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Breast Diseases Flashcards

1
Q

is breast cancer the most common cancer in women

A

yes

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2
Q

what is the most common type of invasive and in situ carcinoma

A

80% ductal type

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3
Q

what is the prognosis of breast cancer

A 
5 year: 
86% for all stages 
97% localised 
78% regional involvement 
23% metastatic
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4
Q

what are the risk factors for breast cancer

A 
being female 
increasing age 
genetic mutations 
atypical ductal or lobular hyperplasia 
lobular carcinoma in situ
atypical epithlial hyperplasia 
first child after 30 
alcohol 
early menarche 
FMHx
previous breast cancer 
nulliparity 
postmenopausal obesity 
alcohol 
hormone replacement 
radiation exposure
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5
Q

what lifestyle changes reduce rsk of breast cancer

A

routine vigorous physical activity

maintenance of health body weight

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6
Q

what are the common breast cancer presentation symptoms

A

50% asymptomatic - screening
50% symptomatic- half of these have a lump

dimple of depressed skin 
visible lump 
nipple change or external inversion 
bloody discharge 
texture change 
colour change
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7
Q

what is the triple assessment for breast disease (for symptomatic patients)

A

Hx
exam +/- mammogram (standard, do 4 views) +/- USS (can see if solid or cystic)
biopsy (histology to see if invasive, ductal or lobular, degree of differentiation, receptor status)

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8
Q

what is the staging for breast cancer

A 
T0 no tumour 
T1 <2cm 
T2 2-5cm 
T3 >5cm 
T4 extension to skin or chest wall/ both

N1 mobile nodes
N2 fixed nodes
N3 ipsiplateral internal mammary nodes involves

M0 no distant mets
M1 mets demonstrable
Mx mets suspected but not confirmed

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9
Q

is disseminated breast cancer curable

A

no

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10
Q

are the majority of breast Cxs early or late stage

A

early

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11
Q

what is the treatment overview for early breast cancer

A

local- surgery, radio

systemic- chemo, hormonal, targeted therapies

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12
Q

what is oncoplastic surgery

A

uses plastic surgery techniques for wider excisions to conserve more of the breast, leaves symmetrical breasts
oncoplastic prodedures shape the breasts

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13
Q

is radio therapy local or systemic treatment

A

local

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14
Q

what is a modified radical mastectomy

A

total mastectomy
removes entire breast inc overlying skin and axillary lymph nodes
preserves pec major which facilitates wound healing and allows reconstruction

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15
Q

what are the options available for breast reconstruction

A

most women who get mastectomy are eligible
can be prosthetic or autologous tissue
both these can be done immediately or delayed
skin sparing mastectomy provides better aesthetic outcome after reconstruction
choice of the reconstruction method depends upon:
-patient’s body habitus
-co-morbidity
-smoking history
-size and shape of her breasts
-her preference
-surgeon’s experience

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16
Q

what are the indications or post mastectomy radiotherapy

A

involvement of >3 nodes
positive surgical margins
and/ or tumours larger than 5 cm

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17
Q

when can partial breast radiotherapy be given

A

intra op or post op (breast conserving therapy)

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18
Q

what are the adjuvant systemic therapies for breast cancer

A

chemo (adjuvant, neoadjuvant)
hormonal therapy
targeted therapy

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19
Q

what drug is most commonly used for hormonal therapy for breast cx

A

tamoxifen

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20
Q

why do lose your hair while getting chemo

A

kills everything in end phase- hair follicles, lining of gut

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21
Q

what are the forms of hormonal therapy for breast cancer

A

non invasive- -SERM= selective estrogenic receptor modulators,

  • aromatase inhibitors (stop production of oestrogen)
  • GnRH (blocks hypothalamic pathway for ovarian stimulation)

invasive:
-oophrectomy (rarely done now for breast Cx)

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22
Q

what receptor is implicated int he pathogenesis of breast cancer as is acted upon by the targeted therapies

A

HER-2

human epidermal receptor

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23
Q

what is herceptin

A

human epidermal growth factor receptor 2 monoclonal antibody
= trastuzumad
targets HER2

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24
Q

what are bevacizumab and lapatinib

A

other biological therapies for breast cx
bevaciumab is a monoclonal antibody that targets vascular endothelial growth factor, first line for metastatic breast cancer
lapatinib- dual inhibitor of epidermal growth factor receptor and human epidermal growth factor 2 tyrosine kinases. used in advanced disease when other biological treatments have already been used

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25
Q

where does breast cancer spread to

A

bone
liver
brain
lung

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26
Q

what can be done for late or advanced breast cancer

A

palliative chemo or radio therapy to relieve symptoms

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27
Q

are 80% of symptomatic breast cases benign or malignant

A

benign

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28
Q

what are the causes of benign breast disease

A

hormonal changes
infective/ inflammatory changes
aberrations in the normal development and involution of the breast (ANDI)

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29
Q

what conditions can be caused by ANDI

A

cysts
fibroadenoma
papilloma

30
Q

what is a fibroadenoma

A

most common benign neoplasm of the breast

31
Q

what is the presentation of a fibroadenoma

A 
palpable mass 1-3 cm 
early reproductive years (15-25)
on exam:
-rubbery to firm 
-mobile
-smooth 
-distinct borders 
-usually non tender
32
Q

how do you diagnose a fibroadenoma

A

USS core biopsy

33
Q

what is the management of fibroadenoma

A

dont need to be removed, most reabsorb and usually become nonpalpable after the menopause
some women prefer to have them removed- lumpectomy/ percutaneous vacuum assisted core biopsy under LA

34
Q

what tumour can a fibroadenoma mimic- how do you tell them apart

A 
phyllodes (these are uncommon) 
phyllodes are:
larger 3-6cm 
occur in older women (35-45)
increase in size
35
Q

what is the management for a phyllodes tumour

A

as can be benign, intermediate or malignant need histology
tumour should be excised with wide 1cm clear surgical margins
follow up
mets rare

36
Q

what is the presentation of a breast cyst

A

common in late reproductive years
palpable, clearly defined, soft, smooth, mobile with distinct borders
often tender, especially before menstruation
may be mulitpl and/ or bilateral

37
Q

what is the management of a breast cyst

A

USS
can leave or
FNA aspiration (for diagnosis and Tx)
if fluid grossly bloody then cytology needed
palpate after aspiration to ensure no residual mass

38
Q

what are breast cysts

A

milk duct that rapidly fill with fluid then cant drain

39
Q

what condition can occur within breast cysts

A

papillomas, esp associated with a bloddy filled cyst

40
Q

what is a papilloma

A

benign intracystic papillary proliferation

41
Q

what is a intracystic carcinoma (malignant papilloma suspected)

A

when fluid in cyst is grossly bloody/ residual mass after aspiration

42
Q

what histological diagnosis for any intracystic solid lesion

A

ultrasound guided core biopsy

43
Q

what is mastalgia

A

breast pain
dull, heavy, achy
begins up to 2 weeks before a period, gets worse immediately premenstrual then improves usually as it ends
cyclic mastalgia is usually bilateral

can be noncyclic: tends to be localised, persistent, less resposive to Tx than cyclical

44
Q

is mastalgia associated with malignancy

A

no

45
Q

what are the non breast causes of anterior chest wall pain

A 
Achalasia
Angina
Cervical radiculitis
Cholecystitis
Cholelithiasis
Coronary artery disease
Costochondritis (Tietze syndrome)
Fibromyositis
Hiatal hernia
Myalgia
Neuralgia
Osteomalacia
Phantom pain
Pleurisy
Psychological pain
Pulmonary embolus
Pulmonary infarct
Rib fracture
Sickle cell disease
Trauma
Tuberculosis
46
Q

what causes cyclic mastalgia

A

intense variant of physiological changes that occur to breast during menstrual cycle

47
Q

what Ix for cyclical mastalgia

A 
complete evaluation and mammogram 
well fitting bra, regular exercise 
primrose oil 
topical NSAID
dialy pain chart
48
Q

when is nipple discharge pathological

A

(most women of repro age can elicit clear, watery yellow discharge)
if it is bloody and particularly from a single duct

49
Q

what is the most common cause of nipple discharge

A

intraductal papilloma/ papillomas (benign lesions)

excise all so dont miss intraductal carcinoma

50
Q

when is nipple discharge associated with malignancy

A

when there is a palpable mass

however all intraductal lesions should be excised and histologically evaluated

51
Q

what Ix for pathological nipple discharge

A

mammography
USS
surgical excision of discharging ducts

52
Q

what is pagets disease of the nipple

A

variant of ductal carcinoma

53
Q

how does pagets disease of the nipple present

A

erythematous weeping lesion on surface of nipple and areola
dry, scaly
patient may perceive this as nipple discharge

54
Q

how do you diagnose pagets disease of the nipple

A

biopsy (incisional or punch)

often underlying palpable mass/ radiological abnormality

55
Q

what management for mastitis

A

Abx for staph aureus e,g, flucloxacillin
examined every three days to see response and ensure no abscess formation
lack of response -> change abx

56
Q

what are the symptoms of mastitis

A 
fever 
erythema
induration 
tenderness
swelling
57
Q

can you breast feed when you have mastitis

A

yes continue if already begun or breast can be pumped until infection clears

58
Q

how does a breast abscess present

A

bulging mass in the central area of mastitis

fluid filled centre on USS

59
Q

management for a breast abscess

A

aspiration under LA for diagnosis (pus filled) and Tx
aspirate sent for microbial analysis
may need repeated aspiration/ surgical drainage
antibiotics continued until cellulitis has cleared

60
Q

what organisms cause nonpuerperal mastitis

A

S aureus
peptostreptococcus magnis
bacteriodes fragilis

61
Q

is nonpuerperal mastitis common

A

no esp in postmenopausal women

62
Q

management for nonpuerperal mastitis

A

re-examined every 3 days until the infection clears. Augmentin 625 mg orally every 8 hours for 7 days as initial therapy is usually effective. Alternately, cephalexin 500 mg orally every 6 hours for 7 days can be prescribed.

63
Q

what is chronic mastitis associated with

A

(uncommon)

subareolar abscess

64
Q

what is a complication of chronic mastitis

A

periareolar fistulae

65
Q

when should you suspect malignancy in mastitis

A

if inresponsive to Abx and spread over entire breast

inflammatory carcinoma

66
Q

what makes mastitis more likely to develop into an abscess

A

poor immune system- diabetes, smoking

67
Q

what is an adenolipoma

A

aka hamartoma- benign breast lesion, Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

68
Q

what is a galactocele

A

a palpable milk-filled cyst most commonly associated with pregnancy or lactation. FNA can diagnose and drain a galactocele

69
Q

what is mondors disease

A

phlebitis (vein inflammation) and subsequent clot formation in the superficial (skin) veins of the breast
usually resolves spontaneously in 8–12 weeks

70
Q

how does mondors disease present

A

firm, vertical, cord-like structure usually associated with a history of trauma to the breast

Reproduction (51 decks)

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