Breast Flashcards
(41 cards)
Give some differentials for breast lump?
Fibroadenoma (smooth, rubbery, mobile)
Cyst (rubbery, smooth, mobile - may be pain fluctuating with menstrual cycle)
Fat necrosis (firm, irregular mass - Hx trauma)
Intraductal papilloma (bloody nipple discharge)
Breast abscess (pain, fever, erythema)
Invasive breast cancer
Ductal carcinoma in situ (DCIS)
Give 3 genes associated with development of breast cancer?
BRCA1
BRCA2
TP53 (Li-Fraumeni syndrome)
Give 4 signs of breast cancer
Painless lump (irregular, hard, fixed) Skin tethering Indrawn nipple Nipple discharge Peau d'orange (dimpled skin)
What makes up the ‘triple assessment’ of a breast lump?
1) Clinical examination
2) Imaging (USS <35, USS + mammogram >35)
3) Biopsy (FNA of core biopsy)
When is breast cancer screening offered?
Every 3 years for women 50-70yrs
What is the lifetime risk of breast cancer in women?
1 in 8
Why are mammograms a good screening tool?
Acceptable test
Early detection means disease can be found before metastatic spread
Important problem (1 in 8 women affected)
Reduces morbidity and mortality by up to 30%
Acceptable treatment for those screened +ve
Not compulsory
What are some controversies surrounding breast cancer screening?
?overdiagnosis
3 in 4 women that are called back will NOT have cancer - so can cause a lot of undue worry
Which lymph nodes to breast cancer spread to?
Axillary (40% have this at presentation)
Supraclavicular
Infraclavicular
Neck (always examine from behind)
What are some features of a benign mass on mammogram?
Rounded, smooth shape
Well-defined margins
What are some features of a suspicious mass on mammogram?
Rough edges
Poorly defined margins
Give 3 RFs for breast cancer
FHx Increasing age Obesity BRCA genes Not breastfeeding Uninterrupted oestrogen exposure - nulliparity, early menarche, late menopause, HRT, OCP
Give 3 protective factors against breast cancer
Breastfeeding
Multiparity
Late menarche
Early menopause
What is the most common type of breast cancer?
Invasive ductal carcinoma
Which is the type of breast cancer that can look like eczema?
Paget’s disease of the breast
What are the different stages of breast cancer?
1 - confined to breast, mobile
2 - confined to breast + nodes in ipsilateral axilla
3 - fixed to muscle, ipsilat LNs, skin involvement
4 - fixed to chest wall, distant mets
What is the index used to predict survival?
How is it calculated?
Give 2 good prognostic factors
Nottingham prognostic index
Grade (1-3) + Nodes (1-3) + 0.2(size, cm)
ER+ve
Low grade, stage and size
Give some differentials for breast pain
Angina Lung disease Oestrogens/HRT Cyclical breast pain Thoracic outlet syndrome Gallstones Costochondritis
Give 4 differentials for nipple discharge
Duct ectasia
Cancer
Lactation
Infection
What are the 2 views taken of each breast in a mammogram?
Cranio-caudal
Mediolateral oblique
What is the role of MRI in breast assessment?
Not routine - can help in difficult cases
Screening in high risk ladies
Assessment of implants
What are the 2 surgical options for treating primary operable breast cancer?
Breast conservation
Mastectomy
What are the indications for breast conservation surgery?
Small tumour relative to breast size (<25% vol)
Not underneath nipple
No prev. radio to breast
Pre-op chemo may allow breast conservation
Patient choice
What are the indications for mastectomy?
Large tumour relative to breast Tumour underneath/in-drawing of nipple >1 cancer in same breast Immediate/delayed reconstruction Patient choice
