Breast Diseases

Question 1

Paget’s Disease of the Breast

Answer 1

• more common in older women
• eczema-like rash around nipple and areola
• has underlying mass
• commonly associated with cancer
• bloody nipple discharge

Question 2

Fibroadenoma

Answer 2

• benign breast lump
• smooth firm and highly mobile
• painless

Question 3

Fibrocystic breast disease

Answer 3

• lumpy breasts
• tender
• fluctuates with the menstrual cycle
• not associated with fever or breast feeding

Question 4

Lactational breast abscess

Answer 4

• caused by infectious mastitis
• typical in breast feeding mothers
• fever, painful breast

Question 5

ductal carcinoma

Answer 5

abnormal proliferation of the ductal cells
- large nuclei
- basement membrane is NOT BREACHED (in-situ)
- INVASIVE DUCTAL CARCINOMA - basement membrane IS BREACHED

Question 6

first line of treatment for mastitis

Answer 6

Flucloxacillin

Question 7

mastitis

Answer 7

• inflammation of the breast tissue due to infection
• causes breast swelling, pain, tenderness and warm
• fever and chills

can lead to pus build up in the breast - causing lactational breast abscess

Question 8

Cyclical Masatalgia

Answer 8

• breast tenderness which fluctuates with the period cycle
• lumpiness is caused due to fibrocystic changes in the cycle
• more common in premenopausal women

Question 9

phyllodes tumour

Answer 9

• breast cancer
• smooth, hard, mobile breast mass
• grows rapidly
• in women from 40-50

Question 10

intraductal papilloma

Answer 10

benign papillary tumour
- bloody nipple discharge
- no palpable mass

Question 11

Radial scar

Answer 11

• sclerosing breast lesion
• central scarring

Question 12

fat necrosis

Answer 12

• inflammatory reaction to adipose tissue damage
• painless breast lump
• skin thickening

Question 13

mammary duct ectasia

Answer 13

• peri-areolar breast caused by inflammation
• breast ducts get dilated
• thick, white nipple discharge

Question 14

What is a breast cyst?

Answer 14

• an overgrowth of glandular connective tissue
• blocks the breast ducts
• lobules fill with fluid

Question 15

Risks for breast cancer

Answer 15

• increased hormone exposure
• late menopause
• early menarche
• HRT
• BRCA gene mutations

Question 16

Lobular Carcinoma

Answer 16

• abnormal growth in the lobules
• more likely to be bilateral
  IN-SITU: BASEMENT MEMBRANE IS NOT BREACHED
  INVASIVE: basement membrane IS BREACHED

Question 17

Medullary Carcinoma

Answer 17

• BRCA1 mutation
• more popular in younger patients

Question 18

Surgical Management of Breast Cancer

Answer 18

• Breast saving mastectomy
  or full mastectomy

Question 19

Tamoxifen Drug Action

Answer 19

AN OESTROGEN RECEPTOR ANTAGONIST
- inhibits the transcription of oestrogen
- used to manage ER POSITIVE TUMOURS

Question 20

Trastuzumb Drug Action

Answer 20

MONOCLONAL ANTIBODY AGONIST
- used to manage HER2 POSITIVE TUMOURS

Question 21

Side Effects of Tamoxifen

Answer 21

causes cardiac toxicity
weight gain
risk of DVT
nausea

Question 22

What is the Triple Assessment for suspected breast cancer?

Answer 22

1. Clinical Exam
2. Radio exam/ mammography
3. Biopsy

Question 23

When is Chemo therapy given?

Answer 23

• for a HER2 NEGATIVE PATIENT

Question 24

Biological Management of Breast Cancer?

Answer 24

Herceptin - for HER2 POSITIVE TUMOUR

Question 25

Hormonal Treatment for Breast Cancer

Answer 25

given for ER POSITIVE TUMOURS give: Aromatase inhibitor OR Tamoxifen

Question 26

what is ANASTROZOLE

Answer 26

Aromatase inhibitor

Question 27

how long is the referral time for suspected cancer patients

Answer 27

urgent 2 week referral

Question 28

where does breast cancer spread first

Answer 28

axillary and cervical lymph nodes

Question 29

when is anastrozole given?

Answer 29

POST MENOPAUSAL

Question 30

when is tamoxifen given

Answer 30

PERI MENOPAUSAL

Question 31

biggest risk factor for breast cancer?

Answer 31

ALCOHOL

Question 32

What screening method is used in women <40

Answer 32

Ultrasound

Question 33

What screening method is used for women >40

Answer 33

Mammogram

Question 34

Why is ultrasound used on women under 40

Answer 34

Their breast cells are less thick so not visible well on mammogram so ultrasound is used

Question 35

Bleeding from nipple Swelling Inverted nipple What it is

Answer 35

Periductal mastitis

Question 36

What is a common risk of mastectomy

Answer 36

Lymphoedema Disruption to the lymphatic system

Question 37

Phyllo does tumour most common characteristic

Answer 37

Grows rapidly in size

Question 38

what happens to the cells in pagets disease of the nipple

Answer 38

the ductal carcinoma cells migrate onto the skin over the nipple - this can cause the eczema around the nipple - bloody discharge

Question 39

risk of tamoxifen?

Answer 39

increases the risk of endometrial cancer - given to PREMENOPAUSAL WITH OESTROGEN POSITIVE BREAST CANCER

Question 40

what is sentinel lymph node biopsy

Answer 40

radioactive substance is injected where the tumour is, and it travels to where the tumour drains into - the path of the tumour can be seen as it lights up