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In who does cystic disease occur?

in >50% of those with fibro adenoma, leading to fibrocystic disease - leads to harder detection of breast cancer


What causes fibrocystic disease?

a higher sensitivity to hormones from the ovaries


Symptoms of fibrocystic disease?

swelling of breast lobules, tenderness and pain, thickening of fibrous tissue, lumps that can chnage size and are moveable, can be in one or both breasts, symptoms worse before period and resolve after menopause, pain under arms, green or dark brown nipple discharge


Treatment of fibrocytsic disease?

analgesics, supportive well fitting bra, warm and cold compresses, limit caffeine and fat intake

if severe pain - contraceptive pill to control hormones, FNA to remove fluid, surgical removal/lumpectomy


Breast cancer red flags?

new of different lumps, redness or puckering of the breast skin, discharge from nipple, indentation or flattening of nipple, size shape, armpit, dimpling, rash


What is intra ductal papilloma?

benign breast condition in women over 40 that develops naturally as the breast ages and changes


Symptoms of intra ductal papilloma?

wart like lump (in a duct, usually close to the nipple), discharge from nipple, not painful but discomfort, can be in one or both breasts


How cancerous are intra ductal papilloma?

they are benign and don't increase cancer risk, unless they contain abnormal cells or there are multiple papillomas, there is a slight increased risk


Treatment of intra ductal papilloma?

vacuum excision, microdochetomy, total duct excision


Limitations of screening?

can give false protection, false positives and negatives, some cancers do not fit the screening criteria, cost to society


Principles of screening?

must be important disease, recognizable at an early stage, fully understood, have a suitable test which is accepted by society, findings should be continuous, an accepted treatment, facilities and treatment available, an agreed policy on who to treat, economically balanced, treatment for the early stage


Breast cancer investigations?

CXR, bone scan, liver USS, CT, MRI, PET CT, LFTs, Ca2+


Stages of breast cancer?

1 - confined to breast and mobile
2 - confined to breast, mobile but lymph node involvement
3 - fixed to muscle, lymph nodes matter, maybe fixed, skin involvement, larger than tumour
4 - complete fixation of tumour to chest wall, distant metastases


Sensitivity equation?

positive/all with disease


Specificity equation?

negative/all without disease


PPV equation?

positive with disease/all positive


How much more common is breast cancer in women than men?



Risk factors for breast cancer?

alcohol, overweight, heavy smoking, HRT, contraceptive pill, family history, over expression of the HER2 gene or BRCA gene


Who is screened in breast cancer?

women every 3 years, 47-73 y/o for a mammo graph screening


Management of breast cancer?

surgery (mastectomy, lumpectomy, quadrentectomy), breast reconstruction, chemo, radiotherapy, ER blocker (tamoxifen), aromatase inhbitor (anastrozole), GnRH analogues (goserelin)


Prognosis of breast cancer?

96% 1 yr, 87% 5 yr, 78% 10 yr

5th highest survival rate of cancer or 10 years


What is the Nottingham Prognostic Index for breast cancer?

NPI = 0.2 x tumour size +histological grade + nodal status


What is lymph-edema?

swelling in one of more extremities caused by impaired flow of the lymphatic system so they are unable to carry excess lymph fluid away from tissues


Function of the lymph system?

collect excess lymph fluid with proteins, lipids and waste products form the tissues and then filter the waste products and contain lymphocytes and excess lymph fluid in the lymph vessels to return to the blood stream


Symptoms of lymph-edema?

mild - heaviness, tingling, tightness, warmth, shooting pains in affected extremity, swelling, decreased ability to feel and see veins and tendons, tightness of jewellery, redness of skin, asymmetrical appearance of extremities, tightness and reduced flexibility in joints, puffiness of skin

severe - more pronounced swelling, and other symptoms


Different types of lymph-edema?

Milroy disease - congenital anatomical abnormality of lymph vessel
lymph-edema praecox - most common primary lymph-edema occurring during puberty
Meige disease orlymph-edema tarda - >35yrs
secondary - blocked lymph system


Causes of lymph-edema?

breast cancer treatment with radiation, trauma, burns, radiation, infections, compression of lymph nodes from tumour, surgery, FILARIASIS


What is filariasis?

the most common cause of lymph-edema, with infestation of lymph codes with Wuchereria bancrofti which is spread by mosquitos leading to swelling, difficulty in fight infections and can cause permanent disability - common in the tropics


Investigations of lymph-edema?

CT/MRI to define lymph node architecture and identify tumors and other abnormalities
lymphoscintigraphy injects a tracer dye into lymph vessels and observing the flow using imaging technologies
Doppler US are sound wave tests to evaluate blood flow to identify blood clots which could be causing limb swellign


How can radiation cause lymph-edema?

causing scarring and inflammation of the lymph nodes