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Revision > breast > Flashcards

breast Flashcards

1
Q

what is the benign breast disease that affects women <30

A

fibroadenoma

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2
Q

how would a fibroadenoma present

A

firm
mobile = breast mouse
multiple
painless

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3
Q

what is the diagnosis for all suspected breast lumps

A

triple assessment

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4
Q

what is the pathology of a fibroadenoma

A

well circumscribed

well differentiated gland embedded in well differentiated connective tissue stroma

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5
Q

management of fibroadenoma

A

reassurance and discharge

excision if >3cm

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6
Q

what are fibrocystic changes

A

term which includes benign and non-neoplastic changes in the breast

includes fibroids and cysts

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7
Q

what is the clinical presentation of fibrocystic change

A 
breast pain 
tenderness 
lump
cyst 
felt in 2nd part of MC
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8
Q

what age group are affected by fibrocystic change

A

25-45

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9
Q

how to manage fibrocystic change

A

reassurance
analgesia
cyst aspiration
rare excision

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10
Q

what are the 2 most common types of breast cancer

A

ductal carcinoma

lobular carcinoma

invasive adenocarcinomas

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11
Q

where do all breast cancers arise from

A

epithelial lining of terminal duct lobular unit

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12
Q

risk factors for breast cancer

A

increasing lifetime oestrogen exposure - female, increase in age, obesity, long term COCP, early menarche, late menopause

family hx

alcohol consumption

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13
Q

clinical presentation of breast cancer

A

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
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14
Q

what are the 2 types of ductal carcinoma

A

DCIS (ductal carcinoma in situ)

IDC (invasive ductal carcinoma)

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15
Q

what is DCIS

A
  • 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
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16
Q

what is IDC?

A
  • 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)
17
Q

what is the 2nd most common invasive breast cancer

A

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
18
Q

what is the triple assessment

A

clinical exam and hx of breast lump

radiological imaging - mammography or US

histology and cytology - fine needle aspirate or core needle biopsy

19
Q

what can a mammography identify

A

microcalcifications associated with DCIS

20
Q

management of breast carcinoma

A 
surgery 
radiotherapy
hormone therapy - tamoxifen 
biological therapy - herceptin for HER+
chemo
21
Q

what is the sentinel node biopsy

A

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

22
Q

which breast cancers are associated with worse prognosis

A

ER negative tumour

HER2 (oncogene)

23
Q

What is the aim of the breast cancer screening programme?

A

Identify DCIS and small invasive carcinoma at early stage

24
Q

How often are women between 50-70 called for breast cancer screening?

A

Every 3 years

25
Q

How are needle tests for fine needle aspirate/core biopsy reported

A

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

Revision (20 decks)

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