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Breast Flashcards

1
Q

What attaches the breast to the dermis? What is its function?

A

Suspension ligament of cooper: helps support the lobules of the gland

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2
Q

How many lobules does each breast contain?

A

15-20 lobules of glandular tissue

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3
Q

What is each lobule drained by?

A

Lactiferous duct

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4
Q

Describe the structure of the nipple.

A

Contains collagenous, dense connective tissue, elastic fibres and bands of smooth muscle.
The tips of the nipples are fissured with lactifeous ducts opening into them

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5
Q

What is gynaecomastia?

A

Postnatal development of rudimentary lactiferous ducts in males

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6
Q

What is the nervous supply to the breast?

A

Anterior and lateral cutaneous branches of 4-6th intercoastal nerves. Convey sensory fibres to the skin of the breast. Sympathetic fibres to the blood vessels and to the smooth muscle around the nipple.

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7
Q

Describe the lymphatic drainage of the breast.

A

Most from lateral quadrants: axillary lymph nodes
Some may drain directly to supraclavicular or inferior cervical nodes
Lymph from medial quadrants: parasternal or to opposite breast

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8
Q

What is the role of a sentinel lymph node (first draining node) in breast cancer?

A

Lymphatic mapping and staging patients
A radiolabelled colloid is used to locate the sentinel node
At the time of surgery, a vital blue dye is injected
Combination of radioisotope and she provides most accurate means of localising the node.

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9
Q

What is a fibroadenoma?

A

Benign breast tumour. Circumscribed mobile nodule in reproductive age. Freely mobile, nonpainful mass.

May regress with age if left untreated

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10
Q

What is an intraduct papilloma?

A

Benign breast tumour. Lactiferous ducts, nipple discharge.

Can show epithelial hyperplasia, which might be atypical.

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11
Q

What is cytology?

A

Microscopic examination of a thin layre of cells on a slide obtained by:
Fine needle aspiration
Direct smear from nipple discharge
Scrape of nipple with scalpel

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12
Q

Describe the technique of fine needle aspiration.

A

23G needle. 10ml syringe. Alcohol swab. Vial with saline for needle washings. Insert needle 45 degrees. Aspirate using in and out action applying negative pressure on syringe. Release pressure and remove needle.

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13
Q

What does a benign cytology look like?

A
  • low/ moderate cellulartiy
  • cohesive groups of cells
  • flat sheets of cells
  • bare ovel nuclei in background
  • cells of uniform size
  • Uniform chromatin pattern
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14
Q

What does a malignant cytology look like?

A
  • high cellularity
  • crowding/ overlapping of cells
  • loss of cohesion
  • nuclear pleomorphism
  • hyperchromasia
  • absence of bipolar nuclei
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15
Q

What is the cytology scoring system?

A
  • C1 Unsatisfactory/ Insufficient cells for diagnosis
  • C2 Benign
  • C3 Atypia (probably benign)
  • C4 Suspicious (probably malignant)
  • C5 Malignant
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16
Q

When is fluid from a breast cyst analysed?

A
  • fluid is bloodstained

- there is residual mass

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17
Q

What are the advantages of breast cytology?

A
  • simple procedure (can be done at clinic)
  • well tolerated by patients
  • inexpensive
  • immediate results
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18
Q

What are the limitations of cytology?

A
  • flase negatives
  • false positives
  • invasion cannot be assessed
  • grading cannot be done
  • lesion can be missed
  • technical (difficult to examine cells)
  • interpretation
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19
Q

What are the complications of FNA?

A

Pain
Haematoma
Fainting
Infection, pneumothorax (rare)

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20
Q

What are the contraindications of FNA?

A

There are none

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21
Q

Why is a core biopsy undertaken?

A
  • confirm invasion
  • tumour typing and grading
  • immunohistochemistry
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22
Q

How many lactiferous ducts does the breast have?

A

15-20 ducts

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23
Q

How many lobes does the breast have?

A

8-10 lobes

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24
Q

Where does carcinoma of the breast arise?

A

Lobular unit

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25
Q

What are the benign conditions of the breast?

A
  • fibrocytic change
  • fibroadenoma
  • intraduct papilloma
  • fat necrosis
  • duct ectasia
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26
Q

What ia fibrocystic change?

A

Painful, lumpy area

Fibrosis, adenosis, cysts, apocrine metaplasia, ductal epithelial, hyperplasia

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27
Q

What is a fibroadenoma?

A

Circumscribed mobile nodule in reproductive age
Proliferation of epithelial and stromal elements
Most common breast tumour in adolescents
Non- painful mass
May regress if left untreated

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28
Q

How is fat necrosis caused in the breast?

A

Trauma

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29
Q

What is the pathology of a fibroadenoma?

A

Ducts distorted elongated
Slit-like structures intracanalicular pattern
Ducts not compressed
Pericanalicular growth pattern

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30
Q

What is a lactating adenoma?

A

Enlarging masses during lactation or pregnancy

Prominent secretory change

31
Q

At what age is an intraduct papilloma common?

A

Middle aged women

32
Q

What can fat necrosis in the breast stimulate>

A

Carcinoma

33
Q

What is seen in hostology of fat necrosis of the breast?

A

Histocytes with foamy cytoplasm
Lipid filled cysts
Fibrosis, calcifiactions, egg shell on mammography

34
Q

What is phyllodes tumour?

A

Fleshy tumour, leaf-like pattern and cysts on cut surface
Circumscribed, connective tissue and epithelial elements
1-15cm
Less than 1% of breast tumours
Benign, borderline, malignant
Metastases are hematogenous

35
Q

How many females will breast cancer affect?

A

1 in 8

36
Q

What are the macroscopic features of a breast carcinoma?

A

Hard lump, fixed mass, tethering to skin, dimpling of skin

37
Q

What are the risk factors for breast cancer?

A 
Female
Age: increased risk with age
Menstrual history
Age at first pregnancy 
Radiation 
FH: first degree relative
Personal history
Hormonal treament 
Genetic factors
38
Q

What genes are most commonly associated with hereditry breast cancer?

A

BRCA1: 20-40%
BRCA2: 10-30%

39
Q

What are the two non-invasive breast carcinomas?

A

Ductal carcinoma in situ

Lubular carcinoma in situ

40
Q

What are the invasive breast carcinomas?

A

Invasive ductal carcinoma
Invasive lobular carinoma and variants
Special types

41
Q

What is meant by an in-situ carcinoma?

A

Preinvasive: does not form a palpable tumour
Not detected clinically
Multicentricity and bilaterality
No metastatic spread (basement membrane)
Risk of invasion depending on grade

42
Q

What are DCIS graded on?

A

Nuclear morphology

43
Q

What are the various ‘special types’ of breast carcinoma?

A

Tubular carcinoma
Mucinous carcinoma
carcinoma with medullary features
Metaplastic carcinoma

44
Q

What are the procedures used in diagnosing a breast carcinoma?

A 
Clinical examination 
Radiology (mammogram, US, MRI) 
Fine needle aspiration cytology, FNA
Needle core biopsy 
Wide local excision with adequate margins
45
Q

What are microcalcifications?

A

Tiny deposits of calcium can appear anywhere in the breast and often show up on a mammogram
Most women have one or more areas of microcalcifications of various sizes
Majoirty of calcium deposits are harmless
A small percentage may be in precancerous or cancerous tissue

46
Q

What are the two most important mammographic indicators of breast cancer?

A

Masses

Microcalcifications: can indicate an early cancer

47
Q

What can be concluded from a breast tumour histology report?

A 
Invasive vs non-invasive
Histological type: ductal vs lobular 
Grade (aggressiveness under microscope)
Size
Margins 
Lymph nodes 
Oestogen/ progesterone receptor 
HER-2
48
Q

Describe the ways in which breast cancer can spread.

A

Local: skin, pectoral muscles
Lymphatic: axillary and internal mammary nodes
Blood: bone, lungs, liver, brain

49
Q

What is the best prognostic indicator in breast cancer?

A

Node status

50
Q

What prognosis is associated with a younger age?

A

Poorer prognosis

51
Q

What is HER 2?

A

A protein that helps breast cancer cells grow quickly. Higher than normal levels of HER 2 is HER 2 positive. These cancers grow and spread faster. They respond to treatment with drugs that target the HER 2 protein.

52
Q

What molecular makers are used in testing breast tumours?

A

ER/ PR strong predictors of response to hormonal therapies

HER-2: about 20-30% positive-predicts response to trastizumab

53
Q

What are the subtypes of tumour based on molecular classifiaction?

A 
Basal-like
Luminal A
Luminal B
HER 2
Normal/ breast like
54
Q

What is paget’s disease of the nipple?

A

Result of intraepithelial spread of intraductal carcinoma
Large pale-staining cells within the epidermis of th enipple
Limited to the nipple or extend to the areola
Pain or itching, scaling and redness, mistaken for eczema
Ulceration, crusting and serous or blood discharge

55
Q

What is gynecomastia?

A

Increase in subareolar tissue
No risk of malignancy
In 30-40% of adult males

56
Q

What is gynecomastia associated with?

A

hyperthyroidism, cirrhosis of the liver, chronic
renal failure, chronic pulmonary disease, and hypogonadism, use of hormones - estrogens, androgens, and other drugs (digitalis, cimetidine, spironolactone, marihuana, and tricyclic antidepressants)

57
Q

What are the presenting features of breast cancer?

A 
Lump 
Mastalgia
Nipple discharge
Nipple changes (paget’s disease)
Change in the size or shape of the breast
Lymphoedema 
Dimpling of the breast skin
58
Q

Why is mammography sensitivity reduced in younger women?

A

Presence of increased glandular tissue

59
Q

What is meant by the sensitivity of a test?

A

The ability of a test to detect the disease if it is there

60
Q

Describe the T staging of a breast tumour?

A 
Tx         Primary tumour cannot be assessed 
T0         Primary tumour not palpable 
T1       Clinically palpable tumour -size < 2 cm 
T2         Tumour size 2-5 cm 
T3         Tumour size > 5 cm 
T4a        Tumour invading skin 
T4b    Tumour invading chest wall 
T4c     Tumour invading both 
T4d     Inflammatory breast cancer
61
Q

Describe the N staging of breast cancer.

A

N0 No Regional lymph nodes palpable
N1 Regional lymph node palpable- mobile
N2 Regional lymph node palpable- fixed

62
Q

Describe the M staging of breast cancer.

A

Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

63
Q

What are the two main types of surgery in the treatment of breast cancer?

A

Breast conservation surgery

Mastectomy

64
Q

What patients are suitbale for breast conservation surgery?

A

Tumour size clinically < 4 c m
Suitbale for chemotherapy
Single tumours

65
Q

What lymph node will the tumour first spread to?

A

Sentinel lymph node

Biopsy to find lymphatic spread

66
Q

What is done if the SLN is found to contain tumour?

A

Remove all nodes or give radiotherapy to all the axillary nodes

67
Q

What are the complications of axilary treatment?

A 
Lymphoedema 
Sensory disturbance
Decrease ROM of the shoulder joint 
Nerve damage 
Vascular damage 
Radiation-induced sarcoma
68
Q

What factors are involved with increased risk of disease recurrence?

A 
Lymph node involvement 
Tumour grade
Tumour size
Steriod receptor status
HEr2 status 
Lymphovascular invasion
69
Q

What treatments are used as adjuvant treatments?

A

Radiotherapy (local)
Hormone therapy (systemic)
Chemotherapy (systemic)
Targerted therpaies (systemic)

70
Q

When is hormone therapy given?

A

Oestrogen receptor positive tumours. Blocks stimulation of cell growth by oestrogen

71
Q

What hormone therapies are used in oestrogen receptor positive tumours?

A

Tamoxifen
Armidex
Letrozole

72
Q

Describe anti-HER2 therapy

A

Trastuzumab
Monoclonal antibody agaisnt HER 2 recpetor
Given to patients with over-expression of HER2 and chemptherapy
50% decrease risk of recurrence
33% increase in survival at 3 years

73
Q

Where may breast cancer metastasis to?

A

Bone, lung, liver, brain, bone marrow, contralateral breast

Reproduction (13 decks)

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