breast Flashcards
what is the benign breast disease that affects women <30
fibroadenoma
how would a fibroadenoma present
firm
mobile = breast mouse
multiple
painless
what is the diagnosis for all suspected breast lumps
triple assessment
what is the pathology of a fibroadenoma
well circumscribed
well differentiated gland embedded in well differentiated connective tissue stroma
management of fibroadenoma
reassurance and discharge
excision if >3cm
what are fibrocystic changes
term which includes benign and non-neoplastic changes in the breast
includes fibroids and cysts
what is the clinical presentation of fibrocystic change
breast pain tenderness lump cyst felt in 2nd part of MC
what age group are affected by fibrocystic change
25-45
how to manage fibrocystic change
reassurance
analgesia
cyst aspiration
rare excision
what are the 2 most common types of breast cancer
ductal carcinoma
lobular carcinoma
invasive adenocarcinomas
where do all breast cancers arise from
epithelial lining of terminal duct lobular unit
risk factors for breast cancer
increasing lifetime oestrogen exposure - female, increase in age, obesity, long term COCP, early menarche, late menopause
family hx
alcohol consumption
clinical presentation of breast cancer
most occur in upper outer quadrant of breast
hard painless lump nipple inversion skin dimpling ulceration peau d'orange nipple/areola eczema - pagets disease (DCIS) palpable axillary nodes metastatic disease
what are the 2 types of ductal carcinoma
DCIS (ductal carcinoma in situ)
IDC (invasive ductal carcinoma)
what is DCIS
- epithelial cells show cytological changes of malignancy
- basement membrane is intact - cells have not invaded into the surrounding tissue
- carcinoma in situ as the carcinoma has not invaded the adjacent breast tissue and does not have the potential to metastasise
- it does not fulfil the 2 defining criteria for a malignant tumour but it is pre-cancer because (if untreated) it can progress to IDC
what is IDC?
- tumour cells have invaded through the basement membrane into the adjacent tissue
- the adjacent breast tissue has been invaded and it has the potential to metastasise
- fulfils the 2 defining criteria for malignant tumour (IDC = cancer)
what is the 2nd most common invasive breast cancer
invasive lobular carcinoma
- Composed of tumour cells which infiltrate the normal breast tissue as linear cords of cells (single file)
- this discohesive growth pattern = reflects the loss of function of E-cadherin-catenin cell adhesion system
what is the triple assessment
clinical exam and hx of breast lump
radiological imaging - mammography or US
histology and cytology - fine needle aspirate or core needle biopsy
what can a mammography identify
microcalcifications associated with DCIS
management of breast carcinoma
surgery radiotherapy hormone therapy - tamoxifen biological therapy - herceptin for HER+ chemo
what is the sentinel node biopsy
1st node draining the cancer
identify the node with dye or isotope
if sentinel node + = contains metastatic tumour and axillary clearance indicated
if sentinel node - = no metastatic tumour present so no involvement of axillary nodes
which breast cancers are associated with worse prognosis
ER negative tumour
HER2 (oncogene)
What is the aim of the breast cancer screening programme?
Identify DCIS and small invasive carcinoma at early stage
How often are women between 50-70 called for breast cancer screening?
Every 3 years
How are needle tests for fine needle aspirate/core biopsy reported
Numbering system
C=cytology B=biopsy
C1/B1= inadequate or not diagnostic C2/B2 = Benign (fibroadenoma, fibrocystic) C3/B3 = equivocal favour benign C4/B4 = equivocal favour malignant C5/B5 = malignant including DCIS
