Onc2 Flashcards
(22 cards)
RF’s for breast Ca
- INCREASING AGE
- Personal history of atypical hyperplasia or lobular carcinoma in insitu
- strong family history of disease
- BRCA1/BRCA2 gene mutation
- previous radiotherapy
- Recent hormonal exposure - increased bone mass, obesity
Factors that can prevent breast cancer
- Mediterranean diet
- Physical activity
- Normal BMI (post menopausally)
- Decreased ALCOHOL consumption
How often should mammograms be taken for asymptomatic low risk women
Every 2 years between 50 and 74
Woman with a first degree relative under the age of 50 with breast cancer
Yearly mammograms from the age of 40
BRCA1/2 - screening
Multiple cases of breast and/or ovarian cancer on one side of family raise possibility of BRCA1/2 mutation.
FRA- BOC is an online screening tool which can be useful
What are indications for HIGH risk of Breast ca?
1.Women at HIGH RISK of Ovarian cancer
2. TWO First or second degree relatives on ONE side of the family with breast or ovarian cancer and at least one family member on the same side with ONE of the following:
additional relative with breast or ovarian ca
one relative with breast ca under 40
bilateral breast Ca
breast AND ovarian in the same woman
Ashkenazi Jewish ancestry
Breast cancer in a male
3. One First or second degree with breast under 45 and one first or second on the same side of the family under 45 with Sarcoma (bone/soft tissue cancer)
4. Family member with established high risk gene mutation
So basically - a) risk of ovarian,b) two members on one side with ovarian/breast and another who’s had high risk stuff - bilateral, male, ashkenazi, young c) breast under 45 and sarcoma under 45 d) established gene mutation
What would you do if a patient presents who is at HIGH risk of breast cancer
REFER TO CANCER SPECIALIST OR A FCS (FAMILY CANCER CLINIC)
They may:
GENETIC TESTING
Start the patient on CHEMOPREVENTION a SERM (selective oestrogen receptor modulator) eg Raloxifene (Fewer ADR) or tamoxifen (great efficacy)
OR aromatase inhibitor - anastrazole
ALTERNATIVE
Risk reducing mastectomy
Risk reducing bilateral salpingo-oopherectomy
Individualised ongoing surveillance regimen
Most common presenting symptoms of breast cancer
- NEW Breast lump
- thickening or ridge
- breast or nipple asymettry
- Skin changes such as dimpling, redness
- nipple changes
- nipple discharge
- unilateral breast pain
History in a patient presenting with a new breast symptom?
- PRevious breast problems and investigations
- Risk factors particularly strong fro breast or ovarian ca
- hormonal status, menstrual history, recent pregnancies and breast feeding
- Current meds or recent changes in meds - esp endogenous hormones, alternative meds
- Most recent imaging results
- Previous interventions - radiation or breast surg
- recent breast trauma
HOPC
site, duration, changes?, relationship to menstrual cylce or exogenous hormones? ASSOCIATED - nipple discharge, lump, pain, asymetry, skin dimpling, nipple changes
What are the important steps in a breast examination?
INSPECTION
arms by side
arms raised over head
pressing on hips leaning forward
Breast contours -skin changes like erythema, puckering, dimpling, peau d’orange, visible lumps
Nipples - height, inversion, erythema, eczema, nodules, ulcers
PALPATION
patient seated - palpate supraclavicular lymph nodes and axillary fossae
palpate breasts and bimanual examination
Patient lying down with ipsilateral arm behind her hed
palpate all quadrants and axillary tail, and around and behind the nipple
If a breast symptom shows: normal clinical examination and findings on history and exam consistent with hormonal changes?
Treat pain
Ressure
Review in 6-8 weeks(immediately after period)
If persists - ultrasound and/or mammogram
if normal -reassure
encourage breast awareness
Advice re: future screening
How would you treat a lump that is reported as a simple cyst on ultrasound
iF symptomatic - for fine needle aspiration
if a lump remains or if the fluid is equivocal/bloody -send for cytology and refer to a breast surgeon
If no lump remains and the fluid is normal/straw coloured
if symptomatic - send for cytology and refer depending on the results
How would you treat a lump reported as a COMPLEX cyst or solid benign lesion
Refer for Non excisional core biopsy
if its consistent with benign clinical and imaging findings - reassure - ift its inconsistent then refer to breast surgeon
What is the process with management of nipple discharge
Most of the time you will order an ultrasound AND mammogram and then refer to breast surgeon
The only time you wouldnt is if bilateral discharge, only on expression, with no discrete lesion and negative for blood - advice to cease expression, mammogram if due and then review in TWO to THREE MONTHS - if persistent then send on to breast surgeon
When investigating a breast symptom without redflags would you do a ultrasound, mammogram or both
Ultrasound first under age of 35 unless suspicious then add mammogram
Mammogram and ultrasound over the age of 35
Indications for surgical referral in breast symptoms
- Any of the components of the triple test are positive
- A cyst aspiration is incomplete, results in bloody aspirate or a lump remains post aspiration
- nipple eczema doesnt respond to topical therapy after 1-2 weeks
- Inflammatory breast conditions that do not resolve after 2 weeks of antibiotic treatment
- If any test of results is inconsistent with other results
Difference between NASH and Non NASH
Non alcoholic fatty liver disease - can be simple steatosis (Without fibrosis or lobular inflammation)
Or NASH - non alcoholic steato hepatitis - steatosis PLUS lobular inflammation and fibrosis
What’s you’re approach to fatty liver disease?
Bascially LFTs are up and ultrasound demonstrates NASH - refer
ultrasound demonstrates non-NASH - then if they have metabolic syndrome or features of MetSy then refer
ultrasound demonstrates non- NASH and otherwise fit and well - 6 months of exercise/weight loss/diet change -repeat lft and u/s - if improved - reinforce and monitor
if not improved - refer
Mx of NAFLD
SNAP
Agressive cv risk mx and weight loss
Immunise Hep A and B
consider bariatric surg
drug therapy - statins
If cirhosis - refer
if severe metab syndrome - refer
if not improving after 6 months of lifestyle managment - refer
