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Phase 3a Medicine🩺 > Breast👙 > Flashcards

Breast👙 Flashcards

1
Q

What does a ‘snowstorm’ sign in USS indicate?

A

The ‘snowstorm’ sign on ultrasound of axillary lymph nodes indicates extracapsular breast implant rupture.

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2
Q

What is the typical appearance of inflammatory breast cancer?

A

Typical appearance (progressive, erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP) and an elevated CA 15-3.

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3
Q

What is mammary duct ectasia?

A

Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’

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4
Q

What is fat necrosis?

A

More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted

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5
Q

What is the definition of cyclical mastalgia?

A

Breast tenderness which comes and goes with the menstrual cycle. Thought to be associated with changes to hormone levels during the menstrual cycle.

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6
Q

What pathogen is commonly implicated in breast abscess?

A

Staphylococcus Aureus.

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7
Q

For which genetic conditions would you be offered MRI breast screening?

A

Patients between 25 and 60 years with BRCA gene carriage confirmed (or similar high risk genes) Patients between 20-70 years if they have Li Fraumeni or tp53 mutation.

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7
Q

For which genetic conditions would you be offered MRI breast screening?

A

Patients between 25 and 60 years with BRCA gene carriage confirmed (or similar high risk genes) Patients between 20-70 years if they have Li Fraumeni or tp53 mutation.

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8
Q

What is intraductal papilloma?

A
  • Growth of papilloma in a single duct
  • Usually presents with clear or blood stained discharge originating from a single duct
  • No increase in risk of malignancy
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9
Q

When would you use Tamoxifen in breast cancer treatment?

A

It is used in pre-menopausal and post-menopausal women who have ER +ve breast cancer.

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10
Q

When would you use trastuzumab (Herceptin)?

A

This is the most common type of biological therapy used for breast cancer. It is only useful in the 20-25% of tumours that are HER2 positive. It cannot be used in patients with a history of heart disorders.

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11
Q

What is the most common cause of blood stained nipple discharge?

A

Intraductal papillomata are the commonest cause of blood stained nipple discharge in younger women. There is seldom any palpable mass. An ultrasound is required and possibly a galactogram.

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12
Q

When do you refer for surgical excision for fibroadenoma?

A

Surgical excision if >3cm

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13
Q

What is the epidemiology of breast cancer?

A

Most common cancer in women. 1 in 8 women will develop breast cancer in their lifetime.
The median age is 62

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14
Q

What gene mutation increases risk of breast cancer in males?

A

BRCA2. Other risk factors include the use of estrogens, Klinefelter’s syndrome.

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15
Q

Between what age are women screened in the UK?

A

Between the ages of 47 and 73

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16
Q

What are the common histological types of invasive breast cancer?

A

Ductal (70%) and lobular (10%)
Rarer subtypes include tubular, mucinous and medullary but treatment is the same regardless

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17
Q

What are the receptors that can be affected in breast cancer?

A

Oestrogen receptor, the progesterone receptor or the HER-2 receptor (Human Epidermal growth factor receptor type)

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18
Q

Is Oestrogen receptor positive breast cancer a marker of good or bad prognosis?

A

The oestrogen receptor is expressed on more than half of all breast cancers, (the rate of positivity is roughly equivalent to the age of the patient). It denotes that the cancer is sensitive to oestrogen which stimulates tumour growth and also that anti-oestrogen therapy will help to control the disease. It is a marker of good prognosis because the women can be treated with anti-oestrogens and the cancers tend to be less biologically aggressive. The Progesterone receptor is also an indicator of sensitivity to anti-oestrogens (the ER and PgR are linked).

19
Q

Is HER-2 Receptor positive breast cancer a good or a bad prognostic factor?

A

The Her-2 receptor is over expressed in 15% of all breast cancers and is a poor prognostic marker. It is a receptor for the epidermal growth factor receptor (her-2) and if this receptor is up regulated, i.e. there are more copies on the cell surface than in normal cells, the growth pathway is up-regulated and the cells behave in a very aggressive manner.

20
Q

What is the standard mastectomy technique used?

A

Done through a transverse incision and which leaves the pectoralis major and minor muscle behind. This gives a good cosmetic result.

21
Q

Give some indications for mastectomy

A
  • Patients choice
  • Large tumour relative to the patient’s breast such that breast conservation surgery would remove more than 20% of the breast volume.
  • Multifocal or multicentric
  • Sub-areolar tumour
  • Contraindication to radiotherapy
  • Failed conservation surgery
  • Very strong family history in a young patient with breast cancer
  • Bilateral prophylactic mastectomy in breast cancer gene carriers
  • Local recurrence after wide local excision
  • Inflammatory breast cancer
22
Q

What is an axillary node clearance?

A

This is the standard procedure in a woman who has known axillary nodal disease either detected on a pre-operative ultrasound scan of the axilla (standard in all women with cancer) or because she has had a positive sentinel node biopsy (see below). Axillary clearance involves removal of all of the lymph nodes in the axilla, of which there are usually between 10 and 25.

23
Q

What are some complications of axillary node clearance?

A

Seroma formation (60%), need for a drain postoperatively, shoulder stiffness, permanent or temporary paraesthesia under the arm due to damage to the intercostobrachial nerve, lymphoedema

24
Q

What is the Nottingham prognostic index?

A

It is based on the grade, size and nodal status of a cancer according to the formula. It is used to determine prognosis and treatment for operable breast cancer. The lowest score is 2 and the highest is 7. It is not relevant for in-operable disease.

25
Q

What is an adjuvant treatment?

A

Any treatment given following the primary treatment (usually surgery but there are some exceptions in some types of cancer) which treats prospectively on the basis of risk of recurrence/metastasis. The patient will have no gross disease or evidence of viable residual disease but prognostic factors suggest a probability that recurrence or metastases may develop in time. These treatments aim to target micro-metastases or microscopic disease at the primary site and may include radiotherapy, chemotherapy, endocrine therapy or targeted molecular therapies such as trastuzumab.

26
Q

What is standard chemotherapy regimen for breast cancer?

A

Epirubicin, 5 fluorouracil and cyclophosphamide, usually as 6-8 courses over 12 weeks often with addition of a taxane.

27
Q

What are some features of locally advanced breast cancer?

A
  • Ulceration
  • Peau d’orange
  • Inflammatory breast cancer
  • Fixed to chest wall
  • Fixed, matted axillary lymph nodes
28
Q

What is Paget’s disease of the nipple?

A

This is an eczematous change of the nipple due to an underlying malignancy and should be suspected in apparent nipple eczema that does not resolve with two weeks of steroid/antifungal cream.
It is caused by the infiltration of the tumour cells through the ducts onto the nipple surface where they infiltrate the epidermis.

29
Q

Where is the most common location of breast cancer metastases?

A

Commonly affects the bones where sclerotic or lytic metastases may occur causing pain, pathological fracture or spinal cord compression. Other sights of metastases are bone, soft tissue, pleura, lung, liver and brain.

30
Q

What is the treatment of bony metastases in breast cancer?

A

Treatment of bone metastases is with endocrine therapy if the primary was oestrogen sensitive, radiotherapy to badly affected areas to reduce pain, surgery to treat or prevent pathological fractures and bisphosphonates. Recently a new targeted molecular agent, denosumab has been advised to control disease. This acts as an osteoclast inhibitor and so reduces bone breakdown.

31
Q

What is ductal carcinoma in situ?

A

This is a pre-malignant condition that has become more prominent since the advent of breast screening. Most DCIS cases are completely asymptomatic and are detected by breast screening. The lining epithelium of the breast ducts becomes thickened as the cells proliferate and eventually appear full of cells, often with central necrosis. Cytologically the cells appear malignant but they have not yet acquired the ability to invade the basement membrane and therefore cannot metastasise.

32
Q

What is the definition of gynaecomastia?

A

This is defined as a >2cm lump of breast tissue behind the male nipple.

33
Q

Where is the BRCA1 gene located?

A

Chromosome 17

34
Q

Where is the BRCA2 gene located?

A

Chromosome 13 and also has an autosomal dominant inheritance pattern with high penetrance

35
Q

What is Li-Fraumeni Syndrome?

A

Results from carriage of germ line mutation in the TP53 gene. Carriers have a very strong predisposition to sarcomas, often in childhood, bone cancers, brain tumours, lymphomas, leukaemias and breast cancers. 50% of carriers develop some form of cancer by 30 years.

36
Q

What is part of the Triple Assessment?

A

Clinical score 1 5 (1 is normal, 5 clearly malignant)
Imaging score 1 5
Biopsy score 1 5

37
Q

What are the indications for surgery for breast abscess?

A

*Failure of repeated aspiration
and antibiotics
*Large multiloculated collection
*Overlying skin necrosis
*Patient intolerance of aspiration
*Unable to aspirate (pus too
viscid)

38
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

39
Q

What is a protective factor against breast cancer?

A

Breastfeeding

40
Q

What is the treatment for intraductal papilloma?

A

Require complete surgical excision. After removal the tissue is examined for atypical hyperplasia or cancer that may not have been picked up by the biopsy

41
Q

How long is Tamoxifen given in oestrogen-receptor positive breast cancer?

A

5-10 years

42
Q

What chemoprevention is given to women at high risk of breast cancer?

A
  • Tamoxifen if premenopausal
  • Anastrozole if postmenopausal
43
Q

What is a risk of TRAM flap breast surgery?

A

Poses a risk of developing an abdominal hernia due to the weakened abdominal wall

44
Q

What are the common antibiotics given for non-lactational mastitis?

A

They need to be broad-spectrum. NICE guidelines recommend
- Co-amoxiclav
- Erythromycin/Clarithromycin plus metronidazole

45
Q

What should be included in initial assessment of gynaecomastia in men?

A

They should have a testicular examination. There is a link between gynaecomastia and Leydig cell testicular tumours. About 2% of patients presenting with gynaecomastia have a testicular tumour

Phase 3a Medicine🩺 (12 decks)

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