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Flashcards in Breast cancer Deck (20):
1

3 parts of triple assessment

1) palpation

2) mammogram (>40)  or US (<40) - younger women have more dense breasts  

When a woman complains of a breast lump US is always performed even if the woman has had a mammogram/ always scan axilla too 

3) needle biopsy

 

Imaging always performed regardless of whether or not there is a clinically palpable abnormality 

2

what is the 1-5 scale used for triple assessment

1) normal 2) benign 3) inderterminante / probably benign 4) suspicious 5) malignant

3

what features of a lump make you suspicious of malignancy

hard

irregularly

non tender

tethering

4

risk factors for breast cancer

F age earlier menarche HRT use older age at menopause FH - how many, 1st/2nd degree, age affected BRACA1/2 not having children obese alcohol physical inactivity sex hormones breast density older age at first birth OCP

5

How to describe a breast lump

size

shape

location - most breast cancer occurs in upper outer quadrant (approx. 50%)

margin 

skin tethering? - lump is attached to skin, can be moved in an arc without moving skin but if the lump if pulled outside the arc the skin indents 

skin fixation - lump cannot be mpved without moving skin

6

Breast anatomy 

Q image thumb

1) chest wall

2) pectoralias muscles

3) breast lobules

4) nipple

5) areola

6) milk ducts

7) fatty tissue

8) ski 

7

Breast history questions?

lump?

 pain if so SOCRATIES

skin changes

nipple discharge

nipple indrawn/inverted

abscess

deformity 

what age they started periods

menopause?

smoker?

drinks alcohol?

DH- HRT or OCP now or previously

any children - age at 1st pregnancy? breast fed?

FH - 1st degree, 2nd degree, none, age 

previous breast problems?

hysterectomy? ovaries removed?

previous mammogram? and when it was

8

explaning a mammogram to a patient

  • uncomfortable but not painful
  • two xrays of each breast
  • all mammographers female
  • cant tell which quadrant the lump is in without a CC view

9

what can you see on a mammogram

pectoralis major

fibroglandular tissue

axillary lymph nodes

10

if you feel a lump on palpation but US and mammogram come back negative what do you do 

NEEDLE BIOPSY 

11

Types of breast cancer 

Invasive ductal carcinoma -most common

invasive lobular carcinoma - second most common

 

12

Treatment for breast cancer 

MDT and sentinel node biopsy always

accurate diagnosis and staging

Surgery - mastectomy vs wide excision and radiotherapy

tamoxifen if oestrogen positive 

if HER2 postive (human epidermal growth factor receptor 2) - anti HER2 therapy e.g. tastuzumab 

 

13

when to do masectomy over wide excision and radiotherapy 

multifocal

local recurrence

DCIS or invasion >4cm 

14

If sentinel node biopsy comes back positive for cancer

axillary node clearance and radiotherapy

15

When is chemotherapy used in breast cancer

mainly after breast surgery if increasing number of lymph nodes, increasing grade of cancer, increasing size of tumour 

to eradicate micro metastatic disease

sometimes offered neoadjuvant mainly for larger or inoperable tumours to shrink and allow surgery 

16

what tool is used to estimate breast cancer survivial and benefits of hormone therpay, chemo and trastuzumab 

PREDICT 

17

Stage vs grade of cancer

Stage: TNM, tumour size, number of lymph nodes and metastases

Grade: how aggressively the cancer is growing and how much they look like normal cells

grade 1: resemble normal cells arent growing rapidly

grade 2: dont look like normal cells, growing faster than normal cells

grade 3: cells look abnormal and may grow or spread more aggressively 

18

Options after masectomy

having a tattoo 

implant based reconstruction

wearing a prosthesis

going flat chested

autologous reconstruction - flaps where they take muscle from areas of your body and create a breast

19

side effects of tamoxifen

cataracts

DVT

endometrial thickening

menopausal symptoms - hot flushes, vaginal dryness, nausea, low libido 

20

DCIS

ductual carcinoma insitu

cancer cells formed within milk duct but not yet invaded through basemnt menbrane to surrounding tissue, necrotic cells often calcify to produce microcalcification seen on mammogram

can become invasive and spread outside of the duct in some cases