Benign / Malignant Breast Flashcards
1
Q
What is grading?
A
A measure of tumour differentiation
How similar it is to original tissue
2
Q
What is the commonest cause of a breast lump in PTx aged under 30yrs?
A
Fibroadenoma
3
Q
What is the commonest cause of a breast lump in PTx aged 30-50?
A
Cyst
4
Q
What is the commonest cause of a breast lump in PTx aged over 50yrs?
A
Breast cancer
5
Q
What imaging modality has the highest sensitivity at viewing the breast?
A
MRI
6
Q
What age group does fibrocystic change occur in?
A
40 - 50 years
7
Q
An early menopause is a RF for fibrocystic change T or F
A
False, a late menopause is
8
Q
What symptom of the climacteric period is associated with fibrocystic change?
A
Abdominal menses e.g. menorrhagia, oligomenorrhea
9
Q
How may fibrocystic change present?
A
Multiple smooth lumps
Cyclical breast pain
10
Q
Are lumps in fibrocystic change solid or fluid full?
What type of epithelium are they lined by?
A
Fluid full
Lined by apocrine epithelium
11
Q
What Ix should you do for suspected fibrocystic change?
A
US breast - fluid full not worrying
12
Q
What is the Mx of fibrocystic change?
A
Nothing, most resolve post menopause
13
Q
How does a fibroadenoma present?
- Is it painful?
- Firm or solid?
- Mobile or fixed?
- Rough or well circumscribed?
A
Painless
Well circumscribed
Firm
Mobile
14
Q
What is the pathology of fibroadenomas?
A
Epithelial + stromal hyperplasia
15
Q
Fibroadenomas are premalignant. T or F
A
False
16
Q
What Ix should be done for fibroadenomas?
A
US +- core needle biopsy if suspicious
17
Q
What is the definitive Dx for fibroadenomas?
A
Core needle biopsy
18
Q
What is the Mx of a fibroadenoma?
A
Nothing, can excise if PTx requests
19
Q
What is the name of the benign breast lump caused by normal breast components in abnormal proportion and distribution?
A
Hamartoma
20
Q
What age range are breast papillomas most common in?
A
35 - 60 years
21
Q
How do breast papillomas present?
A
Discharge +- bloody
+-Lump
22
Q
Where in the breast are papillomas found?
A
Intraduct
23
Q
Breast papilloma Ix
A
US / mammo
+
Core needle biopsy
24
Q
Breast papilloma Mx
A
Excise
Very rarely malignant
25
Breast papillomas may calcify. T or F
True
26
What age range are breast cysts most common in?
40 - 50 years
27
Breast cysts are:
- [Solid/fluid full]
- [Soft/firm]
- [Mobile/fixed]
- [Distinct/indistinct] border
Breast cysts are:
- Fluid full
- Soft
- Mobile
- Distinct border
28
Breast cysts Ix
FNA
29
What is the aetiology of fat necrosis?
Trauma - seat belt injury
Warfarin
Idiopathic
30
Fat necrosis pathology
Foamy macrophages - fibrous scar
31
Fat necrosis Ix
Exclude malignancy
32
What cause of a breast lump is due to disordered proliferation, may calcify and presentation mimics carcinoma?
Sclerosing adenosis
33
What is the pathology of radial scars?
Fibrotic core
| Stellate architecture
34
Radial scars are premalignant. T or F
False
35
Radial scars are often multiples. T or F
True
36
Radial scar Ix
US / mammo
| Biopsy
37
What is carcinoma in situ?
Malignancy confined above the basement membrane
| -not truly malignant since not invasive
38
What is the main ductal carcinoma precursor?
DCIS ductal carcinoma in situ
39
What are the grades of DCIS? Which one is commonest
Low
Intermediate
High - commonest
40
What is the Mx of high grade DCIS
Wide local excision + radiotherapy
41
What type of ductal carcinoma precursor is Paget's disease of the nipple?
High grade DCIS
42
How does Paget's present?
Red
| Dry or weeps
43
What are the 2 types of lobular carcinoma precursors and what separates them?
Lobular CIS: >50% lobule effected
| Atypical hyperplasia: <50%
44
Is lobular or ductal carcinoma precursors associated with CDH1 mutations?
Lobular
45
Are lobular or ductal carcinoma precursors more likely to be multifocal / bilateral?
Lobular
46
What is the Ix for LCIS and DCIS?
If mammogram +ve do vacuum biopsy + US axilla
47
Breast cancer effects 1 in how many women?
1 in 8
48
The incidence of breast cancer is decreasing. T or F
False, increasing
49
Who is eligible for breast screening and how often?
Age 50 - 70
| Every 3 years
50
If something potential malignant is found on a mammogram at screening, what is the next step?
Refer for vacuum biopsy
| US axilla
51
What colour is fat on a mammogram?
Dark
52
Calcification on a mammogram is most likely caused by what?
DCIS
53
Mammograms can differentiate solid and cystic lesions. T or F
True
54
Does breast density increase or decrease with age?
Increase - hence screening harder or easier ???
55
What age group is breast cancer most common in?
Over 50 years
56
What features of a gynae history are risk factors for breast cancer?
```
Early menarche
Late menopause
Not breastfeeding
Parity 0
1st pregnancy over 30yr
Current OCP use
Current or long term HRT
```
57
What are the 2 main types of breast carcinomas and which is most common?
Ductal 80%
Lobular
(There are others but they're less common)
58
What type of cancer is breast cancer?
Adenocarcinoma
59
What hormone receptors are sometimes expressed by breast carcinomas? List them in order of frequency
ER estrogen receptor
PR progesterone receptor
HER2
60
Where do HER2+ cancers commonly metastasise?
Brain, lung, pleura, bone
61
Where do lobular cancers commonly metastasise?
Lung, pleura, peritoneum, gut, bone
62
What % of breast cancer is detected by screening?
50%
63
How may breast cancer present?
- Lump
- Nipple inversion
- Skin change e.g. puckering, peau d’orange, dimpling
- Pain
- Bloody discharge,
64
If breast cancer is suspected from a presentation to primary care, what should a GP do?
Refer to 1 stop breast clinic
65
What happens in the 1 stop breast clinic
Triple assessment
- Exam + history
- Mammo or US
- If +ve; core needle biopsy and US axilla
66
What is a sentinel node?What is the sentinel node in most breast carcinomas?
1st that drains a tumour
| Axillary
67
After analysing the biopsy specimen, if the breast carcinoma has invaded local structures, what additional Ix should be done and why?
CT chest abdo pelvis
| Look for met
68
How are hormone receptors checked for when investigating breast cancer?
Gene expression profiling immunostaining of the biopsy
69
What staging system is used for breast cancer?
TNM
70
What do TNM stand for?
T: 0-4 local
N: 0-3 nodes
M: 0-1 distant blood borne met
71
What is the 1st line Mx in non-metastasized breast cancer?
Breast conserving surgery + radio
72
What is neo-adjuvant and adjuvant Tx?
Neo-adjuvant pre surgery
| Adjuvant post surgery
73
What neo-adjuvant Tx is done for breast cancer?
Chemo to shrink tumour
| Hormonal therapy if ER+
74
What is the Layman's term for breast conserving surgery?
Lumpectomy
75
Breast conserving surgery should leave a ____ margin. It involves a ____ guided ____ local excision. Breast reconstruction is offered which is referred to as ____ surgery.
Breast conserving surgery should leave a 1CM margin. It involves a WIRE guided WIDE local excision. Breast reconstruction is offered which is referred to as ONCOPLASTIC surgery.
76
What is the main SE of totally axillary clearance?
Lymphedema
77
In breast cancer surgery, patients are offered immediate or delayed reconstructions. What are the 2 options for surgical reconstruction?
Implant or autologous flap
78
What adjuvant therapy is given for breast cancer?
Radiotherapy
Chemotherapy
+-Hormonal therapy
79
What is the purpose of adjuvant radiotherapy in breast cancer?
To decrease local recurrences
80
What hormonal therapy options are there for ER +ve breast cancer?
Tamoxifen
| Aromatase inhibitors
81
When are aromatase inhibitors used over tamoxifen fro breast cancer?
Post-menopausal
82
What are the side effects of tamoxifen?
Increases endometrial cancer
| Vag bleeding
83
What are the names of the aromatase inhibitors used for breast cancer?
Letrozole
| Anastrozole
84
What are the SEs of ER blockade?
Hot flushes
| Vag dryness
85
What hormonal therapy option is there for HER2 +ve breast cancer? What drug class does it belong to?
Herceptin trastuzamab
| Monoclonal Ab
86
What are the SEs of herceptin trastuzamab?
Allergy
| Reversible HF
87
Anthracycline FEC100 plus a taxane is the standard _____ option for breast cancer
Chemotherapy
88
What are the main SEs of chemotherapy?
Anorexia, malaise, neutropenia, alopecia, myalgia
89
Tumour markers are used in the Dx of breast cancer. T or F
False, used to monitor Tx
90
What tumour markers are used to monitor Tx response in breast cancer?
CEA and CA15-3
91
Post breast cancer Tx, how are PTxs monitored for recurrences?
Mammogram once a year for 3 years
| Then back into national screening programme
92
What are the 3 main progonostic factors that influence breast cancer outcome?
Tumour size
Grade
LN involvement
93
What is the Mx of bone mets in breast cancer?
Radio
| Bisphosphonate PO ibandronic acid
94
What is the palliative Mx of breast cancer?
Chemo +- hormonal Tx
95
What type of breast cancer occurs post radio Tx
Angiosarcoma
96
What is the name of the breast tumour that can be benign or malignant, is composed of epithelium and stroma and is slow growing? IT is most common in 35 - 50 year olds
Phyllodes tumour
97
What cancers most commonly metastasize to the breast?
```
Lymphoma
Melanoma
Lung
Ovary
RCC
Others
```
