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Medicine Phase 2a Other (Infectious diseases etc) > Breast Tumours > Flashcards

Breast Tumours Flashcards

1
Q

Examples of benign breast tumours

A

Fibroadenoma
Intraductal papilloma
Phyllodes tumour

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2
Q

Characteristics of fibroadenoma

A

Small
Aka breast mouse as tumour is not tethered
Sharp edges
Most common type of benign breast tumour in young women

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3
Q

Characteristics of Intraductal papilloma

A

Small
Under areola
Bloody discharge from nipple

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4
Q

Characteristics of Phyllodes tumour

A

Large
Leaf-life projections
Rapid growing

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5
Q

Examples of malignant breast tumours

A 
Ductal carcinoma in situ (DICS)
Comedocarcinoma
Invasive ductal
Invasive lobular
Medullary
Inflammatory
Paget's disease of the breast
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6
Q

Characteristics of ductal carcinoma in situ

A

From ductal hyperplasia

Cheesy discharge, confined to ducts

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7
Q

Characteristics of comedocarcinoma

A

High grade ductal carcinoma in situ
Characterised by central necrosis
Cheesy discharge

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8
Q

Characteristics of Invasive ductal tumour

A

A hard mass
Sharp edges
Most common
Very aggressive

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9
Q

Does invasive lobular tumour present as unilateral or bilateral

A

Bilateral presentation

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10
Q

Characteristics of medullary tumour

A

Well differentiated
Lacks desmoplastic reaction
Lymphatic infiltrate
Good prognosis

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11
Q

Characteristics of inflammatory tumour

A

Invades the dermis and lymphatic system
Peau d’orange appearance
Retracted nipple

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12
Q

Characteristics of Pagets disease of the breast

A

Epidermal infiltration of ductal carcinoma

Eczematoid nipple changes

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13
Q

What is the most common breast tumour

A

Invasive ductal tumour (malignant)

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14
Q

Which breast tumour is described:

High grade ductal carcinoma in situ that is characterised by central necrosis. Cheesy discharge also present

A

Comedocarcinoma (malignant)

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15
Q

Which breast tumour is described:
Well differentiated tumour that lacks desmoplastic reaction. Lymphatic infiltrate also present.
What is prognosis like for this tumour?

A

Medullary carcinoma

Malignant tumour but good prognosis

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16
Q

Which breast tumour is described:

Large with leaf-like projections. Also rapid growing.

A

Phyllodes tumour (benign)

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17
Q

What is the most common type of benign breast tumour in young women

A

Fibroadenoma

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18
Q

Investigations

A

Triple assessment:
1 Examination
2 Imaging
3 Biopsy

Physical examination for lumps and masses
Bloods
Radiology

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19
Q

Blood tests done

A

FBC, WCC, U and Es, LFTs, TFTs

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20
Q

Radiology assessments done

A

Mammogram, ultrasound scan,
fine needle biopsy under ultrasound guidance (core needle biopsy may be required)
Look for metastasis with CXR, CT scan and MRI scan

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21
Q

What does CT and MRI stand for

A

Computerised Tomography

Magnetic resonance imaging

22
Q

Risk factors for breast cancer

A 
Female
Increasing age
Family history of breast cancer
Alcohol
Obesity
Genetic involvement
Increased oestrogen exposure
23
Q

Give examples of genetic risk factors for breast cancer

A 
BRCA 1 (chromosome 17)
BRCA 2 (chromosome 13)
24
Q

Give examples of increased oestrogen exposure

A 
Early menarche
Late menopause
Oral contraceptive pill use
Hormone replacement therapy
Decreased parity
Not breastfeeding
25
Q

Complications

A 
Death
Metastasis
Complications of chemotherapy regimen
Complications of radiotherapy regimen
Depression
26
Q

What does treatment depend on

A

Cause of breast tumour

Whether it is benign or malignant

27
Q

Conservative treatment

A

Patient and family education
Refer to Macmillan nurses
Offer genetic counselling
Provide psychological assessment and support

28
Q

*How is prognosis assessed

A

Nottingham Prognostic Index (NPI)

=(0.2 x invasive size) + lymph node stage + grade of tumour

29
Q

Types of medical treatment

A

Adjuvant hormone therapy
Chemotherapy and Radiotherapy regimens (vary depending on tumour)
HER2 directed therapy
(depending on type of tumour)

30
Q

**Medical treatment: Hormone Therapy

A

Premenopausal women are treated with TAMOXIFEN
Postmenopausal women are treated with ANASTRAZOLE (Aromatase inhibitor)
(if a woman becomes menopausal during treatment, she will benefit from switching medications)

31
Q

What is tamoxifen

A

Selective oestrogen receptor modulator

32
Q

Why are postmenopausal women treated with anastrazole (not tamoxifen)

A

Anastrazole = Aromatase inhibitor

Trials like ATAC trial have suggested that aromatase inhibitors are superior to tamoxifen in postmenopausal women

33
Q

Medical treatment: Describe HER2 directed therapy

A

Treatment with TRASTUZUMAB (Herceptin)

This is a monoclonal antibody against the extracellular domain of the HER2 receptor

34
Q

Surgical treatment: primary aim

A

To remove the invasive and noninvasive cancer with clear margins

35
Q

*Surgical treatment options

A

Lumpectomy followed by radiotherapy

Mastectomy (particularly for circumstances like multifocal breast disease)

36
Q

Surgical treatment: what else is assessed (other than breast tumour itself)

A

Ipsilateral axilla should be assessed with ultrasound, fine needle aspiration or core biopsy
Clinical staging of axilla should by assessed by sentinel lymph node biopsy. This is to avoid unnecessary axillary clearance in patients

37
Q

Important questions in history

A

Size - Has it changed? Over what duration?
Onset - when did they first notice?
Is lumps size or discomfort related to menstraul cycle in any way? (progesterone)
Pain? (SOCRATES)

38
Q

Local associated symptoms of breast cancer

A 
Nipple discharge/bleeding
Nipple inversion
Skin changes (on lump or elsewhere)
39
Q

Systemic symptoms

A

General cancer symptoms - fever lethargy etc
Gland swelling
Pain elsewhere -spine, abdomen

40
Q

Past medical Hx

A

Age at menopause

Age at first pregnancy

41
Q

Family history

A

BRCA mutations
Smoking
Alcohol
Recreational drug use

42
Q

1st line assessment

A

Mammogram (low dose x-ray think)

43
Q

Investigations after mammogram

A

MRI

Biopsy

44
Q

Pros of breast cancer screening

A

Diagnose people sooner to improve prognosis and save lives
High sensitivity on test
Good treatment if diagnosed
Informed consent of complications

45
Q

Cons of breast cancer screening

A

Over diagnosis
Exposure to radiation
False positives

46
Q

*Normal screening age for mammograms

A

50-70 (due to menopausal age)

Every 3 years (varies upon family history)

47
Q

If cancer is suspected, how long until a patient should be seen be a specialist

A

Within 2 weeks

48
Q

Most common breast cancer

A

Ductal carcinoma

49
Q

Risk factors of breast cancer

A 
Genetic 
Female
Late menopause and early menarche
Increasing age
Not giving birth
Not breast feeding
50
Q

Common metastases locations

A

Brain, Bone, Liver, Lung

Medicine Phase 2a Other (Infectious diseases etc) (26 decks)

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