Breast Flashcards
(119 cards)
1
Q
What are the 3 parts of the breast?
A
Glandular tissue
Stroma
Lymphatic vessels
2
Q
What is oestrogen and progesterone released by?
A
Ovaries
3
Q
Where is prolactin released from?
A
Pituitary gland
4
Q
What is Tietze syndrome also known as?
A
Costocondritis (will rub hand up and down sternum when describing, aggravated by exercise)
5
Q
Benign breast disease is responsible for what proportion of symptomatic ladies?
A
80%
6
Q
What is the common demographic for fibroadenoma?
A
20-30
African Women
7
Q
What condition is described as a breast mouse?
A
Fibroadenoma
8
Q
How is a diagnosis of fibroadenoma confirmed?
A
US core biopsy
9
Q
Fibroadenoma are biphasic TRUE/FALSE
A
TRUE
Epithelial and stromal component
10
Q
Non-cyclic is less responsive to treatment that cyclic mastalgia TRUE/FALSE
A
TRUE
11
Q
If someone presents with mastalgia what is the treatment?
A
Thank you, next
IF you want to be of help…
Reassure, advise regular exercise and well fitting bra
Tamoxifen effective in 65%-90% pain but interferes with contraception and may bring on menopause
12
Q
What lumps in the breast are tender esp before mensuration, may be multiple and/or bilateral and in the late reproductive years?
A
Cysts
13
Q
What is used to diagnose and treat a cyst?
A
FNA
14
Q
What is the most common aetiology of spontaneous nipple discharge?
A
Intraductal papilloma or papillomas
15
Q
Why should all intraductal lesions be excised and histologically evaluated?
A
Not to miss the rare intraductal papilloma
16
Q
What is Paget’s disease of the nipple?
A
High grade DCIS extending along ducts to reach the epidermis of the nipple
17
Q
How does Paget’s disease usually present?
A
Dry, scaly, eczematous lesion
18
Q
How is the diagnosis of Paget’s disease made?
A
Histological tissue biopsy
19
Q
Causes of gynaecomastia?
A
Endogenous/exogenous hormones
Cannabis
Prescription drugs
Liver disease
20
Q
What do you get in gynaecomastia?
A
Get ducts without the lobular development
21
Q
Fibrocystic change is v common with the most common age group being 40-50 TRUE/FALSE
A
TRUE
22
Q
Fibrocystic change usually resolves or diminishes after menopause TRUE/FALSE
A
TRUE
23
Q
Under the microscope what type of change are there thin walled microscope cysts, that may have a fibrotic wall and are lined by apocrine epithelium?
A
Fibrocystic
24
Q
What are two types of sclerosis lesions?
A
Sclerosing adenosis
Radial scar/complex sclerosing lesions
25
What histologically has a fibroelastic scar, radiating fibrosis containing distorted ductules, fibrocystic change and epithelial proliferation?
Radial scar/complex sclerosing lesion
26
90% of periductal mastitis affects?
Smokers
27
If you tried to operate on someone with periductal mastitis then you would get...
Mammary fistula
28
What is the diagnostic and therapeutic treatment for breast abscess?
Aspiration
(can be sent for microbiological analysis)
Has to be repeated every 3 days
29
What may present with pain, acute episodic episodes, bloody/purulent discharge, fistulation, nipple retraction and distortion?
Duct ectasia
30
Duct ectasia is associated with smoking. If you stop smoking it will go away. TRUE/FALSE
TRUE
31
What is non puerperal mastitis due to?
Duct ectasia
32
What is the treatment for nonpueral mastitis?
Augmentin or Cephalexin
33
If chronic mastitis and there is periareolar fistulae when should it be excised?
When the inflammation is quiescent
34
How does adenolipoma present?
Smooth Palpable lump
35
What is fat necrosis caused by?
Local trauma
| Warfarin therapy
36
Fat necrosis even when it resides may still leave a characteristic mammography lesion. TRUE/FALSE
TRUE
37
What does this describe?
| A palpable milk-filled cyst most commonly associate diet pregnancy/lactation
Galactocele
38
What can be used to diagnose and treat a galactocele?
FNA
39
What is Mondor's disease?
Phlebitis and subsequent clot formation in the superficial (skin) veins of the breast
40
How does Mondor's disease present?
Firm, Vertical, Cord-like structures usually associated with a history of trauma to the breast e.g. surgery
41
Phyllodes tumour is often described as ....... like
Leaf
42
What do phyllodes tumours resemble in clinical presentation and cytology?
Fibroadenomas
43
How can phyllodes tumours be differentiated from fibroadenomas?
Larger (3-6cm)
Tend to occur in older women (35-45y)
Tend to increase in size
44
The diagnosis of phyllodes tumour requires histological verification TRUE/FALSE
TRUE
45
Phyllodes tumours are biphasic, which component is neoplastic?
Stromal component
46
How do intraductal papilloma present?
Age 35-60
Asymptomatic at screening (nodules, calcification) OR
nipple discharge +- blood
47
What is intraductal papilloma?
Rare intracystic carcinoma which occurs within a cyst
48
What is the most common histological type of breast cancer?
Ductal carcinoma
49
What are the typical findings of a ductal carcinoma?
Stellate solid mass or pleomorphic casting microcalcification
50
US is not effective if evaluating calcifications TRUE/FALSE
TRUE
51
What is used to get the definitive diagnosis of ductal carcinoma?
Image-guided tissue core-needle biopsy
52
What is micro invasive carcinoma?
High grade DCIS with invasion of <1mm
| Rare, treat as high grade DCIS
53
Where does DCIS arise?
TDLU, Characteristically unicentric
54
What is DCIS often perceived as on mammography screening?
Malignant calcifications (usually pleomorphic and non casting type)
55
what is the definitive diagnosis method used for DCIS?
Stereotactic vacuum-assisted core biopsy
56
Why is unilateral single duct nipple discharge worrying?
Sign of DCIS
57
Lobular carcinoma spreads diffusely with a typical histological ------- ------ pattern
Indian file
58
Survival for breast cancer is super high TRUE/FALSE
TRUE
1y- 96%
5y-87%
10y-78%
59
1 in - women will develop breast cancer
8
60
Define breast cancer
A malignant tumour of breast epithelial cells which have breached the BM. It arises in the glandular epithelium of the terminal ductal lobular unit. (ADENOCARCINOMA)
61
Breast cancer. Physical activity is protective and NSAID's lower risk?
TRUE
62
Where is the incidence for breast cancer highest?
Europe
63
What HRT reduces the risk of breast cancer?
Oestrogen-only HRT
| Combined- oestrogen and progesterone increases the risk
64
If there is a 1st degree relative with breast cancer how does this affect their risk?
It doubles the risk
65
What are the 4 highest relative risk factors for the development of breast cancer?
Gene mutation
Lobular carcinoma in situ
Ductal carcinoma in situ
Atypical Hyperplasia
66
Why does peau d'orange occur?
Caused by oedema, tissues can't expand due to coopers ligaments, therefore the skin has a puckered appearance.
67
In breast cancer with a score of 3,4 or 5 what grade would you be?
Grade 1
68
What are the 3 hormone receptors that are important to consider when deciding what treatment to use in breast cancer?
ER
PR
HER2
69
The survival is better if ER+, PR+ and HER2+ TRUE/FAL;SE
FALSE
| survival is better is ER+ and PR+ but HER2-
70
If have the ER receptor positive then what additional therapy may be of some benefit?
OOphrectomy
Tamoxifen
Aromatase inhibitor (Latrozole)
GnRH antagonsits
71
If HER2 positive then what drug can be used?
Trastuzamab (Herceptin)
72
The Nottingham prognostic index only takes one thing into account, what is this?
Histopathology
73
How is NPI calculated?
```
0.2 x tumour diameter (cm)
to interpret ( excellent if below 3, poor if above 5.4ish)
```
74
What is the triple assessment done at the one-stop shop for breast cancer?
Clinical - H&E
Imaging- Mammography, US and MRI
Pathology- Cytopathology, Histopathology
75
What is the technique used in order to get a sample for cytopathology?
FNA
76
Different tissues are aspirated to a different extent. What is the pattern of the epithelial tissues?
Flat cohesive honeycomb pattern
77
TRUE/FALSE
| You can tell the difference on a needle core biopsy between carcinoma in situ and invasive carcinoma
DAMN GIRL DAT BE TRUE
| This is what makes it different from cytopathology
78
If disease is impalpable then how are mammographs taken?
Insert a wire first and then take the mammographs
79
If breast conserving surgery is chosen as a treatment option then radiotherapy is used alongside. How is the radiotherapy administered?
Administered in daily fractions (5 days a week) for 3-6 weeks
80
When would have have radiotherapy post-mastectomy?
Involvement of 3+ nodes
Positive surgical margins
Tumours >5cm
81
What does total mastectomy remove?
The entire breast inc the overlying skin and axillary lymph nodes
82
What muscle is preserved in mastectomy and facilitates wound healing and potentially allow reconstruction?
Pectoralis major
83
Long term survival is the same for BCS and Mastectomy. I ain't even saying is it TRUE/FALSE. IT'S TRUE!
TRUE (did you seriously just turn over the card)
84
Having a mastectomy reduces the chances of cancer. TRUE/FALSE
FALSE-IT does not reduce the chances
85
Name 4 risks of implants
Infection
Capsular contracture
Implant rippling
Implant migration
86
TRUE/FALSE
| The breast implant is put in just infront of the pectorals major muscle
FALSE
| It is just under the muscle
87
What percentage of women get an infection and lose the implant?
1 in 4
88
What is a sentinel node biopsy?
Labelled radioisotope, blue dye injected into the aureola and the sentinel nodes pick up the blue dye and they are removed
89
Why is axillary node clearance associated with heavy arm?
Due to lymphoma
90
TRUE/FALSE
| Aromatase inhibitors are more effective than tamoxifen neoadjuvantly
TRUE (Reserved for postmenopausal women)
| Non difference in survival when used adjuvantly
91
Radiotherapy is often used Neo-adjuvantly TRUE/FALSE
FALSE
| It is never used for that purpose , can be used adjuvant though(halves the risk of recurrence)
92
How is adjuvant radiotherapy usually given?
External beam over 3 weeks
| indication to boost treatment would be young age or positive margins
93
What is the most commonly used hormonal therapy?
Tamoxifen
94
How do gCSF injections produce severe axial skeleton pain?
from marrow stimulation
95
Name two things that taxes induce (as SE)
Myalgia
| Peripheral neuroapthy
96
HER2 receptor is found over expressed in what percentage of breast cancers?
15%
97
What drug is 1st line for treatment of metastatic breast cancer?
Bevacizumab
98
What drug can be given palliatively for those with bone mets from breast cancer?
Bisphosphonates ( as prevention)
99
What is the most likely diagnosis if there is bone pain after breast cancer?
Metastasis
100
Who group of patients might have a positive bone scan even though they do not have mets?
Those with osteoporosis
101
Should you care about neutropenia following chemotherapy?
YES obv
102
If patient has hot flushes with tamoxifen/AI then what can be given?
Clonidine
103
Mirena coil is CI if there has been breast cancer TRUE/FALSE
TRUE
104
If there appears a new lump post treatment unless cancer is extremely aggressive it is unlikely to be a met. What is it most likely?
Fat necrosis- due to tissue damage
105
With HER-2 positive breast cancer where do the mets preferentially go to?
CNS and Pleura
106
Where does lobular breast cancer preferentially go to?
Peritoneum
| Gut
107
Where do most breast cancers occur?
In the upper outer quadrant
| hence why an oblique view on mammography is used
108
TRUE/FALSE
| Women with denser breasts are at higher risk of breast cancer
TRUE
109
What does mammography look for?
Calcification
110
Most young women have dense (more fibroglandular tissue) breasts therefore it is easier to detect cancer TRUE/FALSE
FALSE c'mon
111
When does calcification look suspicious?
if it is in a line "looks like it is rough and sharp if rubbed between fingers"
112
TRUE/FALSE
| If lots of fatty breast tissue then the sensitivity of the mammogram will be high
TRUE
113
A biopsy should be done in all women if there is a soft grey lump on USS TRUE/FALSE
FALSE
| No longer biopsy or follow up in women under 40 if there is a soft grey lump on USS
114
What is there commonest breast lump in those <30?
Fibroadenoma
115
What is the commonest breast lump in those 30-50?
Cyst
116
What is the commonest breast Lump in those >50?
Cancer
117
On USS is a lump has echoes in it then it is solid, if it is entirely black then it is what?
A cyst
118
What is the difference in biopsy size for lumps v calcification?
14G for lumps
| 11G for calcification
119
Common sites of mets from breast cancer are...
```
Brain
Bones
Liver
Lung
Pleura
```
