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3A REVISION > BREAST > Flashcards

BREAST Flashcards

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1
Q

What is mastalgia and how common is it?

A

Breast pain, over 50% of women suffer at some point

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2
Q

How common is breast cancer?

A

1 in 8 women, most common in females in UK

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3
Q

On breast examination, give 7 red flag symptoms for breast cancer

A 
Painless lump
Skin distortion
Bloody nipple discharge
Nipple inversion
Axillary lymphadenopathy
Ulcers
Paget's nipple disease
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4
Q

Give risk factors for breast cancer (10)

A 
Increasing age
Family history of breast/ovarian cancer (BRCA1/2)
Young age at menarche
Late menopause
Nulliparity
Obesity 
HRT
Not breastfeeding
Past breast cancer
Alcohol
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5
Q

What is the triple assessment test?

A

Clinical examination
Radiological imaging (mammography, USS)
Pathology (histology, cytology)

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6
Q

What is mammography?

A

Low dose X rays of the breast, where the breast is compressed between 2 plates to flatten tissue and improve resolution

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7
Q

What is breast screening?

A 
To detect cancer at pre-invasive stage
Mammography for all women between 50 and 70 every 3 years
After 70 if self organised
Under 50 if high risk
Trial between 47-73
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8
Q

What is shown on mammogram in ductal carcinoma in situ?

A

Microcalcification

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9
Q

What is shown on mammogram in carcinoma?

A

Irregular spiculated mass

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10
Q

When is breast ultrasound used?

A

When there is a known lesion or suspicious area already identified

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11
Q

How are patients under 25 investigated for breast cancer?

A

Histology or cytology only, ultrasound if clinically suspicious

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12
Q

How are patients 25-40 investigated?

A

Breast ultrasound plus histology or cytology

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13
Q

How are patients over 40 investigated?

A

Mammography and ultrasound and either histology or cytology

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14
Q

When is MRI offered for breast cancer? (3)

A

Annually between 30-50 if high risk family history for screening
To assess extent of diffuse cancers and lymph node involvements
To assess possible recurrence of breast cancer after treatment

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15
Q

How is tissue diagnosis done in breast cancer? (2)

A

Fine needle aspiration cytology

Core biopsy

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16
Q

What is fine needle aspiration cytology?

A

Needle being passed through a lump many times whilst applying suction to the syringe

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17
Q

What is core biopsy?

A

Needle fired into the lesion to remove a core of tissue, with US guidance
Increased accuracy of diagnosis

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18
Q

What increases breast cancer risk in men? (4)

A

Age
Family history
Klinefelter’s
Possible use of oestrogens

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19
Q

Disadvantages of breast cancer screening? (4)

A

Time to attend mammograms
Psychological distress waiting for results
Procedures such as biopsy that are negative
Overdiagnosis - cancer diagnosis that would never have become symptomatic

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20
Q

How much has breast cancer screening reduced mortality by?

A

15-30%

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21
Q

What is pre-invasive disease in breast cancer?

A

Ductal carcinoma in situ

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22
Q

Two histological types of invasive breast cancer?

A

Ductal - invasive ductal carcinoma most common

Lobular - more diffuse

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23
Q

How is breast cancer graded?

A

1 - well differentiated cells, low mitotic rate

3 - badly differentiated, high mitotic rate

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24
Q

What is the immunophenotype of a breast cancer?

Study These Flashcards
A

If it is oestrogen receptor, progesterone receptor or HER-2 receptor positibe

25
What is oestrogen receptor positive cancer?
Expressed on >50% Good prognosis Cancer is sensitive to oestrogen which stimulates the tumour Anti-oestrogens will help
26
What is progesterone receptor positive cancer?
Indicator of sensitivity to anti-oestrogens | Good prognosis
27
What is HER-2 receptor positive cancer?
``` Expressed in 15% Poor prognosis Receptor for epidermal growth factor More aggressive cancer Use trastuzumab ```
28
What is triple negative breast cancer?
Cancers which do not express oestrogen receptors, progesterone receptors of HER-2 receptors Very aggressive Common in younger patients
29
Where does breast cancer metastasise to? (4)
Bone, liver, brain, lungs
30
How is stage 1-2 cancer treated?
Wide local excision surgery or mastectomy (+/- reconstruction) with axillary node sampling/clearance or sentinel node biopsy Radiotherapy to remaining breast if conserved Adjuvant chemotherapy
31
Why is radio/chemotherapy used in breast cancer?
To target micro-metastases and prevent recurrence May be used to shrink a tumour before surgery Palliation for mets
32
When is hormonal therapy used in breast cancer?
All women with oestrogen sensitive breast cancer
33
What hormonal therapy is used in breast cancer adjuvant to surgery?
Tamoxifen - selective oestrogen receptor modulator - inhibits breast oestrogen receptors Aromatase inhibitors - prevent peripheral conversion of androgens to oestrogens in post menopausal women
34
How is Her-2 receptor positive breast cancer treated?
Trastuzumab (herceptin) adjuvant to surgery
35
How is locally advanced breast cancer treated (stage 3)?
Non surgically - hormonal, chemo/radiotherapy | May be offered surgery depending on response
36
What is paget's disease of the nipple?
Eczematous change of the nipple due to an underlying malignancy
37
How is stage 4 metastatic breast cancer treated?
Endocrine therapy if oestrogen or HER-2 positive Radiotherapy to reduce pain Chemotherapy Bisphosphonates for bones
38
Name some types of breast reconstructions? (6)
``` External prosthesis Skin sparing mastectomy Silicone/saline implant Acellular dermal matrix and dermal sling with implant Latissimus dorsi flap +/- implant TRAM flap ```
39
Give 4 signs of surgically significant (potential malignancy) nipple discharge
Persistent Unilateral Spontaneous Bloody or clear
40
What are 3 causes of bloody nipple discharge?
Duct papilloma Duct ectasia Invasive/in situ carcinoma
41
What is duct ectasia?
Lactiferous duct becomes blocked, can cause greenish or bloody discharge Benign
42
What is duct papilloma?
Benign warty growth, usually with clear or bloody discharge
43
What is galactorrhoea?
Milky discharge, may be physiological or due to drugs
44
What are the two types of breast infection?
Lactational (usually peripheral breast) and non lactational (usually central i.e. duct ectasia)
45
Treatment of breast infection?
Aspiration Lactational - flucloxacillin Non-lactational - flucloxacillin plus metronidazole
46
How is breast pain classified?
Cyclical or non cyclical
47
Treatment of cyclical breast pain? (4)
Reassure Proper bra Danazol - weak androgen Tamoxifen - short term
48
Treatment of non cyclical breast pain?
NSAIDs | Exclude other causes i.e. cardiac, MSK
49
What is breast nodularity?
Variation of normal - lumpy breasts, often cyclical so should reexamine after period
50
What is a fibroadenoma?
Common benign mobile lump especially <35yrs | 1/3rd shrink, 1/3rd stay the same, 1/3rd enlarge (surgery to remove)
51
What is a breast cyst?
Abnormal response of part of the breast to hormonal stimulation, common between 40-60 Drain
52
What is gynaecomastia?
>2cm lump of breast tissue behind the male nipple
53
What is pseudogynaecomastia?
Deposition of fat in overweight men
54
Physiological cause of gynaecomastia?
Imbalance of oestrogen and testosterone
55
Pathological causes of gynaecomastia? (3)
Drugs - spironolactone, anabolic steroids, oestrogen Marijuana Testicular failure or tumours
56
How is gynaecomastia treated?
Remove cause i.e. drug | Possible excision if embarrassment
57
If BRCA1/2 gene is present, what is lifetime risk of developing breast cancer?
80%
58
What is the treatment of women with BRCA1/2 genes?
Prophylactic mastectomy, reduces cancer chance by 90%

3A REVISION (17 decks)

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