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Clinical Years / Progress Test > Breast > Flashcards

Breast Flashcards

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1
Q

how does density of breast tissue affect sensitivity of mammography

A

dense breast = more fibroglandular tissue compared to fat

denser breasts make mammography less sensitive

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2
Q

what age women is mammography used in

A

generally women over 40 unless malignancy highly suspected

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3
Q

1-5 scoring for P score/M score/ B score

A

1 - normal
2 - benign
3 - indeterminate/probably benign
4 - suspicious
5 - malignancy

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4
Q

when is USS used

A

alone useful in focal symptoms e.g. a lump and especially in younger patients/those with denser breasts

used with mammogram in those >40

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5
Q

how does a cyst appear on USS

A

fluid filled so a black distinct circle

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6
Q

distinguishing benign from malignant mass on USS

A

shape and margin

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7
Q

types of biopsy

A

fine needle aspiration cytology

core biopsy

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8
Q

C score for cytology scoring (FNA)

A

C1 insufficient sample
C2 benign
C3 indeterminate
C4 suspicious
C5 malignant

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9
Q

Biopsy scoring for B5

A

B5a non-invasive
B5b invasive

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10
Q

benefits of core biopsy over FNA

A

allows better assessment of malignancy including histological type, invasive or not and receptor status

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11
Q

how many cores are taken in a core biopsy

A

3

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12
Q

arterial supply of the breast

A

branches of the axillary artery

perforating branches of both the mammary artery and the intercostal arteries

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13
Q

lymphatic drainage of the breast

A

75% to the axillary nodes (levels 1-3)

rest to internal mammary nodes (more medial part of breast)

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14
Q

triple assessment

A

clinical assessment
imaging
needle biopsy

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15
Q

lymph node management if abnormal nodes on USS and biopsy

A

axillary node clearance

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16
Q

lymph node management if normal pre-op axillary assessment

A

sentinel node biopsy - nearest node to the cancer

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17
Q

grading of cancer

A

1-3 - shows aggressive potential

takes into account amount of gland formation, nuclear features and mitotic activity

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18
Q

what are the receptors in breast cancer

A

ER- oestrogen receptor +ve/-ve

PR - progesterone receptor; less important in deciding treatment

HER - +ve tend to grow and spread faster

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19
Q

treatments in ER +ve breast cancer

A

endocrine therapies that target the oestrogen such as aromatase inhibitors or tamoxifen

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20
Q

treatment in HER +ve breast cancer

A

monoclonal anti-HER2 therapy such as Herceptin (trastuzumab)

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21
Q

commonest type of breast cancer

second most

A

invasive ductal carcinoma

invasive lobular is second most - can be hard to detect because can present as thickening rather than lump - usually needs MRI

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22
Q

types of breast surgery

A

mastectomy

wide local excision with radiotherapy

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23
Q

lymphoedema

A

complication of lymph node clearance causing swelling of the arm as lymph accumulates

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24
Q

indications for mastectomy

A

multi-focality - >2 cancers in same breast

local recurrence

> 4cm lump

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25
when is chemotherapy offered in breast cancer
usually adjuvant - after breast surgery sometimes neoadjuvant - before breast surgery not everyone is offered chemotherapy - depends on patient and tumour factors
26
what is the aim of adjuvant chemotherapy
to eradicate micrometastatic disease and increase chance of cure
27
T categories in breast cancer TNM staging
T0 - no evidence of tumour Tis - carcinoma in situ or pagets with no mass T1 - 2cm or less across T2 - >2cm less than 5cm T3- 5cm or more across T4 - tumour of any size growing into the chest wall or skin
28
N categories TNM staging
N0 no nodes N1 1-3 axillary nodes N2 4-9 axillary nodes N3 10 or more axillary nodes
29
predict tool
uses multiple patient and tumour factors to give percentage improved chance of survival with different therapies including adjuvant chemotherapy and hormone therapies
30
can radiotherapy be given again for a new primary
no - mastectomy usually performed if a new primary cancer develops in a same breast radiotherapy shouldn't be given twice
31
what types of breast cancer is chemotherapy usually used in
HER2 +ve cancers - anti-HER2 + chemotherapy triple negative cancers always give chemotherapy not indicated in Er+ve and PR+ve cancers
32
tamoxifen side effects
vaginal dryness cataracts endometrial thickening DVT
33
what is mastitis
painful inflammatory condition of the breast may or may not be associated with lactation symptoms of pain, fever/general malaise, often wedge shaped area of tender, hard, red, swollen area of breast
34
breast abscess
collection of pus within the breast a severe complication of mastitis
35
lactational mastitis cause
stasis in the milk ducts may be infectious (if so usually staph aureus) or non-infectious
36
important factors to ask about breast pain
relationship to menstrual cycle; cyclical pain usually worse end of cycle (before menstruation) any associated symptoms uni or bilateral PMH, FH, DH etc
37
cyclical breast pain
changes in hormones during menstrual cycle - luteal phase worst (before period) common in premenopausal women may radiate to axilla/arms
38
non-cyclical breast pain
- pain not related to menstrual cycle or - extramammary pain; not from breast itself but rather chest wall/costochondiritis cause often unclear but usually settles
39
breast density link to cancer
independently increases risk for cancer up to 5x + harder to detect in dense breasts
40
lactational mastitis risk factors
baby not attaching well + using dummies/bottles nulliparity a tight bra
41
imaging for suspected abscess/mastitis
USS to look for an abscess if detected needs USS guided drainage
42
Abx of choice for mastitis/abscess in breastfeeding mothers
penicillins
43
physiological changes of the breast during lactation (hormones)
during pregnancy oestrogen stimulates ductal system growth and branching progesterone causes alveolar cells to secrete milk production begins after childbirth under prolactin influence lactation is sustained by oxytocin and prolactin breasts feel larger, firmer and more nodular, areolas may grow and darken
44
important mastitis differential
inflammatory breast cancer may present with skin changes of redness and inflammation as the cancer occurs along the lymph vessels
45
what medications may be used for severe cyclical breast pain
tamoxifen off license Danazol (anti gonadotrophin) licensed for severe breast pain and tenderness in benign fibrocystic disease which has not responded to other treatments
46
breastfeding advice in mastitis
continue to breastfeed on demand from both breasts
47
non-lactational risk factors for mastitis/abscess
diabetes immunocompromise smoking nipple piercing
48
PIP implants and removal if ruptured
a type of now banned silicone implants that are more likely to rupture than other types the NHS will pay for removal but not for new implants
49
most common benign lump young woman
fibroadenoma - smooth, mobile, no skin tethering USS performed to check whether cystic, or solid and confirm benign - on USS, solid with a defined margin
50
assessment of a presumed benign lump
triple assessment should still be performed if patient over 25 - USS guided core biopsy is best if under then biopsy may not be done if benign on clinical examination and USS
51
excision of a fibroadenoma
only normally done if >4cm or growing
52
popcorn calcification
In postmenopausal women, fibroadenomas are prone to involution and often develop characteristic calcification known as 'popcorn calcification'
53
most likely benign lump older woman
cyst
54
breast cysts management/transformation/new lump?
benign - don't need treatment but aspirate if painful or causing discomfort do not transform to cancer if new lump always return don't presume cyst
55
does cystic fluid need cytology when drained
only if blood stained
56
screening mammograms
aged 50-70 every 3 years over 70 on request all are read by two interpreters
57
microcalcification - what is it - causes
small specks on calcium salts too small to feel or call pain common sometimes associated with fibroadenomas, cysts and trauma most important cause - due to ductal carcinoma in situ (DCIS) difficult to differentiate cause- all need further assessment
58
investigation of microcalcification
stereotactic guided core biopsy - doesn't show well on USS
59
ductal carcinoma in situ
cancer cells within the milk ducts but not invaded the basement membrane necrotic cells at the centre often calcify and can follow a linear pattern of microcalcificaiton
60
spread of ductal carcinoma in situ
initially confined to ducts so doesn't have potential to spread can eventually invade the basement membrane and become invasive and then have potential to metastasise more likely to spread if high grade on biopsy
61
localising DCIS for surgery
stereotactic wire localisation using X-ray guidance done before surgery then removed with surgical specimen
62
reasons for repeat surgery/mastectomy after wide excision for DCIS
- adequate margin of healthy tissue not achieved - area of invasive cancer found within the DCIS
63
DCIS follow up
annual mammogram and clinical examination for 5 years
64
breast arterial calcification
tramline appearance - lots of lines of calcification associated with increasing age, diabetes and cardiovascular disease
65
screening for women of high risk what defines high risk
BRCA gene mutations, tp53 gene mutation and previous supradiaphragmatic radiotherapy annual MR and mammography from age 40 high risk is 30%+ lifetime risk of breast cancer
66
what proportion of breast cancers are due to genetics
1 in 20 associated with genes such as BRCA1 or 2
67
normal function of BRCA genes
DNA repair genes
68
male breast cancer risk BRCA genes
BRCA 1 slightly increased risk BRCA 2 more increased risk
69
risk reducing options
enhanced screening risk reducing surgery (mastectomy, oophorectomy) risk reducing drugs e.g. tamoxifen
70
BRCA genes - inheritance - chromosomal locations
autosomal dominant inheritance BRCA 1 chromosome 17 long arm BRCA 2 chromosome 13 long arm
71
prophylactic mastectomy risk reduction
90%
72
duct ectasia
usually post menopausal ducts shorten and dilate may cause a cheese like nipple discharge and slit like retraction of the nipple no specific treatment required
73
aromatase inhibitors - examples - side effects
anastrozole letrozole used in ER+ve side effects; osteoporosis hot flushes arthralgia, myalgia insomnia
74
adjuvant hormonal therapy
if hormone receptor positive tamoxifen is pre and peri menopausal women aromatase inhibitors in post menopausal women
75
2ww breast referral guidelines
30+ with a lump 50+ with unilateral nipple discharge, retraction or other concerning change
76
Paget's disease of the nipple
eczematous change of the nipple associated with an underlying breast malignancy
77
fat necrosis of the breast
more common in obese women/large breasts may follow trivial trauma initial inflammatory response followed by hard irregular lump warrants further investigation
78
tamoxifen action
selective oestrogen receptor modulator - works in premenopausal women
79
aromatase inhibitors action
block peripheral conversion of androgens to oestrogens so only effective in post menopausal women
80
worrying features of nipple discharge
unilateral spontaneous uni ductal blood stained serous
81
2WW breast cancer
aged 30 and over and have an unexplained breast lump with or without pain or aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern consider in with skin changes that suggest breast cancer or aged 30 and over with an unexplained lump in the axilla

Clinical Years / Progress Test (24 decks)

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