Breast Conditions Flashcards Preview

Reproduction > Breast Conditions > Flashcards

Flashcards in Breast Conditions Deck (64):
1

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

1:9

2

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

>8000

3

What is the triple assessment?

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

4

Why is mammography sensitivity reduced in young women?

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

5

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

6

What can core biopsy confirm that FNA can't?

ER, PR, HER2 status

7

What is the most common invasive breast carcinoma?

Ductal carcinoma (80%)

8

What tests are used in breast cancer staging?

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

9

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

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

10

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

N0 Non palpable
N1 Mobile
N2 Fixed

11

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

M0 No mets
M1 Mets

12

What are surgical options for breast carcinoma in the axilla?

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

13

What will all patients get after WLE as adjuvant therapy?

Radiotherapy

14

What radiotherapy will post-WLE patients receive?

40-50Gy over 3 or 5 weeks
Boosts reduce local recurrence

15

What are the complications of radiotherapy post WLE/Mx?

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

16

When is radiotherapy given post Mx?

If there is local involvement

17

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)

18

What are the traditional chemotherapies used in breast cancer?

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

19

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

Oestrogen deprivation- only in ER +ve tumours

20

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

Tamoxifen
Aromatase inhibitors

21

What invasive hormone therapy is carried out in breast cancer?

Oophorectomy

22

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

23

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

24

What can aromatase inhibitors increase the risk of?

Osteoporosis

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