Pre-placement Flashcards
(28 cards)
What can a breast ultrasound be used for?
- Used if results of a mammography scan are unclear or suspicious
- Used if a patient has identified a lump or focal pain e.g. can tell if it’s benign, fluid filled etc
- Allows health professionals to guide a needle into area of concern to biopsy it
- Technique of choice in women <40 as they have very dense breasts
- Used alongside mammography for those 40+
What would malignant lesions look like on an ultrasound of the breast?
- Irregular shape and ill-defined border - finger-like projections
- Enlarged ducts
- Unusual tissue structures
- Posterior shadowing
What would benign lesions look like on an ultrasound of the breast?
- Round or oval shape
- Well defined borders, easily distinguished from surrounding tissue
- Cysts: posterior enhancement
What is the triple assessment comprised of?
- Clinical assessment - history and examination
- Imaging assessment
- Needle biopsy - core biopsy
What is the scoring for the triple assessment?
- Normal
- Benign
- Probably benign
- Probably malignant/suspicious
- Malignant
Why is the triple assessment used?
The use of all 3 components together with concordance between them at MDT helps to minimise the chance of missing a cancer.
What are high risk factors for breast cancer?
- Age
- Female
- HRT/OCP use
- Early menarche
- Not breastfed
- No children
What is important to know in FH of breast cancer when assessing risk?
- The age that family members developed breast cancer
- How many family members are affected
- Whether affected family members are first, second or third degree relatives
What is Paget’s disease of the breast?
- A rare form of breast cancer that causes eczema - changes to the nipple and areola
- Unilateral
- Usually affects nipple from the start whereas eczema generally affects the areolar region and only rarely the nipple
What are accessory (supranumerary) nipples?
Accessory nipples are relatively common and occur along the mammary ridge that develops in the embryo along the trunk on either side from the axilla to the groin. They may be just nipples or have associated breast tissue. They may me mistaken for moles but they have a characteristic appearance and site and are also present from birth.
What are the key features of mammography?
- This is an x-ray of the breasts, performed every 3 yrs for non-symptomatic women
- Taken from 2 angles; medio-lateral oblique (MLO) and cranio-caudal (CC) view
- MLO is used to help see the axillary tail of breast tissue
- All mammograms are read by 2 trained film readers (radiologists, breast physicians or radiographers)
- The radiographer that performs it is always female - exempt from Sex Discrimination Act
- Gives 2 months worth of radiation
Why is the breast tissue compressed in mammography?
- Helps spread out glandular tissue of the breast - reduces problem of overlapping structures
- Compression holds breast still, reducing the risk of blurring of the mammogram which may obscure small details
- Compressed breast is uniformly thin - helps avoid problems with under or overexposure of parts of the image
- Makes the breast thinner - reduces radiation dose that women need in mammography
What age is mammography best performed in?
Younger women tend to have denser breasts and also have a lower incidence of breast cancer. Mammography tends to only be performed on women 40+ unless there is a strong clinical suspicion of malignancy,
Why is axillary nodal status important?
- Important prognostic factor (together with size and grade of cancer) with a direct correlation seen between survival and the number of involved axillary nodes
- Abnormal pre-operative axillary nodes demonstrated on USS and biopsy will be offered axillary node clearance
- Patients with normal pre-operative axillary assessment will be offered a sentinel node biopsy
What does the core biopsy test for?
- Assesses the tissue architecture and determination of histological type as well as whether it is invasive.
- Cells are also checked for ER, PR and HER2
What factors are considered for determining the grade of cancer?
- The amount of gland formation (differentiation or how well the tumour cells recreate normal glands) - scored as 1 above
- The nuclear features (pleomorphism or how abnormal the tumour cells look) - scored as 1 above
- The mitotic activity (how much the tumour cells are dividing) - scored as 1 above
Each of these factors is scored out of 3 and the total used to determine the grade.
What are the 2 functional parts of the breast?
- The epithelial component of the breast is concerned with milk production and consists of the lobules which make milk and the ducts which carry the milk to the nipple
- All the other tissues make up and support the breast, including fat and connective tissue
What are Cooper’s ligaments?
Thin sheets of fascia that extend like a mesh through the breast parenchyma, attaching to the dermis and superficial and deep fascial layers - they provide support to the breast.
What arteries supply the breast?
- Branches of the axillary artery
- Perforating branches of the intercostal arteries
- Perforating branches of internal mammary artery
What are the lymph drainage of the breast?
- Axillary
- Internal mammary nodes
What happens to the breasts following pregnancy/birth?
- Ductal and lobular proliferation occur, with the glandular tissue occupying proportionally more of the breast
- Increased pigmentation of the nipple and areolar occur
- Lactation becomes established if the baby suckles regularly - the hormonal regulation is complex but 2 important hormones are prolactin (lactogenic) and oxytocin (released in response to suckling)
- Oxytocin causes contraction of the myoepithelial cells increasing the supply of milk and mediates the secretion of prolactin
What happens to the breast after menopause?
Atrophy of the glandular elements and a decrease in the amount of fibrous tissue within the breast. Fatty tissue tends to predominate.
What are ER+, PR+ and HER2+ breast cancers treated with?
- ER+ + PR+ - tamoxifen
- HER2+ - Herceptin
What are side effects of Tamoxifen?
- Cataracts
- DVT
- Vaginal dryness (hot flushes, nausea, low libido)
- Endometrial thickening (endometrial polyps, hyperplasia and less commonly endometrial carcinoma)
- Aromatase inhibitors (block oestrogen production in the fatty tissue) can cause osteporosis
