Breast Flashcards
(76 cards)
1
Q
What are the subtypes of breast cancer?
A
invasive ductal carcinoma (most common)
invasive lobular carcinoma
ductal carcinoma in situ
lobular carcinoma in situ
Paget’s disease
2
Q
breast cancer genetics
A
BRCA1/2 - increased risk
(any woman under 50 with breast cancer will be tested regardless of their family history)
3
Q
urgent referral criteria
A
- unexplained lump or skin changes in over 30
- nipple changes in over 50
4
Q
non-urgent referral criteria
A
unexplained lump in under 30s
5
Q
investigations
A
clinical examination - breast and axillary nodes
radiological ( US (under 40), mammogram (over 40)
biopsy (needle core biopsy)
6
Q
Inflammatory breast cancer
A
rare but aggressive
causes lymph vessels of the skin to become blocked
7
Q
Triple negative breast cancer
A
lacks oestrogen receptors and progesterone receptors and does not express HER2 protein on cancer cells
8
Q
HER2 positive breast cancer
A
HER2 protein is expressed which promotes the growth of cancer cells
9
Q
Breast screening programme
A
women aged 50-70 invited every 3 years for mammogram (women over 70 can still self refer)
10
Q
surgical management for breast cancer
A
Wide local excision or mastectomy, including axillary node clearance if sentinel node biopsy shows infiltration (reconstruction at same time or later)
11
Q
radiotherapy in breast cancer
A
- recommended following WLE to reduce recurrence
- may be given to patients with higher stage cancer following mastectomy
12
Q
when is chemotherapy given in breast cancer?
A
- hormone receptor negative
- HER2 positive
chemo may be given to downstage tumours prior to surgery
13
Q
common chemos used in breast cancer
A
- an anthracycline (doxorubicin)
- a taxane (paclitaxel)
14
Q
biological therapy for HER2 positive patients with T1c+ (in combo with surgery, chemo and radiotherapy)
A
trastuzumab (Herceptin)
15
Q
what should be monitored for patients taking trastuzumab (Herceptin)?
A
cardiac function
16
Q
biological therapy for HER2 negative, hormone receptor positive breast cancer?
A
Abermaciclib (selectively inhibits cyclin-dependent kinases 4 and 6)
17
Q
biological therapy for triple negative breast cancer
A
pembrolizumab
18
Q
biological therapy for BRCA positive, HER2 negative high-risk early breast cancer.
A
Olaparib
19
Q
when can hormonal therapies be used in breast cancer treatment?
A
for oestrogen receptor positive breast cancer
20
Q
hormonal therapy for post-menopausal women with ER +ve
A
anastrozole (aromatase inhibitor)
21
Q
hormonal therapy for pre-menopausal women with ER +ve breast cancer
A
tamoxifen (oestrogen receptor antagonist)
22
Q
biphosphonates in the treatment of breast cancer
A
- may be used for reducing occurrence in node-positive cancers
- advised for treatment-induced menopause in women treated with aromatase inhibitors
23
Q
zoledronic acid in breast cancer treatment
A
shows to improve disease-free survival in postmenopausal women with node-positive invasive cancer
24
Q
complications of breast cancers
A
- fatigue
- bone and brain metastases
- psychological difficulties
- recurrence (locally, regionally or distant i.e liver, lungs, brain and bone)
25
general chemo side effects
fatigue, hair loss, easy bruising, bleeding, infection, anaemia, GI effects, peripheral neuropathy and concentration/ memory problems
26
doxorubicin specific side effect
cardiac toxicity, hence patients should have regular monitoring of their cardiac function
27
paclitaxel specific side effects
lung fibrosis
28
breast cancer surgery complications
Venous thromboembolism
Lymphoedema (axillary node clearance)
Pain
29
breast cancer in pregnancy
- most common malignancy to occur during pregnancy.
Radiotherapy and chemotherapy are most commonly delayed until completion of pregnancy, but surgical intervention can be considered.
30
what indicates bad breast cancer prognosis
Advancing age
Being male
Stage III or IV
Tumour size
Tumour grade
Hormone receptor-negative tumours (oestrogen or progesterone receptor-negative)
HER 2 positive tumours
31
Benign breast diseases
term for a variety of non-cancerous conditions that cause breast symptoms such as lumps, pain and nibble discharge
32
name the benign breast diseases
- fibroadenoma
- breast cysts
- mastitis
- intra-ductal papilloma
- radial scar
- fat necrosis
- fibrocystic breast disease
- mammary duct ectasia
33
fibroadenomas
Fibroadenomas are highly mobile, encapsulated breast masses that arise from the breast lobule stroma.
34
breast cysts
the presence of breast lumps, potentially with distension (occurs due to the overgrowth of glandular and connective tissue) and can lead to blocked breast ducts and subsequent fluid accumulation
35
mastitis
- red, painful, tender, hot breasts - patient presenting with a fever
- typically caused by bacterial infections
- often related to breaks in the skin around the nipple.
36
intraductal papilloma
a benign tumour of the breast ducts that presents with bloody discharge from the nipple
- accompanied by breast tenderness and a palpable mass (doesn't always present with these 2 symptoms however)
37
radial scar
a benign sclerosing breast lesion that presents on mammogram as a stellate pattern of central scarring surrounded by proliferating glandular tissue.
38
fat necrosis of the breast
a painless breast mass, skin thickening or radiographic changes on mammogram which occurs in response to adipose tissue damage
39
fibrocystic breast disease
fibrocystic breast disease is due to an exaggerated hormonal response causing inflammation, fibrosis, cyst formation or adenosis
- presenting as lumps, pain, tenderness and cyclical changes
40
mammary duct ectasia
- palpable peri-areolar breast mass
- thick nipple discharge
due to inflammation and dilation of the large breast ducts
41
which benign breast disease may mimic breast cancer on mammogram?
mammary duct ectasia
42
what is the management for benign breast disease generally?
- reassurance and monitoring
- conservative measures e.g bra and compresses
- analgesics for pain symptom relief
43
when are antibiotics used in the management of benign breast disease?
infection - mastitis
44
when is surgical intervention in benign breast disease indicated?
- large fibroadenomas
- persistent cysts
- symptomatic intracductal papillomas
45
when is hormonal therapy considered in the management of benign breast disease?
fibrocystic breast disease - particularly where symptoms are severe and other measures have not had benefit
46
wide local excision
This is used typically for small tumours, when in a favourable position and localised to one region of the breast.
In this procedure, the tumour is removed with 1 cm margins.
Most patients will require radiotherapy following surgery
47
mastectomy
This is used for tumours which are large, in multiple regions of one breast, or for inflammatory breast cancer. It is also used for women who are pregnant, unable to have radiotherapy, or with a strong family history of breast cancer.
48
occult lesion localisation
- tumor is to small to be palpable
- wire used with imaging to localise the tumour
49
axillary node clearance
- us used to detect spread of cancer from breast to lymph nodes
- if appear abnormal, these will be removed during surgery
- if appear normal, sentinel lymph node biopsy will be done to confirm during their surgery
50
symptoms occurring after axillary node clearance
- lymphoma (swelling, tightness, restricted motion, heaviness in the arm - can also effect chest wall/breast)
- shoulder pain
- damage to the brachial plexus (numbness, tingling or weakness in the arm)
- injury to the vasculature causing poor circulation in the arm
51
axillary web syndrome
aka cording
- formation of fibrous cords that extend from the axilla to the hand
- occurs weeks - months after surgery
- visible/palpable cord like structures
- pulling/tight sensation in chest, restricted shoulder movement and pain
- treatment: physical therapy and stretching
52
cyclical mastalgia definition
breast tenderness, which fluctuates in relation to the monthly menstrual cycle - associated with PMS
53
cyclical mastalgia signs and symptoms
- tender breasts
- pain few days prior to period that subsides by the end
- possible lump (fibrocystic changes)
- potentially presents with duct ectasia
54
cyclical mastalgia management
- lifestyle improvements
- analgesics
- monitoring
if no improvements: hormone modulating medications eg oral contraception or danazol (severe cases)
55
what age does fibroadenoma occur commonly
early 20s - usually regress naturally after menopause
- juvenile if seen in teens
56
fibroadenoma classifications
- simple (1-3cm and not associated with breast cancer)
- complex (larger and small increased risk of cancer)
- giant (larger than 5cm)
57
where are fibroadenomas most commonly located
upper outer quadrant
58
what are fibroadenomas
benign fibrous and epithelial tissue tumours - typically from the lobules presenting as smooth, mobile and painless lumps
59
fibrocystic disease of the breast
- 20-50 years old
- engine condition
- 'lumpy breasts'
- pain and cyclical symptoms that peak 1 week prior to period
- caused by hormonal effects leading to chronic change in breast tissue (including small cysts and proliferative changes)
- conservative management - typically resolves following menopause
60
symptomatic intraductal papilloma management
Surgical excision: Complete removal of the papilloma is often done, as biopsy may not detect areas of atypia or neoplasia.
Microdochectomy: Removal of the affected ducts
Some women may require Hadfield's procedure - with the removal of all the major ducts in the breast
61
bloody discharge with intraductal papilloma is associated with...
atypical or malignant lesion
62
lactational breast abscess
Infectious mastitis can lead to a lactational breast abscess, which is a localized accumulation of pus within the breast tissue.
-fever and malaise
- red painful breast
- fluctuant mass
63
what is the most common causative organism of lactational breast abscess
staph. aureus - introduced via a crack in the nipple or milk duct
64
investigations for lactational abscess
- imaging (ultra sound)
- diagnostic aspiration
65
management of lactational abscess
incision and drainage or needle aspiration with antibiotic therapy (oral or IV flucloxacillin although depends on the culture result)
66
phyllodes tumour
- fibroepithelial neoplasm
- 40-50s years old
- rapidly growing, palpable breast mass
- mammography and biopsy
-surgical removal (WLE (under 2cm) or mastectomy (over 2cm))
67
mammary duct ectasia definition
- inflammation and widening of milk ducts
- greater that 2mm in diameter (3mm at the ampulla)
- results in stagnation of secretions within ducts leading to viscous secretions (green, bloody and brown)
68
management for mammary duct ectasia
- reassure
- conservative
- severe symptoms: microdochectomy or total duct excision
69
pagets disease of the nipple
rare form of breast cancer - presents initially with eczema like changes to the nipple (crusty inflamed rush)
70
sclerosis breast lesions
simple : sclerosing adenosis
complex: radial scars
They are benign hyperplastic proliferative conditions affecting the breast
71
sclerosing breast lesion presentation
- usually no symptoms
- small breast lump in 25%
- some pain and discomfort
72
radial scar management
As radial scars are considered to be high-risk lesions of the breast, typical management involves removal of the lesion via:
- surgical excision
- vacuums assisted biopsy
mammograms regularly are required following removal
73
what family history warrants a referral to genetic testing for breast cancer?
- 1st degree male relative of any age with history
- 1st degree female with breast cancer under 40
- 1st degree relative with bilateral under 50
- 2+ first degree relatives with history
74
TNM score : T
Tumour size
T1= below 2cm
T2= 2-5cm
T3= above 5cm
T4= spread to chest wall/skin or is inflammatory
75
TNM score: N
Node spread
N0= no spread
N1= 1-3 local nodes
N2= 4-9 local nodes
N3= 10+ local nodes or spread to supraclavicular nodes/infraclavicular nodes
76
TNM score: M
Metastases
M0= no metasteses
M1= metasteses
