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Reproduction and Sexual Health > Breast diseases > Flashcards

Breast diseases Flashcards

1
Q

what are the risk factors for developing fat necrosis

A

big breasts
trauma such as seat belt injury
warfarin therapy

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2
Q

what causes fat necrosis to develop

A

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

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3
Q

how does fat necrosis present

A

mastalgia
breast lump
involution of the breast

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4
Q

what is duct ectasia

A

blockage and dilatation of lactiferous ducts

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5
Q

what puts you at risk of developing duct ectasia

A

smoking

peri/postmenopausal age

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6
Q

how does duct ectasia present

A

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

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7
Q

how is duct ectasia managed

A

smoking cessation

duct excision

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8
Q

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

A

fibrocystic disease

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9
Q

describe the appearance of lumps in fibroadenomas

A

smooth, discrete and mobile

may be multiple lumps giving cobblestone appearance

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10
Q

what is the management of fibroadenoma

A

no management, will self-resolve

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11
Q

describe the clinical features of duct papilloma

A

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

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12
Q

what is Phyllodes tumour

A

benign growth of stromal tissue

presents in peri-menopausal women

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13
Q

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

A

women who are breast feeding

women with duct ectasia

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14
Q

what are the main causative organisms of mastitis

A

staph aureus

strep spp.

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15
Q

outline the clinical features of mastitis

A

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

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16
Q

what is the main complication of mastitis

A

breast abscess - painful hot lump

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17
Q

if mastitis develops whilst breast feeding, should the woman continue

A

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

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18
Q

what is the management of mastitis

A

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

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19
Q

if a breast abscess is suspected, how is it managed

A

US to confirm

admit for surgical drainage

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20
Q

what is gynaecomastia

A

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

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21
Q

what causes gynaecomastia to develop

A 
puberty 
idiopathic 
testicular tumours 
hypogonadism, liver cirrhosis 
drugs - spirnolactone, anabolic steroids, digoxin, GnRH analogues
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22
Q

how is gynaecomastia managed

A

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

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23
Q

when does screening take place for breast cancer

A

aged 50-70 every 3 years

24
Q

what is the most common type of breast cancer

A

adenocarcinoma

25
Q

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

A

ER
Progesterone
HER2

26
Q

which receptors have a positive effect on outcome in breast cancer

A

ER and PR

27
Q

list some poor prognostic indicators for breast cancer

A

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

28
Q

list some risk factors for developing breast cancer

A 
<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
29
Q

what gene mutations increase risk of developing breast cancer

A

BRCA 1 and 2 mutations

TP53 mutations

30
Q

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

A

ductal carcinoma in situ

lobular carcinoma in situ

31
Q

outline the pathology findings of DCIS

A

malignant cells confined within the basement membrane of acini/ducts

32
Q

what mammogram findings are pathognomonic for DCIS

A

microcalcifications

33
Q

out of DCIS and LCIS which one is usually asymptomatic

A

LCIS is usually asymptomatic as detected through screening

34
Q

describe the appearance of a malignant breast lump

A

irregular, tethered, non-fluctuating

taller rather than wide

35
Q

what are the skin changes seen with breast cancer

A

erythema
Peau d’orange
pagets disease - eczema like

36
Q

what are the nipple changes seen with breast cancer

A

unilateral blood stained discharge
retraction
Pagets

37
Q

how is a breast lump investigated

A

triple assessment
clinical history and examination
mammogram
biopsy for pathology

38
Q

what are the characteristic findings of breast cancer on MXR

A

microcalcifications and usually pleomorphic

39
Q

what is the benefit of ultrasound in breast cancer diagnosis

A

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

40
Q

what is the broad management of breast cancer

A

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

41
Q

what are the 2 options for breast surgery

A

breast conserving - wide local excision

non-conserving - mastectomy

42
Q

which surgical option is generally preferred

A

breast conserving if tumour is <4cm in size

43
Q

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

A

lymphoedema of the arm

damage to the brachial plexus

44
Q

what are the main reconstructive options following breast surgery

A

implants
tissue flaps
nipple remodelling

45
Q

what is a issue with implants

A

placed under the pec major and risk of rippling or migration

46
Q

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

A

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

47
Q

what are the 2 indications for radiotherapy in breast cancer

A

adjuvant as part of WLE to reduce tumour size

palliative

48
Q

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

A

immediate - erythema of area, tiredness

late - skin and lung fibrosis, IHD

49
Q

what is the standard chemotherapy regime for breast cancer patients

A

CMF

cyclophosphamide, methotrexate and 5FU

50
Q

when are endocrine therapies indicated in breast cancer

A

used in oestrogen receptive positive cancers

improves disease free survival

51
Q

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

A

Tamoxifen - partial oestrogen agonist

Letrozole - aromatase inhibitor

52
Q

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

A

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

53
Q

tamoxifen increases risk of which gynae cancer

A

endometrial

54
Q

what are the side effects of endocrine therapies

A 
DVT
infertility
weight gain
osteoporosis 
hot flushes
55
Q

when is immunotherapy recommended in breast cancer

A

used for HER2 +ve tumours

56
Q

what are some examples of immunotherapy agents

A

trastuzimab and herceptin

57
Q

what primary tumours commonly metastasise to the breast

A

bone
liver
lung
brain

Reproduction and Sexual Health (22 decks)

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