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Z Year3 Conditions > BREAST > Flashcards

BREAST Flashcards

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1
Q

In a history what do you ask for about the presence of lump and charcatersitics?

A
  1. Site
  2. Size
  3. Duration
  4. Onset
  5. Change in symptoms
  6. Pain
  7. Skin changes
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2
Q

What questions about nipples do you ask in a history?

A
  1. Discharge: amount, colour, consistency
  2. Bleeding
  3. . Inversion
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3
Q

What associated symptoms do you ask about in a breast history?

A
  1. Relationship to LMP + Sx
  2. Pain
  3. Skin changes
  4. FLAWS
  5. Back pain or breathlessness
  6. . Any other lumps or gland swelling
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4
Q

What are breast cysts?

A

‘lumpy’ breasts associated with pain and tenderness that fluctuate with the menstrual cycle

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5
Q

What are risk factors for breast cysts?

A
  1. obesity
  2. nulliparity
  3. oestrogen replacement therapy
  4. late-onset menopause
  5. later age at first childbirth
  6. Age 30-50 years
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6
Q

What are symptoms of breast cysts?

A
  1. Mastalgia: Pain may be cyclical or non-cyclical
    diffuse and bilateral but may be localised to an area of the breast often associated with a ruptured cyst
  2. Diffuse symmetrical lumpiness through both breasts
  3. Nipple discharge
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7
Q

What are some differential diagnosis for breast cysts?

A 
Chest wall pain
Costochondritis
Fibroadenoma
Breast cancer
Intracystic papilloma
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8
Q

What are complications of breast cysts?

A

LT Breast cancer

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9
Q

What are the investigations for a breast cyst?

A
  1. Mammography
  2. Breast ultrasound
  3. Cyst aspiration (symptomatic)
  4. Biopsy (to exclude breast cancer or a high risk pathology) – if palpable solid mass or imaging studies
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10
Q

What is a positive finding on a mammogram for a breast cyst?

A

dense breasts, circumscribed density

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11
Q

What is an positive ultrasound finding for breast cysts?

A

Breast cysts, solid mass

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12
Q

What is a positive finding for a breast cyst in cysts aspiration?

A

straw-coloured, bloody fluid

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13
Q

What is a positive finding for a biopsy for a breast cyst?

A

apocrine metaplasia, fibrosis, cyst formation, and proliferative changes, atypical ductal hyperplasia

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14
Q

What is the management plan for a breast cyst?

A

Supportive measure (reassurance), analgesia and observation of nipple discharge

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15
Q

What is the prognosis for breast cysts?

A

can relapse

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16
Q

What is breast mastitis?

A

Breast inflammation

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17
Q

What is the common epidemiology of someone with breast mastitis?

A
  1. 15-45 y/o
  2. Especially those who are breast-feeding (6-8 weeks/weaning)
  3. > 30y/o smokers are also at risk
  4. Staphylococcus aureus = most common pathogen
    • Can enter through cracked skin e.g nipple
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18
Q

What are the symptoms of breast mastitis?

A
  1. generalized swelling of breast, inflamed overlying skin – nipple may be cracked
  2. redness, firm
  3. very tender + uncomfortable, warm to touch
  4. Flu like symptoms: fever, aches,
    chills, generally unwell
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19
Q

How does non-lactational breast mastitis present?

A

present with
a history of previous infections with
less pronounced systemic upset

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20
Q

What are the complications of breast mastitis?

A
  1. Breast abscess = collection of pus in the breast tissue due to infection
  2. Mammary fistula
  3. Rarely overlying skin may undergo necrosis
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21
Q

What is the investigations for someone with breast mastitis?

A
  • Focused history
  • Physical exam: temp
  • Pregnancy test (if unexpected)
  • US of an erythematous breast area
  • Diagnostic needle aspiration drainage
  • cytology of nipple discharge or sample from FN aspiration
  • Milk aspirate, discharge or biopsy tissue for culture and sensitivity
  • histopathological examination of biopsy tissue
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22
Q

What is the management of a suspected breast abcess?

A
  • IV or oral Abx
  • US guided FNA
  • Therapeutic + diagnostic uses
  • FBC + blood cultures (if systemic infection)
  • Surgical incision + drainage
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23
Q

What is the management of breast mastitis?

A
  • If lactational: ENCOURAGE BREAST FEEDING
  • Analgesia
  • Abx sometimes required
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24
Q

What is the prognosis of breast mastitis?

A

•Untreated: breast abscess may discharge onto skin surface
•Non-lactational breast abscesses tend to re-occur
Mastitis recover in 2-3 dys

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25
What is breast cancer?
malignancy of breast tissue
26
What is the most common type of breast cancer?
invasive ductal carcinoma
27
What are risk factors for breast cancer?
* Age * FHx – 1st degree relative * Obesity * ↑ Oestrogen exposure * Early menarche (<11) * Late menopause (>55) * HRT/OCP * EtOH consumption * Fatty diet * Previous radiation to the chest * Nulliparity (not having any children) * Familial breast cancer – 5% of cases * BRCA1/2: harmful BRCA mutation 60-80% lifetime risk of developing Breast Ca * Associations with Ovarian and Pancreatic Ca
28
What are the site and skin changes in breast cancer?
1. Increased size 2. lump 3. skin changes: - Armpit skin thickening - peau d’orange - skin dimpling - nipple discharge (sometimes bloody) - nipple inversion - eczematous-looking skin (Paget’s)
29
What is the consistency of the lump in breast cancer?
1. hard lump 2. irregular margins 3. redness 4. non-compressible
30
How tender is the lump in breast cancer?
generally painless, inflammatory breast Ca: painful, warm
31
How fixed is the lump in breast cancer?
tethered to underlying tissue, not free to move
32
What are the symptoms of metastases in bone cancer?
1. bone pain 2. shortness of breath 3. rarely neurological symptoms
33
What is non-invasive breast cancer?
DCIS
34
What is invasive breast cancer?
infiltrative ductal carcinoma (75%), infiltrative lobular carcinoma, Paget’s disease of the breast
35
What are the differentials for breast cancer?
Lung cancer Osteosarcoma Breast sarcoma Brain cancer
36
What imaging is usually done for breast cancer?
* >35yrs: mammogram | * <35yrs: USS
37
What biopsy is done for breast cancer?
1. Fine needle aspiration 2. Core needle biopsy 3. Open (surgical) biopsy
38
Where does breast cancer usually metastasise to?
liver, lung, bones
39
What imaging is used for breast cancer?
* CXR * Liver USS * CT (brain/chest) * Bone scan
40
What bloods are ordered for breast cancer?
FBC, U+Es, calcium, bone profile, LFTs, ESR
41
When do you have an urgent referral?
referral if >30 unexplained breast lump, >50 symtpoms or change to one nipple
42
How do you evaluate a breast lump?
- triple assessment (clinical examination, mammogram + US (m only if >35) and biopsy 1. Hx and examination 2. Imaging< <35=USS and >35 MMG 3. Pathology: FNA and biopsy
43
What are the surgical options for management of breast cancer?
1. Total mastectomy 2. Lumpectomy 3. Sentinel LN biopsy or axillary LN clearance
44
What are the medical treatments for breast cancer?
1. ER antagonists e.g tamoxifen | 2. Aromatase inhibitors e.g letrozole
45
What are the other treatments for breast cancer?
``` 1. Chemotherapy • Neo-adjuvant or adjuvant 2. Monoclonal antibodies 3. Radiotherapy • Reduces risk of recurrence post-surgery ```
46
What is the prognosis for breast cancer?
2 view mammogram every 3 years women 47-73
47
What else may be present in Breast Cancer?
axillary lymphadenopathy
48
What are different types of Breast Cancer?
- begins as an in-situ carcinoma: 1. Ductal carcinoma in situ (if left untreated turn to invasive ductal carcinoma) 2. Lobular carcinoma in situ (LCIS) – doesn’t form into invasive
49
What is the patho of breast cysts?
1. obules fill with fluid 2. Oestrogen causes fluid to be produced 3. Post menopause leads to estrogen levels fall leads cysts usually stop forming 4. HRT leads to cysts
50
When are breast cyst unlikely to form?
after menopause unless of HRT
51
Are there systemic signs in breast cyst?
no
52
What are breast cysts associated with?
1. Most common >35 yo 2. Well circumscribed mass 3. Sudden Enlargement 4. Fluctuant 5. No systemic signs / symptoms
53
When is an USS and when is MMG done for breast cyst?
* <40 yo : USS | * > 40 yo : USS + MMG
54
What does USS show in breast cyst?
USS = fluid filled well circumscribed + disappears after aspiration
55
How is a breast cyst managed if it is large and painful?
1. USS guided aspiration | 2. . If solid lesion seen after aspiration then Biopsy
56
What are DDx for breast erythema and pain?
1. Mastitis 2. Breast Abscess 3. Breast Cancer
57
What are infectious causes of mastitis?
1. Lactational (breast feeding) 2. Duct ectasia 3. Staphyloccocus aureus
58
What are non-infectious causes of mastitis?
1. Idiopathic granulomatous inflammation | 2. Foreign body reaction
59
What are key features of a breast abscess?
1. Localised area of infection 2. Walled off 3. Pus May or may not be ass with Mastitis
60
What is the key way to differentiate breast asbcess and mastisis
IN CAPSULE/LUMP and mastitis is more like diffuse redness
61
What is the Mx of mastitis if lactational/non-severe
1. Warm compress 2. Analgesia 3. Continue Breastfeeding
62
What is the management of mastitis if non-lactational/serve
1. Flucloxacillin (MRSA = Trimethoprim) | 2. Analgesia
63
What would make mastitis severe?
pus, not getting better with warm compress and if breast milk culture positive etc
64
How is a breast abscess managed?
1. Incision + Drainage + Culture 2. IV / PO Abx (doxycycline) 3. Analgesia
65
What are 4 key types of BC and how common are they?
1. Invasive Ductal Carcinoma (most common) goes beyond the ducts 2. Invasive Lobular Carcinoma (2nd most common) 3. Ductal Carcinoma-in-situ 4. Lobular Carcinoma-in-situ
66
What are Breast Cancer lumps like?
irregular/lumpy
67
What is Paget's disease of the Breast?
1. Nipple or Areola 2. Sign that there might be underlying Breast Ca 3. Uncommon to have it w/out Breast Ca 4. 90% cases = Invasive Breast Cancer
68
What are Symptoms of Paget's disease of nipple?
1. Itching in burning in nipple and/or areola area 2. Pain and sensitivity 3. Flattening of nipple 4. Only one breast affected 5. Lump 6. Yellow or bloody nipple discharge
69
When is a 2WW referral necerssary?
1. ≥ 30 yo + unexplained breast lump w/ or w/out pain 2. ≥ 50 yo lump + any symptoms in one nipple: • Discharge • Retraction • Other changes of concern
70
When should you consider a 2WW referral?
1. Skin changes that suggest breast Ca | 2. ≥ 30 yo + unexplained lump in axilla
71
When should you do a non-2ww referral (non-urgent)?
≤ 30 yo unexplained breast lump with or without pain
72
If it is an invasive cancer after doing triple assemsent what else needs to be checked?
receptor status
73
What receptors are checked?
1. ER (oestrogen receptor) 2. PR (progesterone receptor) 3. HER2
74
How is management of BC organised?
1. Lymph nodes 2. Surgery / radiotherapy 3. Receptors
75
How do you manage if there is clinical axillary lymphadenopathy?
axillary lymph node clearance
76
How do you manage is there is no clinical axillary lymphadenopathy?
1. USS + SLNB | 2. +/- Axillary lymph node clearance
77
What is an SLNB?
-Sentinel Lymph node biopsy (hypothetical first group of lymph nodes draining a cancer) -If positive take them out
78
Why are axillary lymph nodes important?
drain 75% of lymph from breasts
79
When is a masectomy done?
1. Mutifocal tumour 2. Central 3. Large lesion in small breast 4. DCIS>4ccm 5. Pt choce
80
When is a wide local excision done?
1. Solitary lesion 2. Peripheral 3. Small lesion in last breast 4. DCIS<4cm 5. Pt choice
81
When is radiotherapy done after masectomy?
if T3/4 or >4 +ve LN
82
What is always done after wide local excision?
radiotherapy
83
What chemo can be given in BC?
* Neoadjuvant (to shrink tumor before surgery | * Adjuvant (alongside)
84
If the cancer is ER+ve and patient is pre or peri menopausal what medication is given?
Tamoxifen (Selective Oestrogen Receptor Modulator) Hormonal Therapy
85
If the cancer if ER +VE and the patient is post-menopausal what medication is given?
1. Anastrazole 2. Letrozole (aromatase inhibitor) Biological Therapy
86
If the cancer is HER2+ve what medication is given?
1. Trastuzumab 2. (Herceptin) Biological Therapy
87
Who is screening given to?
``` -Registered with GP Who: 1. Women 2. Trans mes 3. Trans women 4. Non-binary ```
88
When is screening given?
1. 50-70yo 2. Every 3 years (mammogram)

Z Year3 Conditions (13 decks)

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