion for fine-needle aspiration

A

over 50 years

40s

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24
Q

This is mainly used to elucidate an area of breast
density and is the best method of defining benign
breast disease, especially with cystic changes.

A

Breast ultrasound

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25
Q

When is breast UTZ usually useful

A

It is

generally most useful in women less than 35 years old

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26
Q

Indications for breast UTZ

• pregnant and lactating breast
• differentiating between \_\_\_\_ and \_\_\_
• palpable masses at \_\_\_\_\_\_\_
• for more accurate localisation of lump during
fine-needle aspiration
A

fluid-filled cysts and solid mass

periphery of breast tissue (not screened by mammography)

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27
Q
  • <35 years: _____
  • 35–50 years: __________

• >50 years: bilateral mammography ± bilateral
ultrasound

A

bilateral ultrasound; bilateral mammography if ultrasound suspicious

bilateral mammography + bilateral ultrasound

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28
Q

Ddx: Very young women—12 to 25 years

A

Inflamed cysts or ducts, usually close to areola
Fibroadenomata, often giant
Hormonal thickening, not uncommon
Malignancy rare

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29
Q

Investigations for 12-25 years old presenting with mass

A
  • mammography contraindicated

* ultrasound helpful

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30
Q

Young women—26 to 35 years DDx

A

Classic fibroadenomata
Fibrocystic disease with or without discharge
Cysts uncommon
Malignancy uncommon

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31
Q

Investigations for 26-35 years old presenting with mass

A
  • mammography: breasts often very dense

* ultrasound often diagnostic

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32
Q

Women—36 to 50 years (premenopausal) ddx

A 
Cysts
Fibrocystic disease, discharges, duct papillomas
Malignancy common
Fibroadenomata occur but cannot assume
Inflammatory processes not uncommon
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33
Q

Investigations for 36-50:
1
2

A
  • mammography useful

* targeted ultrasound useful

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34
Q

Women—over 50 years (postmenopausal) ddx

A

Any new discrete mass—malignant until proven
otherwise
Any new thickening—regard with suspicion
Inflammatory lesions—probably duct ectasia (follow to
resolution)
Cysts unlikely

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35
Q

over 50, post menopausal dxtics

A
  • mammography usually diagnostic (first line)

* ultrasound may be useful

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36
Q

Ddx Women—over 50 years, on hormones

A

Any new mass—regard with suspicion
Cysts may occur—usually asymptomatic
Hormonal change not uncommon

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37
Q

Dxtics Women—over 50 years, on hormones

A

• mammography usually diagnostic but breast may
become more dense
• ultrasound may be useful if above normal or unhelpful
and lump suspicious

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38
Q

Oestrogen receptors are uncommon in normal
breasts but are found in _____ of breast cancers,
although the incidence varies with age

A

two-thirds

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39
Q

If the lump is cystic—_____;

if solid—perform a _______ and then manage according to outcomes.

If it is suspicious, an_______ is
the preferred option

A

aspirate
fine-needle biopsy

excisional biopsy

40
Q

Indications for biopsy or excision

of lump

A

• The cyst fluid is bloodstained.
• The lump does not disappear completely with
aspiration.
• The swelling recurs within 1 month

41
Q

Ninety per cent of breast cancers are _________, the remainder being lobular carcinoma, papillary carcinomas,
medullary carcinomas and colloid or mucoid
carcinomas.

A

invasive ductal carcinomas

42
Q

RF for breast CA

A

(>40 years), Caucasian race, pre-existing benign breast lumps,
alcohol >1–2 SDs/day, HRT >5 years, personal
history of breast cancer, family history in a first-degree
relative (raises risk about threefold), nulliparity, late
menopause (after 53), obesity, childless until after
30 years of age, early menarche, ionising radiation
exposure.

43
Q

Up to ______ of cases are familial, with most being

autosomal dominant

A

5%

44
Q

The majority of patients with breast cancer

present with a lump ______

A

(76%).

45
Q

________ is a non-invasive abnormal proliferation of milk
duct epithelial cells within the ductal–lobular system
and is a precursor lesion for invasive breast cancer

A

DCIS

46
Q

Tumour excision followed by whole breast
irradiation was the most preferred local therapy
for most women with _______

A

stage I or II cancer

47
Q

T or F

Total mastectomy and breast-conservation
surgery had an equivalent effect on survival

A

T

48
Q

________is preferred for a large tumour,
multifocal disease, previous irradiation and
extensive tumour on mammography

A

Total mastectomy

49
Q

Recommendations for radiotherapy after

mastectomy are

A

— tumours >4 cm in diameter
— axillary node involvement of >3 nodes
— the presence of positive or close tumour
margins

50
Q

________ following tumour
excision is one of several techniques for partial
breast irradiation

A

Intraoperative radiotherapy

51
Q

Cytotoxic chemotherapy has an important place
in management, especially in young healthy
women who are ____ and ______

A

E receptor negative and have

visceral spread

52
Q

Newer regimens containing _________ have largely replaced the traditional CMF (cyclophosphamide, methotrexate and fluorouracil) regimen

A

anthracyclines (e.g. epirubicin) and a taxane (e.g. docetaxel)

53
Q

Adjuvant hormonal therapy by the anti-oestrogen
agent _______ (o) daily if E receptor + ve,
which is a specific modulating agent, is widely used
and is most suitable in postmenopausal women

A

tamoxifen 20 mg

54
Q

________ (for hormone receptor + ve
cancer in postmenopausal women): anastrozole,
letrozole, exemestane

A

aromatase inhibitors

55
Q

________: recommended for women
with bony metastases since evidence indicates
reversal of bone density loss and cancer
recurrence

A

bisphosphonates

56
Q

fibroadenosis, chronic mastitis, mammary

dysplasia, cystic hyperplasia

A

Fibrocystic disease

57
Q

FCC

•Most common in women between_____
• _______-related (between menarche and
menopause)

A

30 and 50 years

Hormone

58
Q

FCC

Consider mammography if ______

A

diffuse lumpiness is

present in patient >40 years

59
Q

Common in women aged 40–50 years
(perimenopausal)
• Rare under 30 years
• Associated with mammary dysplasia

A

Breast cyst

60
Q

Dx of breast cyst

A
  • Mammography
  • Ultrasound (investigation of choice)
  • Cytology of aspirate
61
Q

Mx of breast cyst

A

• Drainage with a fine needle

Surgery is rarely required

62
Q

Localised nodularity

Usually:
• in upper\_\_\_\_\_ of breast
• a physiological change to breast
• managed with \_\_\_\_\_\_\_
• investigate with imaging in older women if
asymmetric or perceived change
A

outer quadrant

clinical surveillance

63
Q

These milk-containing cysts arise during
pregnancy and present postpartum with similar
signs to perimenopausal cysts.
• They vary from 1–5 cm in diameter

A

Lactation cysts (galactoceles

64
Q

Lactation cysts (galactoceles) aspirate

A

• Treat by aspiration: fluid may be clear or milky.

65
Q

• A discrete, asymptomatic lump
• Usually in 20s (range: second to sixth decade,
commonly 15–35 years)
• Firm, smooth and mobile (the ‘breast mouse’)

A

Fibroadenoma

66
Q

Location of Fibroadenoma

A

• Usually in upper outer quadrant

67
Q

True about Fibroadenoma

They double in size about every_______

A

12 months

68
Q

Fibroadenoma

____ and ________ is recommended plus mammography in older women

A

Ultrasound and fine-needle aspiration or core biopsy

with cytology

69
Q

When to do excision biopsy for suspicious fibroad

A

Excision biopsy if
large (>3–4 cm), continues to enlarge, suspicious
biopsy or woman >40 years

70
Q

These are giant fibroadenoma-like tumours that
are usually benign but 25% are malignant and
metastasise. They are completely excised with a rim
of normal breast tissue

A

Phyllodes tumour

71
Q

_______s usually the end result of a large bruise
or trauma that may be subtle, such as protracted
breastfeeding

A

Fat necrosis

72
Q

T or F

The full triple test is required in fat necrosis

A

t

73
Q

These are benign hyperplastic lesions within large
mammary ducts and are not premalignant (nor
usually palpable).

A

Duct papillomas

74
Q

Duct papillomas should be______

A

excised

75
Q

Synonyms: plasma cell mastitis, periductal mastitis

A

Mammary duct ectasia

76
Q

In this benign condition a whole breast quadrant
may be indurated and tender. The larger breast ducts
are dilated.

A

Mammary duct ectasia

77
Q

Mammary duct ectasia:

The lump is usually located near the _____

A

margin of the areola and is a firm or hard, tender, poorly

defined swellin

78
Q

It should be noted that mammography
may be of limited value in the presence of
prostheses, especially if a________

A

fibrous capsule exists

around the prosthesis.

79
Q

This is a long-term complication of surgery plus
irradiation for breast cancer treatment when there is
a failure of the lymphatic system to adequately drain
extracellular fluid

A

Lymphoedema of arm

80
Q

What to exclude in lymphedema of arm

A

Exclude obstruction of the

deep venous system by Doppler ultrasound

81
Q

Cause of Neonatal enlargement of breasts

A

This is due to transplacental passage of
lactogenic hormones. The swelling usually lasts 7–10
days if left alone

82
Q

The usual presentation is the development of one

breast in girls commonly 7–9 years of age but sometimes younger

A

Premature hyperplasia

83
Q

Screening mammography should be encouraged for

women between ______ and ____

A

50 and 70 years, and performed at

least every 2 years

84
Q

Sp of mammography

A

90%

85
Q

regular BSE is

recommended for all women_____

A

35 years and over

86
Q

_______ commonly occur in women in
their late teens and 20s,

________ between 35 years and the menopause,

and ______is the most common cause of a lump in
women over 50 years

A

Fibroadenomas

benign breast cysts

cancer

87
Q

Never assume a palpable mass is a _____

in any woman over 30 years of age

A

fibroadenoma

88
Q

Gentle palpation is required. Squeezing breast
tissue between finger and thumb tends to produce
_____

A

‘pseudolumps

89
Q

_____ and _____ can be

clinically indistinguishable from breast cancer

A

Mammary duct ectasia and fat necrosis

90
Q

Nine out of 10 women who get breast cancer do

not have a _______

A

strong family history

91
Q

T or F

The oral contraceptive pill has been generally
shown not to alter the risk of breast cancer.

A

T

92
Q

Never assume a lesion is a ________—prove it with

ultrasound or successful aspiration

A

cyst

93
Q

T or F

Mammography can not detect breast cancers which
are too small to feel.

A

F

it can detect

94
Q

T or F

Mammography is not a diagnostic tool.

A

T

95
Q

Recommended mammography screening for

women:

A

50–69 years and those aged 40–49 who

request it.

MC (90 decks)

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