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Yr 3 - Surgery > Breast > Flashcards

Breast Flashcards

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
Q

Who are fibrocystic breast changes common in?

A

Common in women of menstruating age.

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26
Q

What type of pain is fibrocystic change often associated with? Why?

A

Often associated with cyclical breast pain as cyst swell due to changing hormone levels

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27
Q

Does fibrocystic change increase breast cancer risk?

A

No

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28
Q

Describe typical presentation of fibrocystic change

A
  • May present with multiple smooth lumps in a range of sizes
  • Cyclical breast pain
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29
Q

What is involved in the ‘triple assessment’ of a breast lump?

A
  1. Clinical assessment (history & examination)
  2. Imaging (mammograhy or US)
  3. Histology (fine needle aspiration vs core biopsy)
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30
Q

How would you decide between US and mammography?

A

US → used in younger women due to increased density of breast tissue

Mammography → used in women >40 y/o

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31
Q

Give some examples of benign breast tumours

A
  • Fibroadenoma
  • Ductal papilloma
  • Lipoma
  • Adenoma
  • Phyllodes Tumour
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32
Q

What is a fibroadenoma?

A

Made of proliferations of stromal and epithelial tissues in the duct lobules

33
Q

What type of breast tumour can be referred to as a ‘breast mouse’? Why?

A

Fibroadenoma - as move around within the breast tissue

34
Q

What is an adenoma?

A

Benign glandular tumour

35
Q

Why do adenomas mimic malignancy?

A

Lesions often nodular

36
Q

Who are adenomas more commonly found in?

A

Older women

37
Q

What is a papilloma?

A

A warty benign lesion that grows within one of the ducts in the breast.

38
Q

What age group are papillomas usually found in?

A

40-50

39
Q

Typical presentation of a ductal papilloma?

A

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
Q

What is a lipoma?

A

Benign tumours of fat (adipose) tissue. Can occur almost anywhere on the body where there is adipose tissue, including the breasts.

41
Q

Give the characteristics of a breast lipoma

A
  • Soft
  • Painless
  • Mobile
  • Does NOT cause skin changes
42
Q

What is Pyllodes tumour?

A

Rare fibroepithelial tumours - large and rapidly growing

43
Q

What age group do Pyllodes’ tumours most often occur in?

A

Occurring most often between ages 40-50.

44
Q

Are Phyllodes tumours malignant or benign?

A

Can be benign (50%), borderline (25%) or malignant (25%). Phyllodes tumours can metastasise

45
Q

Management of a Phyllodes tumour?

A
  • Surgical removal of tumour. and surrounding tissue (wide excision)
  • Can reoccur after removal
  • Chemotherapy in malignant/metastatic tumours
46
Q

What are the 2 broad types of malignant breast cancers?

A
  1. Carcinoma in situ
  2. Invasive breast cancer
47
Q

What separates carcinomas in situ and invasive breast cancers?

A

Whether they have invaded through the basement membrane

48
Q

What are the 2 main types of breast carcinomas in situ?

A
  1. Ductal carcinoma in situ (DCIS)
  2. Lobular carcinoma in situ (LCIS)
49
Q

What is the most common type of non-invasive breast malignancy?

A

Ductal carcinoma in situ (DCIS) - these make up 20% of all breast cancer diagnoses

50
Q

How does the origin of DCIS and LCIS differ?

A

DCIS → malignant of the ductal tissue of the breast

LCIS → malignancy of the secretory lobules of the breast

51
Q

What % of DCIS will progress to invasive disease without treatment?

A

20-30%

52
Q

Treatment of DCIS?

A

Should be treated with wide local excision/mastectomy

53
Q

Are LCIS more or less likely to progress to invasive?

A

More likely (but these tumours are most rare)

54
Q

What is the age range that the majority of LCIS are seen in?

A

90% of women are pre-menopausal → think about in a younger female

55
Q

What are the 2 main types of invasive breast cancers?

A
  1. Invasive ductal carcinoma (most common)
  2. Invasive lobular carcinoma
56
Q

What age group are invasive lobular carcinomas more commonly seen in?

A

Older women

57
Q

Are invasive lobular or ductal carcinomas more difficult to detect?

A

Lobular - Diffuse spread which makes detection more difficult. Tumours often quite large by the time they’re detected.

58
Q

How does Paget’s disease of the nipple present?

A
  • Looks like eczema of nipple/areolar
  • Erythematous, scaly rash
59
Q

What does Paget’s disease of the nipple indicate?

A

Breast cancer involving the nipple (DCIS or invasive)

In 97% of cases there is an underlying malignancy – either in situ or invasive

60
Q

Management of Paget’s disease of the nipple?

A

Triple assessment

61
Q

What are the 3 types of receptors in breast cancer?

A
  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
Q

What is the prognosis of triple negative breast cancer?

A

This carries a worse prognosis as it limits treatment options.

63
Q

What is the most common hormone status of breast cancer?

A

ER +/- PR positive

64
Q

What staging system is used for breast cancer?

A

TNM

65
Q

What are treatment options for breast cancer?

A

Surgery

Chemotherapy

Radiotherapy

Hormone therapy

66
Q

What is the sentinel node?

A

first lymph node where cancers may spread

67
Q

How is hormone therapy for breast cancer determined?

A

This depends on the hormone status of the tumour

68
Q

For ER+ breast cancers, what is the first line option in premenopausal women?

A

Tamoxifen

69
Q

For ER+ breast cancers, what is the first line option in postmenopausal women?

A

Aromatase inhibitors (e.g. letrozole, anastrozole, exemestane)

70
Q

For HER2+ breast cancers, what is the first line drug?

A

Trastuzumab (Herceptin)

71
Q

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?

A

Block → Breast

Stimulate → Bone & uterus

72
Q

What are the side effect of Tamoxifen stimulating oestrogen receptors in bone & uterus?

A

Bone → Helps prevent osteoporosis

Uterus → BUT increases risk of endometrial cancer

73
Q

What is aromatase? What is its function in post-menopausal women?

A

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
Q

What is the primary source of oestrogen in post-menopausal women?

A

Aromatase converts androgens to oestrogens in adipose tissue

75
Q

Mechanism of aromatase inhibitors?

A

Aromatase inhibitors block the creation of oestrogen in fat tissue

76
Q

What type of drug is Trastuzumab (Herceptin)?

A

Monoclonal antibody (immunotherapy) → cell signalling inhibitor

77
Q

Mechanism of Trastuzumab?

A

1) Blocking HER-2 activating ligand from binding
2) Activating the body’s own immune response against these cells

78
Q

Which organ can be affected by Trastuzumab?

A

Can affect heart function so initial & close monitoring of heart function is required

Yr 3 - Surgery (3 decks)

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