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Year 4 > BREAST AND ONC > Flashcards

BREAST AND ONC Flashcards

(52 cards)

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1
Q

What is the definition of mastitis?
Typically caused by?

A

Inflammation of the breast tissue, often associated with breastfeeding (lactational), typically caused by Staphylococcus Aureus.

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2
Q

What are the clinical features of mastitis?

A

Painful, tender, red, hot breast.

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3
Q

What are the systemic signs that may indicate a breast abscess?

A

Fever or systemic upset.

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4
Q

What investigations are used for mastitis?

A
  • USS to rule out abscess

-Culture

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5
Q

What is the first-line management of mastitis?

A

Continue breastfeeding.

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6
Q

What should be done if the patient is systemically unwell, has nipple fissure, or shows no improvement after 12-24 hours?

A

Treat with oral flucloxacillin for 10-14 days.

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7
Q

How is a breast abscess managed?

A

If abscess is present, perform USS-guided aspiration and administer oral antibiotics.

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8
Q

What is the definition of fibroadenoma?

A

The most common benign breast lump, often found in women < 30 years old. The other differential is a cyst.

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9
Q

What are the clinical features of fibroadenoma?

A

PC: Lump, no significant growth.

O/E: Very mobile, firm, smooth, and regular.

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10
Q

What is the investigation of choice for fibroadenoma?

A

USS: Consider 2WW for triple assessment.

  • Fibroadenoma appears lighter with some signal, while cysts appear darker.
  • If cyst → aspirate, if blood-stained → biopsy.
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11
Q

What is the management of fibroadenoma?

A

Prognosis: Does not lead to malignancy.

  • Many decrease in size.
  • If > 3 cm → surgical excision.

Outcomes:

  • 1/3 stays the same.

-1/3 get bigger

-1/3 get smaller

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12
Q

What is fibroadenosis?

A

Fibroadenosis is a condition with a lumpy breast and painful symptoms, which are worse before menstruation.

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13
Q

What are the clinical features of duct ectasia?

A

Tender lump near the areola and green nipple discharge.

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14
Q

What is fat necrosis?

A

A condition often seen in obese women after trauma, presenting as a firm and round lump that may later become hard or irregular (similar to breast cancer).

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15
Q

What is a duct papilloma?

A

A condition where there is watery or blood-stained nipple discharge with no associated lump.

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16
Q

What is breast cancer?

A

Breast cancer is the most common cancer in women, particularly in older women.

It can be localized (in situ) or invasive, with common metastatic sites being the lungs, liver, bones, and brain.

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17
Q

What are the types of breast cancer?

A

Types include Invasive ductal carcinoma (most common)
Invasive lobular carcinoma
Paget’s disease of the nipple
Inflammatory breast cancer.

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18
Q

What are the risk factors for breast cancer?

A

Risk factors include female sex, genetic mutations (e.g., BRCA1/2, p53), HRT and COCP use, increased oestrogen exposure, obesity, family history, and not breastfeeding.

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19
Q

What are the common clinical features of breast cancer?

A

Clinical features include lymphadenopathy (axillary), a hard, irregular, painless lump, nipple retraction, nipple discharge, skin dimpling (peau d’orange), and possible nipple ulceration.

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20
Q

When should a 2-week wait referral for breast cancer be made?

A

Referral is needed for unexplained lumps in women 30+ or unilateral nipple changes in women 50+

and also for unexplained axillary lumps or skin changes suggestive of breast cancer.

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21
Q

What are the diagnostic investigations for breast cancer?

Study These Flashcards
A

Diagnostic investigations include mammogram, ultrasound, biopsy (fine needle aspiration or core biopsy), and axillary lymph node assessment (USS or biopsy).

22
Q

What is the triple assessment for breast cancer?

Study These Flashcards
A

The triple assessment includes
-clinical assessment
-imaging (USS or mammogram)
-biopsy (FNAC or core biopsy)

Each component is graded from 1 (normal) to 5 (malignant).

23
Q

What is the role of axillary lymph node assessment in breast cancer?

Study These Flashcards
A

If there is palpable lymphadenopathy, an axillary node clearance is performed, but if lymphadenopathy is not palpable, a sentinel node biopsy is done.

24
Q

What are the types of receptor assessment for breast cancer?

Study These Flashcards
A

Receptor assessments include oestrogen receptors (ER)
- progesterone receptors (PR)
- HER2.

Triple-negative breast cancer has a poor prognosis.

25
What is the treatment for breast cancer?
Treatment involves surgery (mastectomy or wide local excision), radiotherapy, chemotherapy, hormonal therapy (e.g., tamoxifen, aromatase inhibitors), and biological therapy (e.g., trastuzumab).
26
Which score is used to calculate prognosis of breast cancer?
Prognosis is calculated using the Nottingham Prognostic Index (NPI) which includes factors like tumor size, lymph node involvement, and tumor grade to determine the 5-year survival rate.
27
What are the common breast surgical complications that occur on Day 1-2?
The common complication on Day 1-2 is referred to as "Wind" and includes pneumonia, aspiration, and atelectasis.
28
What complications occur on Day 3-5 after breast surgery?
On Day 3-5, the common complication is "Water", which refers to urinary tract infections, especially in catheterized patients.
29
What complications are seen from Day 5-7 after breast surgery?
From Day 5-7, the complication is "Wound", which refers to infection at the surgical site or abscess formation.
30
What complications occur after Day 5 afrer breast surgery?
After Day 5, the complication is "Walking", which includes deep vein thrombosis (DVT) or pulmonary embolism (PE).
31
What complications can occur at any time after breast surgery?
At any time, complications include 'Wonder Drugs' (e.g., transfusion reactions, sepsis, and line contamination).
32
What is the definition of febrile neutropenia?
Febrile neutropenia is a common complication of chemotherapy characterized by a low neutrophil count (<0.5).
33
What are the criteria for febrile neutropenia?
The criteria include: 1. patient undergoing chemo 2. Temo >38 3. other signs of sepsis
34
What prophylaxis should be offered for febrile neutropenia?
Fluoroquinolone should be offered if febrile neutropenia is suspected to occur.
35
What is the management of febrile neutropenia?
1. Do not wait for WCC: if the patient is on active chemotherapy and showing signs of infection (e.g., fever). 2. Administer IV piperacillin with tazobactam (Tazocin).
36
What is the definition of Superior Vena Cava Syndrome (SVCS)?
SVCS is an oncological emergency in which the superior vena cava (SVC) becomes obstructed, often associated with lung cancer, especially small cell lung cancer (SCLC).
37
What are the clinical features of SVCS?
PC: -SOB -Headache -Blurred vision O/E -Swelling of he face, neck and arms
38
What investigations should be done for SVCS?
CT chest with contrast is the investigation of choice.
39
What is the management of SVCS?
MDT Approach: Contact the oncology team. Common management includes endovascular stenting for relief, and radiotherapy may also be used.
40
What is the definition of spinal metastases?
Spinal metastases develop prior to metastatic spinal cord compression. Common primary cancers are the PBL triad (Prostate, Breast, Lung).
41
What are the clinical features of spinal metastases?
- Agonising/unrelenting pain, especially in the thoracic or cervical regions - Referred band-like pain - Worse at night, lying flat, or on coughing - When compression occurs, there are sensory changes (numbness, tingling) and motor changes (gait issues, weakness).
42
What investigation should be done for spinal metastases?
An urgent whole spine MRI is required to assess the spine.
43
What is the management for spinal metastases?
High-dose oral dexamethasone for symptom relief, and consult with the oncology team for further management.
44
What are the features of hypercalcemia of malignancy?
Painful bones, renal stones, abdominal pain, and psychic groans.
45
How is hypercalcemia of malignancy differentiated from other causes?
The key differentiator is PTH (parathyroid hormone) levels: - If PTH ↑↑ → Primary hyperparathyroidism - If PTH normal/low → consider malignancy, such as: - Spinal metastasis - Multiple myeloma - Tumour release (e.g., squamous cell lung cancer).
46
What is the management for hypercalcemia of malignancy?
IV saline followed by bisphosphonates for treatment.
47
What is tumor lysis syndrome?
It is the release of tumor cell content following breakdown, often related to the treatment of high-grade leukaemia/lymphoma, particularly after combination chemotherapy.
48
How is tumor lysis syndrome prevented in at-risk patients?
Allopurinol or rasburicase (for higher-risk patients) is used for prevention.
49
What are the common presentations of tumor lysis syndrome?
- Post-chemotherapy - AKI with ↑↑ creatinine - ↑ uric acid - Deranged electrolytes: ↑ potassium/PO4 & ↓ calcium
50
What are the diagnostic criteria for tumor lysis syndrome?
Deranged metabolic panel (at least two of the above) + ANY of the following: - Increased creatinine -Arrhythmia -Seizure
51
What is the management of tumor lysis syndrome?
- IV fluids and correction of electrolyte abnormalities - Refer to specialties (nephrology, cardiology) - ECG monitoring and treat for hyperkalemia to protect the heart
52
which cancer is tumour lysis syndrome most likely?
haematological

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