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Year 3 - Repro and Sexual Health > Breast Week - General > Flashcards

Breast Week - General Flashcards

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1
Q

Give examples of risk factors for breast cancer

A 
Precursor lesions 
Age
Firth child after 30
Nulliparous 
Post-menopausal obesity 
Early menarche 
Genetics
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2
Q

What is the most common type of breast cancer?

A

Ductal

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3
Q

How does invasive and in situ carcinoma present normally?

A

Through screening or patient presents to GP with a lump

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4
Q

How may a breast lump be investigated in a young woman?

A

Ultrasound and mammography

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5
Q

Which type of breast cancer present with an “Indian file” appearance?

A

Invasive lobular carcinoma

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6
Q

How is radiotherapy given for breast cancer?

A

4500-5000 centigrays 5 days per week for 6 weeks

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7
Q

What does a radical mastectomy remove?

A

Entire breast, overlying skin and lymph nodes

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8
Q

How can breast reconstruction be achieved?

A

Through breast prosthesis
Lat dorsi myocutaneous flap plus breast prothesis
Deep inferior epigastric perforator free flap
Transverse rectus abdominis myocutaneous flap
Superior/inferior gluteal artery perforator free flaps

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9
Q

What are the indications for post-mastectomy radiotherapy?

A

Involvement of >3 nodes
Positive surgical margins
Tumour >5cm

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10
Q

Which drug is used to block oestrogen receptors on breast cancer cells?

A

Tamoxifen

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11
Q

Which drug is used to block HER2 receptors in breast cancer?

A

Herceptin/trastuzumab
Bevacizumab
Lapatinib

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12
Q

How does lapatinib work?

A

Dual inhibtion of epidermal growth factor receptor and HER-2 receptor

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13
Q

What is lapatinib used in combination with for advanced breast cancer?

A

Capecitabine

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14
Q

How does a fibroadenoma in the breast present?

A

Palpable mass 1-3cm on breast in early reproductive years

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15
Q

How does a fibroadenoma in the breast feel on examination?

A 
Rubbery-firm
Mobile
Smooth
Distinct borders
Non-tender
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16
Q

How is a fibroadenoma treated?

A

Can be excised for cosmetic reasons but not necessary

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17
Q

Compare a phyllode tumour and a fibroadenoma

A

Phyllode tumour is larger (3-6cm); age 35-45 and grow

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18
Q

Which drug can be used for mastalgia?

A

Tamoxifen

Topical NSAID

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19
Q

How does a breast cyst feel on examination?

A

Mobile
Smooth Well-defined
Soft

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20
Q

When should fluid from a cyst be sent for cytology?

A

If there is blood

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21
Q

What is suspected if there is bloody discharge from a cyst?

A

Intracystic carcinoma

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22
Q

Describe physiological nipple discharge

A

Watery
Clear
Yellow

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23
Q

How is nipple discharge investigated?

A

Mammography
Ultrasonography
Surgical excision of duct

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24
Q

How can Paget’s disease of the breast present?

A

Erythematous weeping lesion on surface of nipple and areola.
Can be dry and scaly
Often underlying palpable mass

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25
How is mastitis caused by staph aureus treated?
Fluclox 500mg orally every 6 hours or Augmentin 625mg every 8 hours for 7 days
26
How does mastitis present?
Erythema Fever Tenderness Swelling
27
How often should a patient with mastitis be examined?
Every 3 days
28
How does a breast abscess present?
Loose or bulging mass | In central area of mastitis
29
How is a breast abscess investigated?
Aspirated with 18-gauge needle under LA | Do every 3 days, esp if >10ml of pus aspirated
30
Which pathogens tend to cause non-puerperal or post menopausal mastitis?
Peptostrep magnus | Bacteroides fragilis
31
How is non-staph mastitis treated?
Augmentin 625mg every 8 hours for 7 days or Cephalexin 500mg every 6 hours for 7 days
32
What is associated with chronic mastitis?
Subareolar abscess
33
What should be considered if mastitis is unresponsive to any antibiotic therapy?
Inflammatory carcinoma
34
How does an adenolipoma classically present?
Smooth palpable mass
35
Which cells are associated with apocrine metaplasia of the epithelial cells?
Eosinophils
36
What is a galactocoele?
Palpable milk-filled cyst a/w pregnancy or lactation
37
How is a galactocoele diagnosed and drained?
FNA
38
Which type of cells does a lipoma contain?
Adipose
39
What is Mondor's disease?
Phlebitis and then clot formation in the superficial veins of breast
40
How does Mondor's disease present?
Firm, vertical cord-like structure | a/w history of trauma
41
How is Mondor's disease managed?
Usually not, should resolve itself in 8-12 weeks
42
How is a mammogram carried out?
X-Ray used in low dose | Breasts compressed to keep tissue immobile and thickness consistent as exposure time is long
43
How does breast density affect cancer risk?
More dense = higher risk
44
What are the advantages of mammography?
Images whole breasts | High sensitivity for DCIS and invasive cancer
45
What is the false positive rate in mammography?
1 in 5
46
What is tomosynthesis?
3D mammogram Taken from multiple angles Slides reconstructed
47
When would an ultrasound be preferred over a mammogram?
Younger women Inflammation/infection Breast problems during pregnancy
48
What does strain elastography measure?
"Stiffness of lumps" | Produces a colour map of the stiffness
49
What colour is normal breast tissue on shear wave elastography?
Blue
50
Why may contrast enhanced ultrasound be used in breast cancer assessment?
Assess response to chemo | Look at nodes
51
How does the stroma aid tumour growth?
Allows neovascularisation Can dissolve "good" collagen May produce some nutrients for cancer
52
What is the downside of using MRI to assess breast cancer?
Pick up tiny bits of cancer that would have been dealt with by chemo/radiotherapy causing mastectomy rates to go up
53
What is a breast lump in a woman under 30 most likely to be?
Fibroadenoma
54
What is a breast lump in a woman 30-50 most likely to be?
Cyst
55
What is a breast lump in a woman over 50 most likely to be?
Cancer
56
How are abnormal lymph nodes identified on ultrasound?
Cortical thickness | Shape
57
What are the main types of surgery used in breast cancer?
``` Breast conserving (wide local excision) Mastectomy ```
58
How is impalpable disease biopsied?
Image guided wire insertion to mark location of abnormality | Can image specimen removed before sending to pathology to ensure got a good specimen
59
Why is a pedicle flap preferred to be used on breast reconstruction?
To allow tissue used to keep its own blood supply
60
What are the advantages of getting breast implants?
Short surgery | Only 1 scar
61
What complications may occur when using breast implants?
``` Infection Migration Loss Capsular contracture Tear ```
62
Describe the two-stage reconstruction done with breast implants
1 - Mastectomy and creation of submuscular pocket. Expander inserted into this 2 - expander exchanged for permanent implant
63
What are the advantages of using animal collagen mesh implant in the breast?
One surgery Better pole expansion Reduced post-op pain Improved aesthetics
64
What treatment is given following wide local excision?
Radiotherapy
65
Why is chemo done before breast surgery?
To shrink tumour and make surgery easier
66
How is trastuzumab given?
S/c mostly | Sometimes IV
67
What follow up is done after breast cancer treatment?
Review in a year | Mammograms annually for 3 years
68
What systemic palliative treatment can be given in wide-spread disease?
ER-blockade | Chemo
69
When is radiotherapy given in palliative care in breast cancer?
Bone mets | Fungating disease
70
What haematological complication may occur with chemo?
Neutropenia
71
What complications may occur with tamoxifen?
Polyps Endometrial cancer Hot flushes
72
In what situation may skin problems be experienced in breast cancer treatment?
Radiotherapy | Bigger breasts
73
What is a new lump immediately following breast cancer treatment likely to be?
Fat necrosis
74
Which group of drugs should you try to avoid with tamoxifen?
Anti-depressants
75
What may be a cause of blurred vision with breast cancer?
Retinal mets
76
Which tumour markers may be checked in breast cancers?
CEA | CA15-3
77
What is the triple assessment of a breast lump?
Clinical Radiological Pathological
78
How is a mammogram carried out?
Breast compressed to keep immobile and keep thickness consistent
79
The radiation dose of a mammogram is low/high ?
Low
80
What is the first sign of DCIS?
Calcification
81
Where do most breast cancers occur?
Upper lateral quadrant
82
Having a higher density breast s a risk factor for breast cancer true/false
True | 76-100th centile density have 5x risk of 1-10th
83
What are the adv of using mammography?
Whole breast imaged | High sensitivity
84
What are the disadv of using mammography?
1 in 5 false positive 10% cancers found are very low risk Radiation exposure Uncomfortable
85
What is tomosynthesis?
3D mammogram | Multiple pictures from various angles
86
Tomosynthesis is less sensitive than mammogram for cancer true/false
False | Is more sensitive and potentially leads to over treatment
87
When in USS performed in breast lump?
Palpable mass Infection/inflame Younger women Image guided biopsy
88
What are the adv of USS over mammogram?
``` Quick No radiation Not uncomfortable Good sensitivity Differentiate between solid and cystic lumps ```
89
What does strain elastography measure?
Stiffness of breast lumbs
90
What colour is normal breast tissue on shear wave assessment?
Blue
91
Why might contrast enhanced ultrasound be used in breast cancer treated?
Assess response to chemo | Look at lymph nodes
92
How does the stroma of tumours promote malignancy?
Allows neovascularisation Dissolves good collagen Allows invasion Produces nutrients for cancer
93
What is used in breast cancer screening of high risk women?
MRI
94
Most common cause of a breast lump in <30
Fibroadenoma
95
Most common cause of a breast lump in 30-50s
Cyst
96
Most common cause of a breast lump in >50
cancer
97
What are spiculate masses indicative of?
Malignancy
98
Where does breast cancer commonly metastasise?
``` Bones lungs Pleura Liver brain ```
99
What is a capsular contracture seen in breast implant?
When the implant is recognised as foreign and scar tissue is formed around it
100
What are the complications of breast implant?
``` Loss of implant Implant tear Implant migration infection Capsular contracture ```
101
Describe a pedicle flap
Uses nearby tissue to allow tissue to keep its own blood supply
102
Describe a free flap in breast reconstruction
Tissue moved to breast area
103
How is a two stage breast reconstruction performed?
Mastectomy and creation of submuscular pocket and expander insertion Fortnightly appointment to expand
104
Which serious condition is a two stage reconstruction associated with?
Lymphoma
105
What are the advantages of one stage reconstruction?
Better pole expansion Red post op pain Better appearance Only one op
106
Which drug is more effect in breast cancer - tamoxifen or aromatase inhibitor
Aromatase inhibitor
107
What does an aromatase inhibitor do?
Converts androgen to oestrogen
108
How is trastuzamab given?
subcut
109
What is the treatment regime of trastuzumab?
3 weekly for a year
110
What are the main side effects of trastuzumab?
Allergic reactions | Cardiac failure
111
What is the follow up to breast cancer after treatment?
Mammograms for 3 years
112
Which anti-depressant should be avoided with tamoxifen therapy?
Paroxetine/fluoxetine

Year 3 - Repro and Sexual Health (23 decks)

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