23) Breast Disease Flashcards
What changes occur to the breast structure after menarche?
Increased number of lobules, increased volume of interlobular stroma
What changes occur to the breast structure during each menstrual cycle?
Cell proliferation and stromal oedema before menstruation and a decrease in size of lobules
What changes occur to the breast structure during pregnancy?
Increase in size and number of lobules, decrease stroma, secretory changes, acini bigger
What changes occur to the breast structure with increasing age?
Terminal duct lobular units decrease in size and number
Interlobular stroma replaced by adipose
What is the cause of cyclical and diffuse breast pain?
Physiological cause
What are some causes of non-cyclical and focal pain?
Ruptured cysts, injury, inflammation
What are some causes of a palpable mass in the breast?
Invasive carcinoma, fibroadenoma, cysts, normal nodularity
What are some causes of milk, spontaneous nipple discharge?
Endocrine disorders e.g. pituitary adenoma
Side effect e.g. OCP
What are some cause of bloody or serous nipple discharge?
Papilloma, duct ectasia, could be malignancy
What are the two things to look out for on a mammogram?
Densities and calcifications
What are some causes of densities on a mammogram?
Invasive carcinoma, fibroadenoma, cysts
What are some causes of calcifications on a mammogram?
Ductal carcinoma in situ, benign changes
At what ages do fibroadenomas usually present?
Any age during reproductive period, often < 30
At what ages do phyllodes tumours usually present?
In 6th decade
Describe the association between age and breast cancer:
Rare before 25 (except familial), incidence rises with age
What are some examples of disorders of development of the breast?
Polythelia (3rd nipple)
Accessory axillary breast tissue
When is acute mastitis likely to present and what is the cause?
During lactation
S. aureus infection due to nipple cracks and fissures
How does acute mastitis present?
Erythematous, painful breast
Pyrexia
May get breast abscesses
What is the cause of fat necrosis of the breast?
Trauma or surgery
What is the most common breast lesion?
Fibrocystic breast changes
How do fibrocystic breast changes present? (include histology)
Mass that mimics carcinoma
Histologically: cyst formation, fibrosis and apocrine metaplasia
What causes fibrocystic breast change to disappear?
Fine needle aspiration
What are some examples of stromal tumours of the breast?
Fibroadenoma, phyllodes, lipoma, leiomyoma and hamartoma
How do fibroadenomas present? (include histology)
Mobile mass, can be multiple and bilateral and grow large
Histologically mixture of stromal and epithelial elements
How do phyllodes tumours present? (include histology)
Masses that are mostly benign
Nodules of atypical stroma with epithelium
What is gynaecomastia?
Enlargement of male breast that can be uni or bilateral
What are some causes of gynaecomastia?
Transient in puberty due to oestrogen peak Klinefelter's syndrome Oestrogen excess - liver cirrhosis Drug related Gonadotropin excess - testicular tumour
What are some risk factors for male breast cancer?
Klinefelter’s syndrome
Men treated with oestrogen for prostate cancer
In what location is female breast cancer most common?
Upper outer quadrant
What are some risk factors for developing breast caner?
No pregnancy Early menarche Late menopause Obesity/high fat diet HRT Radiation Previous breast cancer
What mutations are likely in hereditary breast cancer?
BRCA 1 and 2
p53
What can those with BRCA mutations undergo to reduce risk of breast cancer?
Prophylactic mastectomy
What is an in situ carcinoma of the breast?
Limited to duct and lobules by BM
How does ductal carcinoma in situ present? (include histology)
Mammographic calcifications
Central necrosis histologically
Describe Paget’s disease of the breast:
Cells extend to nipple skin without crossing BM and cause red, crusting nipple
What is Peau d’orange?
Invasive carcinoma spreads to LN so lymph can’t drain. Breast swells and hair follicles pulled down into breast
What are the types of invasive carcinoma of the breast?
Invasive ductal carcinoma
Invasive lobular carcinoma
Tubular and mucinous
Where is breast cancer likely to metastasise?
Bone, lung, liver and/or brain
Axillary LNs
Where is invasive lobular carcinoma likely to metastasise?
Peritoneum, retroperitoneum, leptomeninges, GIT, ovaries and uterus
What determines the prognosis of breast cancer?
In situ or invasive TNM stage Tumour grade Histologic subtype (IDC worse) Gene expression profile
Why is investigating oestrogen and Her2 receptor status important?
Prognosis and specific treatment
Describe the triple approach to diagnosis of breast cancer:
Clinical: history, family history and examination
Radiographic: mammogram and ultrasound
Pathology: fine needle aspiration cytology and core biopsy
Describe the breast cancer screening programme:
Women aged 47-73, 2 view mammograms every 3 years
What is the treatment for local breast cancer?
Mastectomy or breast conserving surgery
Axillary surgery after sentinel node sampling
What are some treatments for systemic breast cancer?
Chemotherapy
Tamoxifen if oestrogen positive
Herceptin if Her2 positive
How can breast cancer survival be improved?
Early detection Neoadjuvant chemotherapy New therapies - Herceptin Gene expression profiles Prophylactic mastectomies in familial cases
