Breast Flashcards

1
Q

Breast cancer screening

a) Who?
b) How? And how often?
c) Success measure

A

a) Women 50 - 70. Also, women who have had breast cancer, or those with FHxx/ genetic risks
b) No risk factors: mammography. Risk factors: triple assessment - clinical examination, radiology (mammography or USS), FNA biopsy. Every 3 years
c) Number of deaths prevented through early detection per 10,000 women screened

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2
Q

Breast cancer: histology

A

Ductal adenocarcinoma

Lobular adenocarcinoma

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3
Q

Paget’s disease of breast

A

Infiltrating malignancy of the nipple epithelium (1% of all breast cancer)

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4
Q

Inflammatory carcinoma

A

Rapidly growing, sometimes painful mass enlarging the breast and causing the overlying skin to become red and warm

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5
Q

Iatrogenic causes of breast cancer

A

HRT
COCP
Radiation to chest

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6
Q

Breast cancer: presentation

A

Usual - painless lump
Other: nipple change, nipple discharge and skin contour changes.
Breast pain/mastalgia alone is a very uncommon presentation.

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7
Q

Breast cancer: two-week referral

A

Age > 30 with unexplained breast lump

Age > 50 with any of the following symptoms in one nipple only: discharge, retraction or any other changes of concern

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8
Q

Breast cancer: investigations

a) In all
b) Palpable lumps
c) Non-palpable lumps
d) Receptor status
e) Other staging investigations

A

a) USS (including regional nodes) and mammography
b) FNA biopsy
c) Core needle biopsy (image-guided)
d) ER, PR and HER-2
e) CXR, LFTs, (plus CT and bone scintigraphy if mets suspected)

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9
Q

Breast cancer: management

a) 2 operation types
b) If ER-positive (pre-menopausal) -risk of this drug?
c) If ER-positive (post-menopausal)
d) If HER-2 positive
e) Other adjuvant treatments
f) To manage bone mets

A

a) Mastectomy or wide-local excision
b) Tamoxifen - risk of endometrial Ca
c) Aromatase inhibitors: Anastrazole (not effective in pre-menopausal women)
d) Trastuzumab
e) Chemo/radiotherapy
f) Bisphosphonates

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10
Q

Features of a malignant vs. benign breast lump

A

Malignant - Hard, painless, irregular margins, fixed to underlying chest wall or muscle, skin changes, nipple changes

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11
Q

Breast lump differentials:

a) Most common between 35 and 50, cannot be reliably distinguished from malignancy; cyclical pain/lump
b) Most common in 20s, firm, non-tender and highly mobile lumps. Still warrant breast clinic referral
c) Benign warty lesion behind areola causing sticky bloody discharge
d) In obese woman, following trauma

A

a) Cyst (fibrocystic change)
b) Fibroadenoma
c) Intraductal papilloma
d) Fat necrosis

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12
Q

Breast Ca: referral guidelines

a) Aged > 30 with…? (2 week wait) - if < 30, non-urgent
b) Aged > 50 with unilateral…? (2 week wait)

A

a) Unexplained breast lump
- also, consider 2 week wait if unexplained axillary lump

b) Nipple changes: discharge, retraction, other changes suspicious of cancer

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