Flashcards in Breast Conditions Deck (64):
How many women are diagnosed with breast cancer at some point in their life?
How many women diagnosed each year with breast cancer are <50yo?
What is the triple assessment?
Clinical- history and exam
Radiological- bilateral mammogram/US
Cyto-pathological- FNA (cells only), core biopsy
Why is mammography sensitivity reduced in young women?
Due to the presence of increased glandular tissue (<40yo)
When is breast US useful?
Assessment of breast lumps
Differentiating solid and cystic lesions
Guidance for FNA/CB
To assess tumour and size and response to therapy
What can core biopsy confirm that FNA can't?
ER, PR, HER2 status
What is the most common invasive breast carcinoma?
Ductal carcinoma (80%)
What tests are used in breast cancer staging?
Bloods- FBC, U&Es, LFTs, Ca2+, PO2-
Bone scan- if indicated
In TNM staging for breast cancer, how is T assessed?
T0 Non palpable
T4 Invading skin/chest wall
In TNM staging for breast cancer, how is N assessed?
N0 Non palpable
In TNM staging for breast cancer, how is M assessed?
M0 No mets
What are surgical options for breast carcinoma in the axilla?
Axillary Node Clearance (ANC)
Axillary Node Sampling (ANS)
Sentinel Lymph Node Biopsy (SNBx)
What will all patients get after WLE as adjuvant therapy?
What radiotherapy will post-WLE patients receive?
40-50Gy over 3 or 5 weeks
Boosts reduce local recurrence
What are the complications of radiotherapy post WLE/Mx?
Skin reaction- Skin telangiectasis
When is radiotherapy given post Mx?
If there is local involvement
When is chemotherapy seen to be effective in women with breast carcinoma?
Greatest in younger women
Benefits increase with increasing adverse prognostic factor (LN +ve, ER -ve <35yo, HER2 +ve)
What are the traditional chemotherapies used in breast cancer?
Anthracycline-containing Combinations using Doxorubicin or Epirubicin
What hormone therapy is carried out in breast cancer and when?
Oestrogen deprivation- only in ER +ve tumours
What non-invasive hormone therapy is carried out in breast cancer?
What invasive hormone therapy is carried out in breast cancer?
Describe tamoxifen hormonal therapy in breast cancer
20mg once daily over 5y
Blocks directly on receptor
Antagonist action in breast Ca
Effective in all age groups
Less effective in HER2+
More effective give after chemo
Describe aromatase inhibitor therapy in breast cancer
Inhibiting ER synthesis
Only effective in post menopausal women
Improve disease free survival
More effective in HER2+ women
What can aromatase inhibitors increase the risk of?
What is ANDI?
Aberration of Normal Development & Involution
What are some examples of ANDIs?
Are fibroadenomas common?
Yes- esp in young women
13% of all palpable breast masses (60% in women aged <20y)
Do fibroadenomas require excision?
Not if proven on US and FNA cytology
Only if unable to obtain pathological diagnosis, increasing in size or deforming
What % of discrete breast masses are cysts?
How should breast cysts be managed?
Aspirate after US/mammography
If residual lump- investigate as lump
How many patients with cysts have carcinomas?
1-3% patients, few are associated with the cyst
Negligible risk of developing cancer in patients with cysts
Are duct papillomas common?
Yes- single or multiple
What can duct papillomas cause?
Bloodstained nipple discharge
How are duct papillomas managed?
Excision by microdochectomy (single duct excision) or total duct excision
What malignancy potential do duct papillomas have?
What are some breast presentations of hormonal changes?
What are the cyclical features of mastalgia?
Average age 34yo
Heightened awareness, discomfort, fullness, heaviness
Classically- outer half of each breast
Can be unilateral
What are the non-cyclical features of mastalgia?
Older women- average 43yo
Pain can arise from chest wall, breast or outside breast
What are the possible causes of mastalgia?
Abnormal plasma fatty acid levels
Role of dietary factors such as caffeine and fats
Changes in hormonal levels
How is mastalgia assessed?
Imaging if necessary (e.g. unilateral)
Distinguish cyclical from non-cyclical
Exclude non breast causes
How is mastalgia with mild/moderate symptoms treated?
Well fitting bra
How is mastalgia with severe symptoms treated?
Consideration of drug treatment:
Evening primrose oil
Gamolenic acid (up to 1000mg/day for up to 6/12)
If no response, stop OCP
Danazol 100mg of
What are the S/E of danazol in mastalgia treatment?
Occurs in 30%
What are the S/E of gamolenic acid in mastalgia treatment?
Occurs in 4%
What are the S/E of bromocriptine in mastalgia treatment?
Occurs in 35%
What are the clinical features of spontaneous nipple discharge?
5-10% of patients with bloodstained discharge will have malignancy
What are the clinical features of physiological nipple discharge?
2/3 of pre-menopausal women can produce nipple secretion by cleansing nipple and applying suction
How is nipple discharge assessed?
If suspicious- duct excision
If bilateral milky discharge (galactorrhoea)- DHx, PL levels
What are the causes of gynaecomastia?
Drugs (cimetidine, digoxin, spironolactone, androgens, antioestrogens)
Who does gynaecomastia effect?
30-60% boys aged 10-16yo
Gynaecomastia resolves spontaneously within 2y in how many effected males aged 10-60yo?
If patients are embarrassed/condition if persistent, how can gynaecomastia be treated?
What is the most common cause of gynaecomastia in men 50-80yo?
How should gynaecomastia be investigated if suspicious?
How should gynaecomastia be treated?
If drug related- withdraw drug
Danazol or Tamoxifen can provide symptomatic improvement
Surgery- in rare cases
What are some infective breast diseases?
Who are breast abscesses common in?
Lactating post partum women
What are the symptoms of breast abscess?
How is breast abscess investigated?
How is breast abscess treated?
Flucloxacillin +- aspiration
Persistent abscess- aspiration/incision & drainage
Persistent- investigation for underlying pathology
What should be encouraged to continue in the presence of breast abscess?
Who is periductal mastitis +-abscess common in?
How is periductal mastitis +- abscess managed?
Incision and drainage
Ix of all persisting lesions