Breast diseases

Question 1

what are the risk factors for developing fat necrosis

Answer 1

big breasts
trauma such as seat belt injury
warfarin therapy

Question 2

what causes fat necrosis to develop

Answer 2

damage to adipocytes causing inflammatory response, in an attempt to remove fat fibrosis and scarring develops

Question 3

how does fat necrosis present

Answer 3

mastalgia
breast lump
involution of the breast

Question 4

what is duct ectasia

Answer 4

blockage and dilatation of lactiferous ducts

Question 5

what puts you at risk of developing duct ectasia

Answer 5

smoking

peri/postmenopausal age

Question 6

how does duct ectasia present

Answer 6

mastalgia
slit like nipple retraction
palpable mass behind nipple
purulent/blood stained discharge

Question 7

how is duct ectasia managed

Answer 7

smoking cessation

duct excision

Question 8

which benign breast disease presents in young women, cyclical sudden mastalgia with smooth discrete lumps

Answer 8

fibrocystic disease

Question 9

describe the appearance of lumps in fibroadenomas

Answer 9

smooth, discrete and mobile

may be multiple lumps giving cobblestone appearance

Question 10

what is the management of fibroadenoma

Answer 10

no management, will self-resolve

Question 11

describe the clinical features of duct papilloma

Answer 11

older women - single lesion
younger women - multiple lesions peripherally
presents with lump and blood stained discharge

Question 12

what is Phyllodes tumour

Answer 12

benign growth of stromal tissue

presents in peri-menopausal women

Question 13

what 2 groups of women are at greatest risk of developing mastitis

Answer 13

women who are breast feeding

women with duct ectasia

Question 14

what are the main causative organisms of mastitis

Answer 14

staph aureus

strep spp.

Question 15

outline the clinical features of mastitis

Answer 15

mastalgia
erythema, tenderness, swelling of the breast
generally feeling unwell

Question 16

what is the main complication of mastitis

Answer 16

breast abscess - painful hot lump

Question 17

if mastitis develops whilst breast feeding, should the woman continue

Answer 17

yes as prevents milk stasis and infection cannot be passed onto the baby

Question 18

what is the management of mastitis

Answer 18

encourage breast feeding and ensure complete draining
1g flucloxacillin QDS 7-10 days
2nd line is 450mg clindamycin TDS 7-10 days

Question 19

if a breast abscess is suspected, how is it managed

Answer 19

US to confirm

admit for surgical drainage

Question 20

what is gynaecomastia

Answer 20

development of breast tissue in men, ductal growth but not lobular

Question 21

what causes gynaecomastia to develop

Answer 21

puberty 
idiopathic 
testicular tumours 
hypogonadism, liver cirrhosis 
drugs - spirnolactone, anabolic steroids, digoxin, GnRH analogues

Question 22

how is gynaecomastia managed

Answer 22

usually no management required as most cases resolve within 2 years
treat underlying cause
if extreme, tamoxifen or danazol

Question 23

when does screening take place for breast cancer

Answer 23

aged 50-70 every 3 years

Question 24

what is the most common type of breast cancer

Answer 24

adenocarcinoma

Question 25

what are the 3 receptors that can be expressed in breast cancer

Answer 25

ER Progesterone HER2

Question 26

which receptors have a positive effect on outcome in breast cancer

Answer 26

ER and PR

Question 27

list some poor prognostic indicators for breast cancer

Answer 27

<35 years old HER2 positive oestrogen receptor negative lymph node positive

Question 28

list some risk factors for developing breast cancer

Answer 28

``` <55 years old early menarche, late menopause nulliparity, first child after 35 years, no breast feeding Hx of breast cancer or radiotherapy HRT and COCP use smoking, alcohol, obesity ```

Question 29

what gene mutations increase risk of developing breast cancer

Answer 29

BRCA 1 and 2 mutations | TP53 mutations

Question 30

what are the 2 precursor lesions that can develop before invasive breast cancer

Answer 30

ductal carcinoma in situ | lobular carcinoma in situ

Question 31

outline the pathology findings of DCIS

Answer 31

malignant cells confined within the basement membrane of acini/ducts

Question 32

what mammogram findings are pathognomonic for DCIS

Answer 32

microcalcifications

Question 33

out of DCIS and LCIS which one is usually asymptomatic

Answer 33

LCIS is usually asymptomatic as detected through screening

Question 34

describe the appearance of a malignant breast lump

Answer 34

irregular, tethered, non-fluctuating | taller rather than wide

Question 35

what are the skin changes seen with breast cancer

Answer 35

erythema Peau d'orange pagets disease - eczema like

Question 36

what are the nipple changes seen with breast cancer

Answer 36

unilateral blood stained discharge retraction Pagets

Question 37

how is a breast lump investigated

Answer 37

triple assessment clinical history and examination mammogram biopsy for pathology

Question 38

what are the characteristic findings of breast cancer on MXR

Answer 38

microcalcifications and usually pleomorphic

Question 39

what is the benefit of ultrasound in breast cancer diagnosis

Answer 39

helps to characterise a lesion, malignant lesions are heterogenous, taller than wide and poorly circumscribed

Question 40

what is the broad management of breast cancer

Answer 40

surgery +/- axillary node clearance chemo or radiotherapy endocrine therapy

Question 41

what are the 2 options for breast surgery

Answer 41

breast conserving - wide local excision | non-conserving - mastectomy

Question 42

which surgical option is generally preferred

Answer 42

breast conserving if tumour is <4cm in size

Question 43

what is the main side effect of lymph node clearance following breast surgery

Answer 43

lymphoedema of the arm | damage to the brachial plexus

Question 44

what are the main reconstructive options following breast surgery

Answer 44

implants tissue flaps nipple remodelling

Question 45

what is a issue with implants

Answer 45

placed under the pec major and risk of rippling or migration

Question 46

outline the main muscles that are used for flaps and their blood supply

Answer 46

latissimus dorsi - thoracodorsal artery abdomen - inferior epigastric buttocks - inferior gluteal artery

Question 47

what are the 2 indications for radiotherapy in breast cancer

Answer 47

adjuvant as part of WLE to reduce tumour size | palliative

Question 48

what are some side effects of radiotherapy (immediate and late)

Answer 48

immediate - erythema of area, tiredness | late - skin and lung fibrosis, IHD

Question 49

what is the standard chemotherapy regime for breast cancer patients

Answer 49

CMF | cyclophosphamide, methotrexate and 5FU

Question 50

when are endocrine therapies indicated in breast cancer

Answer 50

used in oestrogen receptive positive cancers | improves disease free survival

Question 51

what are the 2 main endocrine therapies that are used in breast cancer

Answer 51

Tamoxifen - partial oestrogen agonist | Letrozole - aromatase inhibitor

Question 52

which endocrine therapy is only used in post-menopausal women and why

Answer 52

Letrozole only used for post-menopausal women as induces the menopause

Question 53

tamoxifen increases risk of which gynae cancer

Answer 53

endometrial

Question 54

what are the side effects of endocrine therapies

Answer 54

``` DVT infertility weight gain osteoporosis hot flushes ```

Question 55

when is immunotherapy recommended in breast cancer

Answer 55

used for HER2 +ve tumours

Question 56

what are some examples of immunotherapy agents

Answer 56

trastuzimab and herceptin

Question 57

what primary tumours commonly metastasise to the breast

Answer 57

bone liver lung brain