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Breast Conditions Flashcards

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1
Q

How many women are diagnosed with breast cancer at some point in their life?

A

1:9

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2
Q

How many women diagnosed each year with breast cancer are <50yo?

A

> 8000

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3
Q

What is the triple assessment?

A

Clinical- history and exam
Radiological- bilateral mammogram/US
Cyto-pathological- FNA (cells only), core biopsy

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4
Q

Why is mammography sensitivity reduced in young women?

A

Due to the presence of increased glandular tissue (<40yo)

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5
Q

When is breast US useful?

A

Assessment of breast lumps
Differentiating solid and cystic lesions
Guidance for FNA/CB
To assess tumour and size and response to therapy

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6
Q

What can core biopsy confirm that FNA can’t?

A

ER, PR, HER2 status

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7
Q

What is the most common invasive breast carcinoma?

A

Ductal carcinoma (80%)

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8
Q

What tests are used in breast cancer staging?

A

Bloods- FBC, U&Es, LFTs, Ca2+, PO2-
CXR
AUSS-if indicated
Bone scan- if indicated

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9
Q

In TNM staging for breast cancer, how is T assessed?

A 
T0 Non palpable
T1 <2cm
T2 2-5cm
T3 >5cm
T4 Invading skin/chest wall
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10
Q

In TNM staging for breast cancer, how is N assessed?

A

N0 Non palpable
N1 Mobile
N2 Fixed

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11
Q

In TNM staging for breast cancer, how is M assessed?

A

M0 No mets

M1 Mets

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12
Q

What are surgical options for breast carcinoma in the axilla?

A

Axillary Node Clearance (ANC)
Axillary Node Sampling (ANS)
Sentinel Lymph Node Biopsy (SNBx)

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13
Q

What will all patients get after WLE as adjuvant therapy?

A

Radiotherapy

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14
Q

What radiotherapy will post-WLE patients receive?

A

40-50Gy over 3 or 5 weeks

Boosts reduce local recurrence

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15
Q

What are the complications of radiotherapy post WLE/Mx?

A

Skin reaction- Skin telangiectasis
Radiation pneumonitis
Cutaneous Radio-/Osteonecrosis

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16
Q

When is radiotherapy given post Mx?

A

If there is local involvement

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17
Q

When is chemotherapy seen to be effective in women with breast carcinoma?

A

Greatest in younger women

Benefits increase with increasing adverse prognostic factor (LN +ve, ER -ve <35yo, HER2 +ve)

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18
Q

What are the traditional chemotherapies used in breast cancer?

A

CMF Combinations
Taxane Combinations
Anthracycline-containing Combinations using Doxorubicin or Epirubicin

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19
Q

What hormone therapy is carried out in breast cancer and when?

A

Oestrogen deprivation- only in ER +ve tumours

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20
Q

What non-invasive hormone therapy is carried out in breast cancer?

A

Tamoxifen

Aromatase inhibitors

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21
Q

What invasive hormone therapy is carried out in breast cancer?

A

Oophorectomy

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22
Q

Describe tamoxifen hormonal therapy in breast cancer

A 
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
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23
Q

Describe aromatase inhibitor therapy in breast cancer

A

Inhibiting ER synthesis
Only effective in post menopausal women
Improve disease free survival
More effective in HER2+ women

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24
Q

What can aromatase inhibitors increase the risk of?

A

Osteoporosis

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25
What is ANDI?
Aberration of Normal Development & Involution
26
What are some examples of ANDIs?
Fibroadenoma Breast cysts Duct papilloma
27
Are fibroadenomas common?
Yes- esp in young women | 13% of all palpable breast masses (60% in women aged <20y)
28
Do fibroadenomas require excision?
Not if proven on US and FNA cytology | Only if unable to obtain pathological diagnosis, increasing in size or deforming
29
What % of discrete breast masses are cysts?
15%
30
How should breast cysts be managed?
Aspirate after US/mammography | If residual lump- investigate as lump
31
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
32
Are duct papillomas common?
Yes- single or multiple
33
What can duct papillomas cause?
Bloodstained nipple discharge
34
How are duct papillomas managed?
Excision by microdochectomy (single duct excision) or total duct excision
35
What malignancy potential do duct papillomas have?
Minimal
36
What are some breast presentations of hormonal changes?
Mastalgia Nipple discharge Gynaecomastia
37
What are the cyclical features of mastalgia?
``` Premenopausal Average age 34yo Heightened awareness, discomfort, fullness, heaviness Classically- outer half of each breast Can be unilateral ```
38
What are the non-cyclical features of mastalgia?
Older women- average 43yo Pain can arise from chest wall, breast or outside breast Continuous/random Burning/drawing
39
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
40
How is mastalgia assessed?
``` Hx Exam Imaging if necessary (e.g. unilateral) Distinguish cyclical from non-cyclical Exclude non breast causes ```
41
How is mastalgia with mild/moderate symptoms treated?
Reassurance Well fitting bra Topical NSAIDs
42
How is mastalgia with severe symptoms treated?
``` Reassurance 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 Bromocriptine Tamoxifen Not diuretics ```
43
What are the S/E of danazol in mastalgia treatment?
Weight gain Acne Hirsutism Occurs in 30%
44
What are the S/E of gamolenic acid in mastalgia treatment?
Nausea Slow response Occurs in 4%
45
What are the S/E of bromocriptine in mastalgia treatment?
Nausea Dizziness Occurs in 35%
46
What are the clinical features of spontaneous nipple discharge?
Bloodstained/not bloodstained Single/multiple duct 5-10% of patients with bloodstained discharge will have malignancy
47
What are the clinical features of physiological nipple discharge?
Common 2/3 of pre-menopausal women can produce nipple secretion by cleansing nipple and applying suction Colour- white/yellow/green/blue-black
48
How is nipple discharge assessed?
``` Hx Exam Imaging If suspicious- duct excision If bilateral milky discharge (galactorrhoea)- DHx, PL levels ```
49
What are the causes of gynaecomastia?
``` Puberty Idiopathic Drugs (cimetidine, digoxin, spironolactone, androgens, antioestrogens) Cirrhosis/Malnutrition Primary hypogonadism Testicular tumours Secondary hypogonadism Hyperthyroidism Renal disease ```
50
Who does gynaecomastia effect?
30-60% boys aged 10-16yo
51
Gynaecomastia resolves spontaneously within 2y in how many effected males aged 10-60yo?
80%
52
If patients are embarrassed/condition if persistent, how can gynaecomastia be treated?
Surgery
53
What is the most common cause of gynaecomastia in men 50-80yo?
Idiopathic
54
How should gynaecomastia be investigated if suspicious?
Triple assessment
55
How should gynaecomastia be treated?
If drug related- withdraw drug Danazol or Tamoxifen can provide symptomatic improvement Surgery- in rare cases
56
What are some infective breast diseases?
Abscess Periductal mastitis Fat necrosis
57
Who are breast abscesses common in?
Lactating post partum women
58
What are the symptoms of breast abscess?
Pain Swelling Tenderness
59
How is breast abscess investigated?
Cytology/bacteriology
60
How is breast abscess treated?
Flucloxacillin +- aspiration Co-amoxicillin Persistent abscess- aspiration/incision & drainage Persistent- investigation for underlying pathology
61
What should be encouraged to continue in the presence of breast abscess?
Breast feeding
62
Who is periductal mastitis +-abscess common in?
Female smokers
63
How is periductal mastitis +- abscess managed?
Antibiotics Aspiration Incision and drainage Ix of all persisting lesions
64
How is fat necrosis managed?
Triple assessment | Most of the time spontaneously resolving

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