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BREASTS Flashcards

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1
Q

What is involved in Triple Assessment?

A

Clinical Examination (P1-5)
Imaging (U1-5; M1-5)
Biopsy (B1-5)

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2
Q 
Breast screening
1-
2-
3-
4-
5-
What do they mean?
A 
1-normal
2-benign
3-indeterminate
4-suspicious
5-malignant
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3
Q

What is the wait when women with breast symptoms sent by GP to fast track clinic

A

2 wk wait

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4
Q

Out of 100 ladies breast screened, how many will need more tests, how many will have cancer?

A

4 need more tests

1 cancer

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5
Q

What kinds of imaging in triple assessment?

A

ultrasound

MAMMOGRAM

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6
Q

what are the two mammograms views?

A

cranio-caudal (squashed from top)

medio-lateral-oblique (squashed from side)

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7
Q

What kind of biopsy in triple assessment?

A

core biopsy
(with x ray guidance)
with local anaesthetic

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8
Q

Radiologist hooks wire on lesion on lesion to guide surgeon on day of surgery. Whats this called?

A

wire localisation

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9
Q

How many women get breast cancer?

A

1 in 8

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10
Q

What age group is NHS breast screening for?

A

47-73yrs

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11
Q

Name 4 risk factors for breast cancer.

A

age
FHx
uninterrupted oestrogen exposure
obesity

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12
Q

How many years after stopping COCP is breast cancer risk back to normal?

A

10yrs

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13
Q

What are the pre-malignant breast cancers

A

ductal carcinoma in situ (DCIS)

lobular carcinoma in situ

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14
Q

How frequent is NHS breast screening?

A

every 3 yrs

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15
Q

What imaging does NHS breast screening involve?

A

2view mammography

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16
Q

What is the most common invasive breast cancer?

A

invasive ductal carcinoma

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17
Q

70% of breast cancers are…

A

invasive ductal carcinoma

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18
Q

Why is invasive lobular carcinoma more difficult to identify?

A

stringy diffuse tissue thickening

not just lump

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19
Q

Which BC especially affects young women?

A

medullary

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20
Q

Which BC especially affects elderly women?

A

colloid / mucoid

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21
Q

If BC is oestrogen receptor positive, is that a better or worse prognosis?

A

better

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22
Q

If BC is HER2 receptor positive, is that a better or worse prognosis?

A

worse

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23
Q

What is HER2?

A

human epidermal growth factor receptor

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24
Q

What % of BCs are oestrogen receptor positive?

A

60%

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25
What % of BCs are HER2 receptor positive?
30%
26
What are the four aspects of the breast examination?
inspection palpation of breast palpation of axilla further Ex - spine, hepatomegaly
27
Apart from a breast lump, how else can breast cancer present?
change in size/shape of breast skin changes e.g. peau d'orange, Paget's change bloody nipple discharge nipple inversion armpit lump
28
Red scaly itchy rash behind the nipple. Painful and bleeds when scratch. Sign of malignancy behind nipple. What's this called?
Paget's change
29
What scale is used to determine prognosis after surgery for breast cancer?
Nottingham prognostic index`
30
is it's a CYSTIC lump, what kind of biopsy is better?
fine needle aspiraiton
31
if it's a SOLID lump, what kind of biopsy is better?
core biopsy
32
What is stage4 breast cancer?
mets, fixed to chest wall
33
What is the treatment for stage 1-2 breast cancer?
surgery radio chemo hormone therapy
34
What is the treatment for stage 3-4 breast cancer?
radio / bisphosphonates for bone pain | chemo
35
Name four types of hormone therapy for stage1-2 breast cancer.
tamoxifen aromatase inhibitors ovarian ablation ovarian supppression
36
What hormone therapy for PRE-menopausal ladies with stage 1-2 breast cancer?
ovarian ablation | to decrease oestrogen synthesis
37
What hormone therapy for POST-menopausal ladies with stage 1-2 breast cancer?
aromatase inhibitors | to decrease oestrogen synthesis
38
How long do you take tamoxifen?
5yrs post-op | oral once a day
39
Targeted drug for HER2 positive?
TRASTUZUMAB (herceptin)
40
You give radiotherapy after breast surgery. Whereabouts depending on which surgery?
to breast after wide local excision to chest wall after mastectomy to axillary lymph node if not cleared
41
Talk me through breast cancer surgery.
can be : - wide local excision (breast-conserving), or - mastectomy +/- reconstruction and! - sentinel node biopsy, or - axillary node sampling / clearance
42
What can be a side effect from axillary lymph node radiotherapy?
lymphoedema in arm
43
How might you locate breast lump for surgery if it's impalpable?
radiological wire localisation
44
Give me three reasons why you might advise a mastectomy over wide local excision?
- >25% breast vol - multifocal lumps - location e.g. cleavage area
45
Give me four options for breast reconstruction.
tissue expanders implants lat dorsi flaps TRAM flaps
46
What is a TRAM flap in breast reconstruction?
transverse rectus abdominis muscle
47
Give me three reasons why you might advise breast-conserving surgery (wide local excision) over mastectomy.
small lump one specific area can tolerate radio
48
When do you give chemo in treatment of breast cancer?
neo-adjuvant for all - given before surgery to shrink the tumour e. g. cyclophosphamide
49
Most common cause of breast lump in 15 to 30 yr olds?
fibroadenoma
50
breast mice
a.k.a fibroadenoma | wiggle around with clear edges
51
What actually is fibroademona?
benign overgrowth of conn tiss in lobule
52
26 yr old presents with painless, firm mobile breast lump. Most likely diagnosis?
fibroadenoma
53
what is the treatment for fibroadenoma?
observation and reassurance | excision if large
54
23yr old presents with breast lump which is painless, firm and mobile with clear edges. What investigations do you carry out?
clinical Ex ultrasound (only biopsy if inconclusive)
55
23yr old presents with breast lump which is painless, firm and mobile with clear edges. What investigations do you carry out?
clinical Ex ultrasound (only biopsy if inconclusive)
56
Can you biopsy a cyst?
no. it's not solid. | fine needle aspiration.
57
40 yr old presents with round fluid filled breast lump, painless. Likely diagnosis?
breast cyst
58
What is the treatment for breast cysts?
usually none drainage with fine needle aspiration if v large or painful
59
37 yr old presents with breast lump, which is causing her pain. On clinical Ex, you feel a round fluid filled lump. Ultrasound confirms it's a large breast cyst. What is the treatment?
it's large and painful, so drainage with fine needle aspiration
60
In which group is breast abscess much worse at clearing up in ?
smokers
61
What bacteria tends to cause infective mastitis during breastfeeding?
Staph aureus
62
Apart from lactation, what else can cause infective mastitis?
skin infections | nipple piercings
63
What is the treatment for a breast abscess / infective mastitis?
antibiotics +/- drainage.
64
What is the most common cause of mastitis (inflammation of breast tissue)?
milk blockages | not always infectious so wouldnt need abx!
65
What is duct ectasia?
ducts widen and fluid builds up - secretions stagnate - green/brown/bloody discharge
66
Scarring of breast after injury. What's this?
fat necrosis
67
When is the typical time for duct ectasia?
around the menopause
68
I banged my boob on the door handle. What might I get now.
fat necrosis
69
Give me two types of intraductal papilloma.
central (near nipple) | peripheral
70
What is the most common cause of bloody nipple discharge in women 20-40?
intraductal papilloma
71
Small benign tumour that forms in milk duct of breast. What's this?
intraductal papilloma
72
What actually is intraductal papilloma?
small benign tumour that forms in milk duct of breast
73
These very small lumps may not show up on mammography and commonly cause blood nipple discharge.
intraductal papilloma
74
Often intraductal papilloma isn't palpable on clinical Ex or visible on US / mammogram. What investigation might you need?
galactrogram to guide biopsy.
75
Mulitple. Younger women. Increased malig risk. Which kind of intraductal papilloma is this?
peripheral
76
Solitary. Near nipple. Around menopause. Which kind of intraductal papilloma is this?
central
77
What treatment might be required for intraductal papilloma?
excision of duct

Gynaecology (8 decks)

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