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Year 3 Clinical > Benign and Malignant Breast Conditions > Flashcards

Benign and Malignant Breast Conditions Flashcards

1
Q

Occurrence of breast cancer?

A

Most common cancer in women

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2
Q

Different histological types of breast malignancies?

A

There are 24, 7 of which are in-situ and 17 are invasive

Each type has unique characteristics, behaviour, prognosis and optimum treatment varies

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3
Q

Most common types of breast cancer?

A

For both invasive and in-situ breast carcinoma, 80% of cases are DUCTAL TYPE

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4
Q

Risk factors for breast cancer?

A

Female gender

Increasing age

Gene mutations and FH of breast cancer

PMH of breast cancer

Atypical ductal or lobular hyperplasia

Lobular carcinoma in-situ

Atypical epithelial hyperplasia

Nulliparity and birth of 1st child >30 years of age

Post-menopausal obesity

Alcohol consumption ≥1 time a day

Early menarche and late menopause

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5
Q

PC of breast cancer?

A

50% are asymptomatic and present via the screening route

50% are symptomatic:
• Lump (50%)
• Dimpled or depressed skin
• Nipple change 
• Bloody discharge
• Texture change
• Colour change
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6
Q

Diagnosis of breast carcinoma?

A

Mammography

USS, part. in young woman or any woman with mammographically dense breasts

Definite diagnosis - image-guided core-needle biopsy

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7
Q

PC and diagnosis of DCIS?

A

Usually non-palpable but perceived on mammography as malignant calcifications

Definite diagnosis - biopsy

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8
Q

What is lobular carcinoma-in-situ?

A

Thought to be a tumour marker with assoc. increased risk of eventual invasive carcinoma, usually of the ductal types

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9
Q

Spread of lobular carcinoma-in-situ?

A

Spreads diffusely, so often not apparent by palpation or imaging until it reaches an advanced stage

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10
Q

Important factors when considering histology of the biopsy?

A
  1. Invasive VS non-invasive
  2. Ductal VS lobular
  3. Degree of differentiation
  4. Receptor status
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11
Q

Treatment of breast cancer?

A

Local:
• Surgery
• Radiotherapy

Systemic:
• Chemotherapy (adjuvant or neoadjuvant)
• Hormonal therapy, like SERMs (selective estrogen receptor modulators, e.g: tamoxifen), AIs (aromatase inhibitors), GnRH antagonists, oophorectomy
• Targeted therapies, e.g: Herceptin for HER2 over-expression

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12
Q

Types of surgery for breast cancer?

A

Breast-conserving surgery (BCS) - preferred treatment; it is a wide local excision +/- oncoplastic procedure
Radiotherapy is an essential part of this therapy

Modified mastectomy - removes entire breast, overlying skin and axillary lymph nodes; pectoralis major muscle is preserved (this is the modification), as it it allows wound healing and potentially allows reconstruction
With mastectomy, most are candidates for breast reconstruction

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13
Q

What are ANDIs?

A

Abberations in the normal development and involution of the breast, e.g:
• Fibroadenoma
• Cysts
• Papilloma

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14
Q

Occurrence of fibroadenoma?

A

Most common benign neoplasm of the breast

Can occur at any age but usually early reproductive life

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15
Q

PC of fibroadenoma?

A

Palpable mass in EARLY REPRODUCTIVE years of life

It is rubbery-firm, mobile and smooth, with distinct borders

Usually non-tender

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16
Q

Diagnosis of fibroadenoma?

A

Confirmed with ultrasound core biopsy

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17
Q

Risks assoc. with fibroadenoma?

A

NOT pre-malignant

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18
Q

Mx of fibroadenoma?

A

Tend to remain unchanged or decrease in size and become non-palpable after menopause (falling oestrogen levels)

Some women may want excision:
• Open lumpectomy
• Percutaneous vacuum-assisted core biopsy

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19
Q

Differences between fibroadenomes and the uncommon Phyllodes tumour?

A

Similar to fibroadenomas in PC and cytology

Often larger (3-6cm)

Tend to occur in older women (35-40 years of age), rather than during early reproductive years

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20
Q

Histological types of Phyllodes tumour?

A

Benign

Indeterminate

Malignant

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21
Q

Mx of Phyllodes tumour?

A

Excision with wide, clear, surgical margins

Careful follow-up

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22
Q

Issues assoc. with Phyllodes tumour?

A

Metastasis is rare

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23
Q

What is mastalgia?

A

Breast pain, which is a common breast symptom for women during their reproductive years

NOTE - ensure the pain is not of non-breast aetiology, i.e: anterior chest wall pain

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24
Q

Pattern of mastalgia?

A
  1. Cyclic (usually) - usually diffuse and most intense during the intermediate pre-menstrual phase of the cycle; usually bilateral but can be unilateral
  2. Non-cyclic (can occur) - usually localised, often persistent and less response to treatment that cyclic variant
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25
Q

Issues assoc. with mastalgia?

A

Rarely assoc. with malignancy, unless there is a palpable breast mass

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26
Q

Non-breast aetiologies of anterior chest wall pain?

A 
Achalasia
Angina
Cervical radiculitis
Cholecystitis
Cholelithiasis
Coronary artery disease
Costochondritis (AKA Tietze syndrome)
Fibromyositis
Hiatus hernia
Myalgia
Neuralgia
Osteomalacia
Phantom pain
Pleurisy
Psychological pain
PE
Pulmonary infarct
Rib fracture
Sickle cell disease
Trauma
TB
27
Q

Ix of mastalgia?

A

Examination

Mammogram for a woman ≥35 years of age

28
Q

Mx of mastalgia?

A

Reassure the patient that symptoms are physiological, if cyclic variant, and that there is no evidence of cancer; most require no further treatment

Advise simple measures:
• Well-fitting, firm bra
• Regular exercise

Other therapies effective for mastalgia:
• Evening primrose oil
• Tamoxifen
• Topical NSAIDs

29
Q

Occurrence of cysts?

A

Palpable breast cysts commonly occur during late reproductive years

NOTE - cysts are not pre-malignancy per se

30
Q

Examination features of a cyst?

A

Typically palpable, clearly defined, soft, mobile and smooth with distinct borders

Cysts are often slightly tender, esp. before menstruation

May be multiple and/or bilateral

31
Q

Ix and Mx of cyst?

A

FNA - aspirate as much fluid as possible; only grossly bloody fluid requires cytologic evaluation

After FNA, palpate the area of the cyst to ensure that there is no residual mass

32
Q

What is a papilloma?

A

Benign, intracystic papillary proliferation that can occur within a cyst and is often assoc. with BLOODY CYST FLUID

33
Q

When is an intracystic carcinoma suspected?

A

When the fluid is grossly bloody or there is a residual mass after aspiration

USS-guided core biopsy is recommended for histological diagnosis of any intracystic solid lesion or irregular cystic wall

34
Q

Describe normal nipple discharge

A

Usually clear, yellow and watery

It can be elicited from the nipples of most women of reproductive age; this is physiological

35
Q

Pathological nipple discharge?

A

Bloody discharge, part. from a single duct, should be evaluated

36
Q

Most common cause of spontaneous nipple discharge?

A

Intraductal papilloma(s), which are benign lesions

i.e: nipple discharge is rarely a sign of malignancy, unless there is an assoc. palpable mass

37
Q

Treatment of intraductal lesions?

A

All are excised and histologically evaluated, in order to ensure that it is not the rare intraductal carcinoma

38
Q

Ix of pathological nipple discharge?

A

Mammography

USS

Surgical excision of discharging ducts (usually required to establish pathological cause and to relieve the discharge)

39
Q

PC of Paget’s disease of the nipple?

A

Can present as an erythematous WEEPING lesion on the nipple surface and areola

However, it usually presents as a dry, scaly, eczematous lesion

This can be perceived as nipple discharge

40
Q

Ix for Paget’s disease of the nipple?

A

Histologic tissue biopsy (incisional or punch biopsy)

Often, there is an underlying palpable mass or a radiological abnormality

41
Q

What is mastitis?

A

Inflammation of the breasts; there are 2 main types

  1. Puerperal mastitis (pregnancy or lactation-related) - common; mainly caused by Staph. aureus
  2. Non-puerperal mastitis - uncommon and, in post-menopausal women, it is rare; assoc. SMOKING
    Organisms are mixed, e.g: S. aureus, Peptostreptococcus magnus and/or Bacteroides fragilis are common bacterial pathogens
  3. Chronic mastitis - uncommon and can be assoc. with sub-areolar abscess
42
Q

PC of mastitis?

A

Fever

Erythema, induration, tenderness and swelling

43
Q

Mx of puerperal mastitis?

A

Flucloxacillin 500mg PO, every 6 hours for 7 days

OR

Augmentin 625mg PO, every 8 hours for 7 days

NOTE - must treat with a full course of antibiotics effective against S. aureus

Patient should be examined every 3 days to be certain that infection is responding and for evidence of abscess formation

If lack of response, change antibiotic

44
Q

Advice on breastfeeding with mastitis?

A

Continue if already begun and/or the infected breast can be pumped, until mastitis clears

45
Q

Ix for mastitis?

A

Cultures are useless

46
Q

Complications of mastitis?

A

Breast abscess

47
Q

PC of breast abscess?

A

Flocculent, and sometimes, bulging mass, usually located in the central area of the mastitis

48
Q

Ix of breast abscess?

A

USS confirms fluid-filled (pus) center

Aspiration with a gauge needle, using LA, is diagnostic and can be therapeutic, if all pus is removed; it is sent for analysis

49
Q

Mx of breast abscess?

A

Aspiration may have to be repeat every 3 days, part. if there is >10ml of pus initially aspiratied

If repeated aspirations are ineffective, open surgical dependent drainage under general anaesthesia is required

Continue antibiotics until all evidence of inflammation (cellulitis) has cleared

50
Q

Mx of non-puerperal mastitis?

A

Augmentin 625mg PO, every 8 hours for 7 days, is usually effective

OR

Cephalexin 500mg PO, every 6 hours for 7 days

Re-examine patient every 3 days, until infection clears

51
Q

Complications of chronic mastitis?

A

Peri-areolar fistulae can occur (must be surgically excised when inflammation is quiescent)

52
Q

Potential cause of mastitis that is unresponsive to antibiotics?

A

Consider inflammatory carcinoma, part. if it spreads over the entire breast

53
Q

What is an adenolipoma?

A

Unusual variant of a lipoma; it is BENIGN

PC as a smooth palpable mass, with a characteristic mammographic pattern

54
Q

What is apocrine metaplasia of the epithelial cells?

A

Can occur in the lining of a breast cyst; the cells enlarge and are eosinophilic

BENIGN

55
Q

What is ductal hyperplasia?

A

Benign histological process, however, if the hyperplasia is atypical, assoc. with an increased risk of carcinoma and may begin the transformation for DCIS and eventual invasive ductal carcinoma

56
Q

What is fat necrosis?

A

Pathological cell death of fat, often secondary to breast trauma, e.g: seat belt injury, but not always

It can mimic cancer on examination but has a distinct appearance on mammography

57
Q

Mx of fat necrosis?

A

Usually subsides spontaneously but may leave a residual lesion of mammography

58
Q

What is a galactocoele?

A

Palpable, milk-filled cyst that is most commonly assoc. with pregnancy or lactation

59
Q

Ix and Mx of a galactocoele?

A

FNA to diagnose and drain

60
Q

Ix for a lipoma?

A

Can be palpable on examination

Thin, smooth border on mammography

Biopsy shows only adipose cells

61
Q

What is Mondor’s disease?

A

Phlebitis and subsequent clot formation in the superficial (skin) veins of the breast

Usually assoc. with a Hx of breast trauma, e.g: surgery

62
Q

PC of Mondor’s disease?

A

Firm, vertical, cord-like structure

63
Q

Mx of Mondor’s disease?

A

Lesions usually resolves spontaneously in 8-12 weeks

Year 3 Clinical (100 decks)

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