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Yr 3 - Surgery > Breast > Flashcards

Breast Flashcards

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1
Q

Breast tissue is made up of lobules and ducts. What is the function of both?

A

Lobules → milk secreting glands

Duct → carry milk towards nipple

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2
Q

What is this network of lobules & ducts in the breast supported by?

A

Fat & fibrous tissue

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3
Q

Describe the shape of the breast

A

‘Teardrop’ - heads up towards the armpit

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4
Q

Fill out a SOCRATES structure for taking a breast lump/change/pain history

A

Site - Point to location of pain/lump/change

Onset - How long has it been there for?

Characteristics of the lump (from examination AND history)

Radiation - Does it affects both breasts or one? Does the pain radiate anywhere?

Associated Symptoms - Nipple discharge, skin changes, breast changes, fever/weight loss/lethargy?

Timing - Any association with the menstrual cycle? How has the lump/pain progressed?

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5
Q

Give some characteristics of breast lumps

A
  • Singular/multiple
  • Size of lump
  • Painless/painful
  • Hard/soft
  • Round/irregular
  • Mobility - fixed/tethered/mobile
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6
Q

Exposure to oestrogens increases your risk of developing breast cancer, so it is important to ask about the past obstetric/gynae history. What 5 questions should you ask?

A
  1. Age of menarche
  2. Age of menopause
  3. Number of children
  4. Age of 1st pregnancy
  5. Breastfeeding history
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7
Q

How does the age of menarche/menopause affect breast cancer risk?

A
  • Early menarche (before 12) – increased risk
  • Late menopause (after 55) – increased risk

Due to longer exposure to oestrogen

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8
Q

How does the number of children you have had affect breast cancer risk?

A
  • Women who have children have a slightly lower risk than women who don’t
  • The risk reduces further the more children you have
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9
Q

How does the age of your first pregnancy affect breast cancer risk?

A

The younger you are when you have your first child, lower the risk of developing breast cancer later in life

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10
Q

What specifically should you ask about in DH in a breast consultation?

A
  • COCP
  • HRT
  • Allergies
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11
Q

How does the COCP affect breast cancer risk?

A

Slightly increased risk of breast cancer up to 10 years after stopping

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12
Q

How does HRT affect breast cancer risk?

A

only the pill (oestrogen & progesterone) that increases risk of breast cancer, topical therapies do not

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13
Q

What 3 cancers should you specifically ask about when taking a FH in a breast consultation?

A

Breast, ovarian and prostate

Ask about age of onset

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14
Q

What should specifically be asked about in a SH during a breast consultation?

A
  • Smoking (risk factor)
  • Alcohol (risk factor)
  • Living situation (support)
  • Activities of daily living (ADLs) – exercise tolerance & performance status
  • Occupation
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15
Q

Give some differentials for a breast lump or pain

A
  • Infection
  • Cyclical (around periods)
  • Fibroadenoma
  • Fibrocystic change
  • Breast abscess
  • Lipoma
  • Papilloma
  • Adenoma
  • Breast cancer
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16
Q

Describe the typical presentation of the breast/breast lump in breast cancer

a) breast lump characteristics
b) nipple symptoms
c) systemic symptoms

A
  • Lump: irregular, fixed/tethered, hard, painless lump
  • Can be associated with bloody nipple discharge/nipple symptoms
  • Potential systemic symptoms: fever, weight loss, lethargy
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17
Q

Who are breast infections most common in?

A

Breastfeeding women

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18
Q

Describe the typical presentation of a breast infection

A
  • Acutely painful, hot erythematous and tender breast
  • Purulent nipple discharge
  • Fever/unwell
  • Can present as simple mastitis or breast abscess
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19
Q

What is a fibroadenoma?

A

Most common benign tumours of stromal/epithelial breast duct tissue.

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20
Q

What is the most common benign tumour of the breast?

A

Fibroadenoma

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21
Q

Describe the typical presentation of a fibroadenoma

a) lump
b) nipple
c) systemic

A
  • Present with a firm, mobile, well-defined lump which are usually painless
  • Does NOT cause nipple discharge
  • Will NOT cause systemic symptoms
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22
Q

Do fibroadenoma increase the risk of breast cancer?

A

No

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23
Q

Who are fibroadenomas most common in?

A

Younger women (20-40) i.e. of reproductive age (tend to improve after menopause)

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24
Q

What is fibrocystic change?

A

The connective tissues (stroma), ducts and lobules of the breast respond to the female sex hormones (oestrogen and progesterone), becoming fibrous (irregular and hard) and cystic (fluid-filled). These changes fluctuate with the menstrual cycle.

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25
Who are fibrocystic breast changes common in?
Common in women of menstruating age.
26
What type of pain is fibrocystic change often associated with? Why?
Often associated with **cyclical breast pain** as cyst swell due to changing hormone levels
27
Does fibrocystic change increase breast cancer risk?
No
28
Describe typical presentation of fibrocystic change
* May present with **multiple smooth lumps** in a range of sizes * **Cyclical breast pain**
29
What is involved in the ‘triple assessment’ of a breast lump?
1. Clinical assessment (history & examination) 2. Imaging (mammograhy or US) 3. Histology (fine needle aspiration vs core biopsy)
30
How would you decide between US and mammography?
US → used in younger women due to increased density of breast tissue Mammography → used in women \>40 y/o
31
Give some examples of **benign** breast tumours
* Fibroadenoma * Ductal papilloma * Lipoma * Adenoma * Phyllodes Tumour
32
What is a fibroadenoma?
Made of proliferations of stromal and epithelial tissues in the duct lobules
33
What type of breast tumour can be referred to as a ‘breast mouse’? Why?
Fibroadenoma - as move around within the breast tissue
34
What is an adenoma?
Benign _glandular_ tumour
35
Why do adenomas mimic malignancy?
Lesions often nodular
36
Who are adenomas more commonly found in?
Older women
37
What is a papilloma?
A warty **_benign_** lesion that grows within one of the **ducts** in the breast.
38
What age group are papillomas usually found in?
40-50
39
Typical presentation of a ductal papilloma?
Often asymptomatic – often picked up incidentally on mammograms or ultrasound. * Nipple discharge – clear or blood-stained * Tenderness or pain * Palpable lump * Usually found \<1cm from nipple
40
What is a lipoma?
Benign tumours of **_fat_** (adipose) tissue. Can occur almost anywhere on the body where there is adipose tissue, including the breasts.
41
Give the characteristics of a breast lipoma
* Soft * Painless * Mobile * Does NOT cause skin changes
42
What is Pyllodes tumour?
Rare fibroepithelial tumours - large and rapidly growing
43
What age group do Pyllodes' tumours most often occur in?
Occurring most often between ages 40-50.
44
Are Phyllodes tumours malignant or benign?
Can be benign (50%), borderline (25%) or malignant (25%). Phyllodes tumours can metastasise
45
Management of a Phyllodes tumour?
* Surgical removal of tumour. and surrounding tissue (wide excision) * Can reoccur after removal * Chemotherapy in malignant/metastatic tumours
46
What are the 2 _broad_ types of **malignant** breast cancers?
1. Carcinoma _in situ_ 2. _Invasive_ breast cancer
47
What separates carcinomas in situ and invasive breast cancers?
Whether they have invaded through the basement membrane
48
What are the 2 main types of breast carcinomas in situ?
1. Ductal carcinoma in situ (DCIS) 2. Lobular carcinoma in situ (LCIS)
49
What is the **most common type** of _non-invasive_ breast malignancy?
Ductal carcinoma in situ (DCIS) - these make up 20% of all breast cancer diagnoses
50
How does the **origin** of DCIS and LCIS differ?
DCIS → malignant of the **ductal** tissue of the breast LCIS → malignancy of the **secretory** lobules of the breast
51
What % of DCIS will progress to invasive disease without treatment?
20-30%
52
Treatment of DCIS?
Should be treated with wide local excision/mastectomy
53
Are LCIS more or less likely to progress to invasive?
More likely (but these tumours are most rare)
54
What is the age range that the majority of LCIS are seen in?
90% of women are pre-menopausal → think about in a _younger_ female
55
What are the 2 main types of invasive breast cancers?
1. Invasive **ductal** carcinoma (most common) 2. Invasive **lobular** carcinoma
56
What age group are invasive lobular carcinomas more commonly seen in?
Older women
57
Are invasive lobular or ductal carcinomas more difficult to detect?
Lobular - **Diffuse spread** which makes detection more difficult. Tumours often quite large by the time they’re detected.
58
How does Paget's disease of the nipple present?
* Looks like eczema of nipple/areolar * Erythematous, scaly rash
59
What does Paget's disease of the nipple indicate?
Breast cancer involving the nipple (DCIS or invasive) ## Footnote In 97% of cases there is an **underlying malignancy** – either in situ or invasive
60
Management of Paget's disease of the nipple?
Triple assessment
61
What are the 3 types of receptors in breast cancer?
1. Oestrogen receptors (ER) 2. Progesterone receptors (PR) 3. Human epidermal growth factor (HER2) *Triple-negative breast cancer* is where the breast cancer cells do NOT express ANY of these three receptors.
62
What is the prognosis of triple negative breast cancer?
This carries a **worse prognosis** as it limits treatment options.
63
What is the most common hormone status of breast cancer?
ER +/- PR positive
64
What staging system is used for breast cancer?
TNM
65
What are treatment options for breast cancer?
Surgery Chemotherapy Radiotherapy Hormone therapy
66
What is the sentinel node?
first lymph node where cancers may spread
67
How is hormone therapy for breast cancer determined?
This depends on the hormone status of the tumour
68
For ER+ breast cancers, what is the first line option in **premenopausal** women?
Tamoxifen
69
For ER+ breast cancers, what is the first line option in **postmenopausal** women?
Aromatase inhibitors (e.g. letrozole, anastrozole, exemestane)
70
For HER2+ breast cancers, what is the first line drug?
Trastuzumab (Herceptin)
71
Tamoxifen is a selective oestrogen receptor modulator (SERM) i.e. either blocks or stimulates oestrogen receptors. Where does it block oestrogen receptors? Where does it stimulate oestrogen receptors?
Block → Breast Stimulate → Bone & uterus
72
What are the side effect of Tamoxifen stimulating oestrogen receptors in bone & uterus?
Bone → Helps prevent osteoporosis Uterus → BUT increases risk of endometrial cancer
73
What is aromatase? What is its function in post-menopausal women?
Aromatase in an enzyme found in fat (adipose) tissue that converts androgens to oestrogen in post-menopausal women – after menopause, the action of aromatase in fat tissue is the **primary source of oestrogen**
74
What is the primary source of oestrogen in post-menopausal women?
Aromatase converts androgens to oestrogens in adipose tissue
75
Mechanism of aromatase inhibitors?
Aromatase inhibitors block the creation of oestrogen in fat tissue
76
What type of drug is Trastuzumab (Herceptin)?
Monoclonal antibody (immunotherapy) → cell signalling inhibitor
77
Mechanism of Trastuzumab?
1) Blocking HER-2 activating ligand from binding 2) Activating the body’s own immune response against these cells
78
Which organ can be affected by Trastuzumab?
Can affect **_heart_** function so initial & close monitoring of heart function is required

Yr 3 - Surgery (3 decks)

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