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Flashcards in Breast Lump Deck (95):
1

The genetic predisposition to breast cancer
continues to be delineated with the strong
predisposition from mutations in the genes ______ and _____

BRCA1
and BRCA2

2

The commonest lumps are those associated with
______

mammary dysplasia (32%)

3

_______ is also a common cause of
cysts, especially in the premenopause phase

Fibrocystic disease

4

Over________ of isolated breast lumps prove to be
benign but clinical identification of a malignant tumour
can only definitely be made following aspiration
biopsy or histological examination of the tumour

75%

5

What is the triple test for breast masses?

1 Clinical breast examination
2 Imaging—mammography and/or ultrasound ± MRI
3 Fine-needle aspiration cytology ± core biopsy

6

Breast cancer is the most common cancer in
females. The risk of developing breast cancer
before age 85 in Australian women is ______

1 in 8

7

The average age of diagnosis of breast CA is ____

60.7 years

8

About _____ of all new cancers in women are
breast neoplasms.

25%

9

Ddx for different types of dc

— intraduct papilloma (commonest)
— intraduct carcinoma
— fibrocystic disease

Bloodstained

10

What is the discharge?

— fibrocystic disease
— mammary duct ectasia

Green–grey

11

What is the dc?
— fibrocystic disease
— intraduct carcinoma (serous)
— breast abscess (pus)

Yellow:

12

What is the dc?

— lactation cysts
— lactation
— hyperprolactinaemia
— drugs (e.g. antipsychotic, cocaine)

Milky white (galactorrhoea):

13

Causes of periareolar inflammation

Causes may be
inverted nipple or mammary duct ectasia.

14

It starts as an eczematous-looking, dry
scabbing red rash of the nipple and then proceeds to
ulceration of the nipple and areola

Paget disease of the nippl

15

Time of examination for breast lumps: ideally,__________

4 days after the end
of the period

16

Red flag pointers for breast lumps

• Hard and irregular lump
• Skin dimpling and puckering
• Skin oedema (‘peau d’orange’)
• Nipple discharge
• Nipple distortion
• Nipple eczema
• Postmenopausal women

17

What are the draining lymphatic nodes of the breast

The draining lymphatic nodes are in the axillae,
supraclavicular fossae and internal mammary chain

18

Most cancers occur in the ________

upper outer quadrant

19

Lumps that are usually benign and require no
immediate action are

tiny (<4 mm) nodules in
subcutaneous tissue (usually in the areolar margin);
elongated ridges, usually bilateral and in the lower
aspects of the breasts; and rounded soft nodules
(usually <6 mm) around the areolar margi

20

A hard mass is suspicious of malignancy but
cancer can be soft because of______

fat entrapment

21

The _________ which is usually found in
the heavier breast, is often nodular and firm to hard.

inframammary ridge,

22

Positive signs of malignancy on Xray mammography include an _________

irregular infiltrating mass with focal spotty microcalcification.

23

Xray Mammo for screening

• established benefit for women _______
• possible benefit for women in their ______
• follow-up in those with breast cancer, as 6%
develop in the opposite breast
• localisation of the lesion for fine-needle aspiration

over 50 years


40s

24

This is mainly used to elucidate an area of breast
density and is the best method of defining benign
breast disease, especially with cystic changes.

Breast ultrasound

25

When is breast UTZ usually useful

It is
generally most useful in women less than 35 years old

26

Indications for breast UTZ

• pregnant and lactating breast
• differentiating between ____ and ___
• palpable masses at _______
• for more accurate localisation of lump during
fine-needle aspiration

fluid-filled cysts and solid mass


periphery of breast tissue (not screened by mammography)

27

• <35 years: _____


• 35–50 years: __________


• >50 years: bilateral mammography ± bilateral
ultrasound

bilateral ultrasound; bilateral mammography if ultrasound suspicious

bilateral mammography + bilateral ultrasound

28

Ddx: Very young women—12 to 25 years

Inflamed cysts or ducts, usually close to areola
Fibroadenomata, often giant
Hormonal thickening, not uncommon
Malignancy rare

29

Investigations for 12-25 years old presenting with mass

• mammography contraindicated
• ultrasound helpful

30

Young women—26 to 35 years DDx

Classic fibroadenomata
Fibrocystic disease with or without discharge
Cysts uncommon
Malignancy uncommon

31

Investigations for 26-35 years old presenting with mass

• mammography: breasts often very dense
• ultrasound often diagnostic

32

Women—36 to 50 years (premenopausal) ddx

Cysts
Fibrocystic disease, discharges, duct papillomas
Malignancy common
Fibroadenomata occur but cannot assume
Inflammatory processes not uncommon

33

Investigations for 36-50:
1
2

• mammography useful
• targeted ultrasound useful

34

Women—over 50 years (postmenopausal) ddx

Any new discrete mass—malignant until proven
otherwise
Any new thickening—regard with suspicion
Inflammatory lesions—probably duct ectasia (follow to
resolution)
Cysts unlikely

35

over 50, post menopausal dxtics

• mammography usually diagnostic (first line)
• ultrasound may be useful

36

Ddx Women—over 50 years, on hormones

Any new mass—regard with suspicion
Cysts may occur—usually asymptomatic
Hormonal change not uncommon

37

Dxtics Women—over 50 years, on hormones

• mammography usually diagnostic but breast may
become more dense
• ultrasound may be useful if above normal or unhelpful
and lump suspicious

38

Oestrogen receptors are uncommon in normal
breasts but are found in _____ of breast cancers,
although the incidence varies with age

two-thirds

39

If the lump is cystic—_____;

if solid—perform a _______ and then manage according to outcomes.

If it is suspicious, an_______ is
the preferred option

aspirate
fine-needle biopsy


excisional biopsy

40

Indications for biopsy or excision
of lump

• The cyst fluid is bloodstained.
• The lump does not disappear completely with
aspiration.
• The swelling recurs within 1 month

41

Ninety per cent of breast cancers are _________, the remainder being lobular carcinoma, papillary carcinomas,
medullary carcinomas and colloid or mucoid
carcinomas.

invasive ductal carcinomas

42

RF for breast CA

(>40 years), Caucasian race, pre-existing benign breast lumps,
alcohol >1–2 SDs/day, HRT >5 years, personal
history of breast cancer, family history in a first-degree
relative (raises risk about threefold), nulliparity, late
menopause (after 53), obesity, childless until after
30 years of age, early menarche, ionising radiation
exposure.

43

Up to ______ of cases are familial, with most being
autosomal dominant

5%

44

The majority of patients with breast cancer
present with a lump ______

(76%).

45

________ is a non-invasive abnormal proliferation of milk
duct epithelial cells within the ductal–lobular system
and is a precursor lesion for invasive breast cancer

DCIS

46

Tumour excision followed by whole breast
irradiation was the most preferred local therapy
for most women with _______

stage I or II cancer

47

T or F

Total mastectomy and breast-conservation
surgery had an equivalent effect on survival

T

48

________is preferred for a large tumour,
multifocal disease, previous irradiation and
extensive tumour on mammography

Total mastectomy

49

Recommendations for radiotherapy after
mastectomy are

— tumours >4 cm in diameter
— axillary node involvement of >3 nodes
— the presence of positive or close tumour
margins

50

________ following tumour
excision is one of several techniques for partial
breast irradiation

Intraoperative radiotherapy

51

Cytotoxic chemotherapy has an important place
in management, especially in young healthy
women who are ____ and ______

E receptor negative and have
visceral spread

52

Newer regimens containing _________ have largely replaced the traditional CMF (cyclophosphamide, methotrexate and fluorouracil) regimen

anthracyclines (e.g. epirubicin) and a taxane (e.g. docetaxel)

53

Adjuvant hormonal therapy by the anti-oestrogen
agent _______ (o) daily if E receptor + ve,
which is a specific modulating agent, is widely used
and is most suitable in postmenopausal women

tamoxifen 20 mg

54

________ (for hormone receptor + ve
cancer in postmenopausal women): anastrozole,
letrozole, exemestane

aromatase inhibitors

55

________: recommended for women
with bony metastases since evidence indicates
reversal of bone density loss and cancer
recurrence

bisphosphonates

56

fibroadenosis, chronic mastitis, mammary
dysplasia, cystic hyperplasia

Fibrocystic disease

57

FCC

•Most common in women between_____
• _______-related (between menarche and
menopause)

30 and 50 years

Hormone

58

FCC

Consider mammography if ______

diffuse lumpiness is
present in patient >40 years

59

Common in women aged 40–50 years
(perimenopausal)
• Rare under 30 years
• Associated with mammary dysplasia

Breast cyst

60

Dx of breast cyst

• Mammography
• Ultrasound (investigation of choice)
• Cytology of aspirate

61

Mx of breast cyst

• Drainage with a fine needle
Surgery is rarely required

62

Localised nodularity

Usually:
• in upper_____ of breast
• a physiological change to breast
• managed with _______
• investigate with imaging in older women if
asymmetric or perceived change

outer quadrant


clinical surveillance

63

These milk-containing cysts arise during
pregnancy and present postpartum with similar
signs to perimenopausal cysts.
• They vary from 1–5 cm in diameter

Lactation cysts (galactoceles

64

Lactation cysts (galactoceles) aspirate

• Treat by aspiration: fluid may be clear or milky.

65

• A discrete, asymptomatic lump
• Usually in 20s (range: second to sixth decade,
commonly 15–35 years)
• Firm, smooth and mobile (the ‘breast mouse’)

Fibroadenoma

66

Location of Fibroadenoma

• Usually in upper outer quadrant

67

True about Fibroadenoma

They double in size about every_______

12 months

68

Fibroadenoma

____ and ________ is recommended plus mammography in older women

Ultrasound and fine-needle aspiration or core biopsy
with cytology

69

When to do excision biopsy for suspicious fibroad

Excision biopsy if
large (>3–4 cm), continues to enlarge, suspicious
biopsy or woman >40 years

70

These are giant fibroadenoma-like tumours that
are usually benign but 25% are malignant and
metastasise. They are completely excised with a rim
of normal breast tissue

Phyllodes tumour

71

_______s usually the end result of a large bruise
or trauma that may be subtle, such as protracted
breastfeeding

Fat necrosis

72

T or F
The full triple test is required in fat necrosis

t

73

These are benign hyperplastic lesions within large
mammary ducts and are not premalignant (nor
usually palpable).

Duct papillomas

74

Duct papillomas should be______

excised

75

Synonyms: plasma cell mastitis, periductal mastitis

Mammary duct ectasia

76

In this benign condition a whole breast quadrant
may be indurated and tender. The larger breast ducts
are dilated.

Mammary duct ectasia

77

Mammary duct ectasia:

The lump is usually located near the _____

margin of the areola and is a firm or hard, tender, poorly
defined swellin

78

It should be noted that mammography
may be of limited value in the presence of
prostheses, especially if a________

fibrous capsule exists
around the prosthesis.

79

This is a long-term complication of surgery plus
irradiation for breast cancer treatment when there is
a failure of the lymphatic system to adequately drain
extracellular fluid

Lymphoedema of arm

80

What to exclude in lymphedema of arm

Exclude obstruction of the
deep venous system by Doppler ultrasound

81

Cause of Neonatal enlargement of breasts

This is due to transplacental passage of
lactogenic hormones. The swelling usually lasts 7–10
days if left alone

82

The usual presentation is the development of one
breast in girls commonly 7–9 years of age but sometimes younger

Premature hyperplasia

83

Screening mammography should be encouraged for
women between ______ and ____

50 and 70 years, and performed at
least every 2 years

84

Sp of mammography

90%

85

regular BSE is
recommended for all women_____

35 years and over

86

_______ commonly occur in women in
their late teens and 20s,

________ between 35 years and the menopause,

and ______is the most common cause of a lump in
women over 50 years

Fibroadenomas

benign breast cysts


cancer

87

Never assume a palpable mass is a _____
in any woman over 30 years of age

fibroadenoma

88

Gentle palpation is required. Squeezing breast
tissue between finger and thumb tends to produce
_____

‘pseudolumps

89

_____ and _____ can be
clinically indistinguishable from breast cancer

Mammary duct ectasia and fat necrosis

90

Nine out of 10 women who get breast cancer do
not have a _______

strong family history

91

T or F

The oral contraceptive pill has been generally
shown not to alter the risk of breast cancer.

T

92

Never assume a lesion is a ________—prove it with
ultrasound or successful aspiration

cyst

93

T or F

Mammography can not detect breast cancers which
are too small to feel.

F

it can detect

94

T or F

Mammography is not a diagnostic tool.

T

95

Recommended mammography screening for
women:

50–69 years and those aged 40–49 who
request it.