Breast

Question 1

When to 2ww

Answer 1

• unexplained lump >30
• Unilateral nipple changes >50
• Skin changes
  Non urgent referral
• Unexplained lump in <30

Question 2

Whats in triple assessment

Answer 2

• Clinical assessment
• Imaging = USS, mammography
• Histology = fine needle, core biopsy

Question 3

Fibroadenoma

Answer 3

• Benign tumours of stromal/epithelial
• painless, smooth, round
• Mobile

Question 4

Fibrocystic breast changes

Answer 4

• Benign
• stroma, ducts and lobules respond to hormons = fibrous and cystic
• lumpy, tender, size change

Question 5

Mx fibrocystic

Answer 5

• good bra
• NSAIDs
• Heat
• Hormonal tx

Question 6

Breast cysts

Answer 6

• Benign individual fluid filled lumps
• Smooth
• Well defined
• Mobile
• Can be fluctuant
• assess to exclude cancer

Question 7

Fat necrosis

Answer 7

• benign lump
• localised degeneration and scarring of fat tissue #- localised trauma, radiotherapy or surgery
• Painless, firm, irregular, fixed

Question 8

Lipoma

Answer 8

• Benign tumour of adipose
• Soft, painless, mobile, no skin changes

Question 9

Non cyclical breast pain causes

Answer 9

• Medications = HRT
• infection
• Pregnancy
• Cancer

Question 10

presentaiton mammary duct ectasia

Answer 10

• discharge
• tenderness
• retraction or invesrion
• breast lump

Question 11

Mx MDE

Answer 11

• triple assessment
• Mammogram = microcalcifications

Question 12

intraductal papilloma

Answer 12

• warty lesion in duct
• nipple discharge, pain, lump
• triple assessment
• mx = surgery

Question 13

mx mastitis

Answer 13

• continue breastfeeding
• flucloxacillin

Question 14

Mx breast abscess

Answer 14

• non lactational = co amoc, or macrolides plus met
• refer to on call surgery
• abx
• USS
• drainage
• culture

Question 15

pagets

Answer 15

• eczematous change due to underlying malignancy
• suspect if eczema not resolved in 2w
• surgery

Question 16

DCIS

Answer 16

• pre cancerous or cancerous epithelial cells of ducts
• localised
• mammogram screening pick up
• full excision

Question 17

LCIS

Answer 17

• pre cancerous
• asymptomatic and undetectable on mammogram
• breast biopsy
• mx close monitoring

Question 18

invasive ductal carcinoma

Answer 18

• originate in cells from breast ducts
• seen on mammogram

Question 19

invasive lobular carcinoma

Answer 19

• cells from rbeast lobules

Question 20

inflammatory breast cancer

Answer 20

• 1-3%
• similar px to abscess/mastitis but no response to abx

Question 21

breast screening age?

Answer 21

• mammogram 3 yearly ages 50-70 (47-73)

Question 22

who count as high risk

Answer 22

• 1st degree relative with breast cancer under 40
• 1st deree male relative
• 1st degree with bilateral <50
• 2 1st degree
  = annual mammogram

Question 23

chemoprevention for high risk

Answer 23

• tamoxifen if pre menopausal
• anastrozole if post

Question 24

3 receptors tested for

Answer 24

• oestrogen receptors
• progesterone receptors
• human epidermal growth factor
  triple negaive = poor prognosis

Question 25

features of locally advanced cancer

Answer 25

- ulceration - peau d'orange - inflammatory breast cancer - fixed to chest wall - fixed, matted axillary ln

Question 26

primary tx

Answer 26

-tx intended to cure, or to allow easier or lesser surgery

Question 27

adjuvant tx

Answer 27

- any treatment given following primary treatment to prevent recurrence or mets

Question 28

radiotherapy

Answer 28

- used in breast conserving surgery to reduce recurrence

Question 29

3 scenarios for chemo

Answer 29

- neoadjuvant = shrink pre surgery - adjuvant = after surgery to reduce recurrence - tx of mets

Question 30

meds to oestroge positive

Answer 30

- tamoxifen for pre menopause - aromatase inhibitors for post = letrozole

Question 31

tamoxifen is

Answer 31

- selective oestrogen receptor modulator - blocks ER in breast - Stimulates Er in bones and uterus

Question 32

amromatase inhibitors work by

Answer 32

- aromatase converts androgens to oestrogen - inhibs work by blocking creating of oestrogen in fat tissue

Question 33

trastuzumab is

Answer 33

- monoclonal antibody that targets HER2

Question 34

surveillance mammograms every

Answer 34

- yearly for 5 years

Question 35

mastectomy if

Answer 35

- multifocal tumour - central tumour - large lesion in small breast - DCIS >4cm

Question 36

wide local excision if

Answer 36

- solitary lesion - peripheral tumour - small lesion large breast - DCIS <4cm

Question 37

adverse effects Tamoxifen

Answer 37

- mesntrual disturbance - hot flushes - VTE - endometrial cancer

Question 38

anastrozole adverse effects

Answer 38

- osteoporosis (DEXA before intiating) - hot flushes - arthralgia - insomnia