Breast Medicine Flashcards by Laura Gumbley

List some differential diagnoses for breast lump

Malignancy
Fibroadenoma
Cyst
Breast abscess
Fat necrosis
Sclerosing adenosis

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Describe what you would find on examination of a patient with a breast cyst

A smooth, firm, mobile lump which is not tethered to the skin.

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What is the peak age for fibroadenoma of the breast?

16-24

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Describe what you would find on examination of a patient with a fibroadenoma of the breast

Discrete, firm, non-tender, highly mobile lump

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True / False: Fibroadenomas predispose to cancer and therefore should be removed

False - Fibroadenomas of the breast do NOT predispose to cancer and can be left alone

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What is the management of mastitis in a woman who is breastfeeding?

Antibiotics e.g. co-amoxiclav, flucloxacillin
Warm compress
Encourage the woman to express milk in order to prevent stagnation of the infection

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What is the common bacterial cause of mastitis?

Staph. aureus

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Breast lump in a woman with a history of road traffic accident whilst wearing a seatbelt might lead you to suspect what breast pathology?

Fat necrosis

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A patient presents with ‘breast pain’ - what important question must you ask?

What relationship does the pain have to her periods?

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What is duct ectastia and when does it typically present?

Blocking of the breast duct and stagnation of fluid behind it. Typically occurs around menopause as ducts are becoming smaller.

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What is sclerosing adenosis of the breast?

Benign condition resulting from over-proliferation of the terminal duct lobules

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True / False: Breast cancer is the most common female cancer, accounting for over 20% of female cancers

True

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What is the process of breast cancer screening?

Women aged 50 - 70 are offered a mammogram every 3 years. After age 70, women can request a mammogram if they wish to have one.

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What does the ‘triple assessment’ involve?

Clinical examination i.e. full history and examination of the breast and axilla
Radiological assessment i.e. mammography and/or ultrasound
Histological assessment i.e. core biopsy or fine needle aspiration cytology

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What does FNAC mean?

Fine needle aspiration biopsy

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Women over how old can receive a mammogram as part of the triple assessment?

Women over 35 years old will receive a mammogram in breast clinic. Women below this age will have breast tissue which is too dense.

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What is carcinoma in situ?

Carcinoma which has not invaded through the basement membrane

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What is the most common form of non-invasive breast cancer?

Ductal carcinoma in situ

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What is the characteristic appearance of ductal carcinoma in situ on mammography?

Presence of microcalcifications

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What type of non-invasive breast cancer is more common in pre-menopausal women?

Lobular carcinoma in situ (c.f. ductal CIS which is usually in peri-menopausal or post-menopausal women)

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Which 3 hormone receptors are important in breast cancer?

Oestrogen receptor (ER)
Progesterone receptor (PgR)
HER2 receptor

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What is tamoxifen?

An oestrogen receptor antagonist - used for treatment of oestrogen receptor positive breast cancers

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List some presenting symptoms of breast cancer

Breast lump
Nipple changes i.e. inversion
Skin changes e.g. peau d'orange
Symptoms of metastatic disease
Detection on screening

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What is Paget’s disease?

Study These Flashcards

Eczema of the breast skin caused by an underlying carcinoma

Which surgical options are available for removal of breast cancer?

Wide local excision | Mastectomy

Into which lymph nodes does breast cancer drain?

Axillary lymph nodes | Internal mammary nodes

What are the 2 options for management of lymph nodes in breast cancer

Sentinel node biopsy | Axillary node clearance

What are 2 complications of axillary node clearance?

Arm swelling | Lymphoedema

Give one example of an aromatase inhibitor

Anastrazole

What is the treatment for a breast cyst?

Usually nothing - manage conservatively | Some may opt for aspiration

What is the typical presentation of inflammatory breast cancer?

Erythema and oedema of the breast, in the absence of fever or other infective markers. WCC and CRP are normal.

What is the tumour marker which is usually raised in inflammatory breast cancer?

CA 15-3

What is Mondor's disease?

Thrombophlebitis of breast veins

What factors might indicate a wide local excision is indicated in the management of a breast tumour?

``` Small tumour (4cm in large breast Single focus of the lesion ```

True / False: All women who have a wide local excision as management of a breast tumour will need post-operative radiotherapy

True

What are the complications of a mastectomy?

``` Failure to completely excise the tumour Bleeding Infection Seroma Psychological impacts ```

What is a seroma?

Accumulation of serous fluid in the space left after removal of breast tissue in mastectomy. Drains are inserted during surgery to minimise risk.

Where does breast cancer metastasise to?

``` Lymph nodes (axillary and mammary) Lung Liver Brain Bone ```

Which endocrine treatment can be given to a patient if their breast cancer is found to be oestrogen receptor positive?

``` Tamoxifen for pre-menopausal women Aromatase inhibitors (anastrozole, letrozole) in post-menopausal women ```

True / False: Most breast cancers which are oestrogen receptor positive will also be positive for the HER2 receptor?

False - Most breast cancers which are oestrogen receptor positive are likely to be positive for the progesterone receptor, but negative for the HER2 receptor

What does it mean if a breast cancer is 'triple negative'?

The cancer does not have oestrogen, progesterone or HER2 receptors

What does HER2 stand for?

Human epidermal growth factor

What are the side effects of tamoxifen?

Menopausal symptoms: Vaginal dryness, VTE, hot flushes, altered libido, weight gain, menstrual disturbance, endometrial cancer

True / False: A pre-menopausal woman found to have oestrogen receptor positive breast cancer will be given Letrozole?

False - Letrozole is an aromatase inhibitor (also anastrozole) and these are contraindicated in pre-menopausal women. Tamoxifen is given to these patients.

What are the side effects of aromatase inhibitors?

Vaginal dryness Osteoporosis Joint / muscle pain Hot flushes

What is the mechanism of action of aromatase inhibitors?

Stops the synthesis of oestrogen

What does a biopsy result of B5a indicate?

Carcinoma in situ

What 2 views are taken on a mammogram?

``` CC = Crania-Caudal MLO = Mediolateral oblique ```

Which patients are offered MRI scanning as part of their assessment?

- Yearly MRI for patients with FHx or who had supra-diaphragmatic radiotherapy - Diagnosed lobular carcinoma when helping to decide whether breast conserving surgery is appropriate - Discordance in triple assessment results - Dense breast tissue

What are the different types of mastectomy?

Simple: Removal of breast only Completion: Removal of remaining breast after previous wide local excision Skin sparing: Breast and nipple removed but skin of breast remains Nipple sparing: Breast tissue removed but skin of the nipple remains Risk reducing: 'Prophylactic' mastectomy i.e. offered to high risk women

What non-surgical options are available for management of breast cancer?

Radiotherapy Chemotherapy (adjuvant or neo-adjuvant) Hormone therapy

Give the indications for neo-adjuvant chemotherapy in the management of breast cancer

- Locally advanced breast cancer to allow for surgery | - To allow immediate reconstruction for extensive disease

Give the indications for adjuvant chemotherapy in the management of breast cancer

``` Node positive HER2 positive Triple negative Grade 3 cancer Young at presentation ```

Give the indications for radiotherapy after a mastectomy

More than 4 positive nodes Tumour larger than 5cm Positive margins

After surgery, what medical treatment will a patient with HER2 positive breast cancer receive?

Herceptin AND chemotherapy - The 2 are given alongside one another

'Slit-like' retraction of the nipple is typical of which condition?

Duct ectasia

Give some presenting features of mammary duct ectasia

Patients around the time of menopause Nipple discharge - might be cream, green, bloodstained (usually comes from several ducts) Slit-like retraction of the nipple

Bloodstained discharge originating from one duct might indicate which condition?

Intraductal papilloma

Breast Medicine Flashcards

(58 cards)