Breast Flashcards
What are fibroadenomas, what are the types and what is their progression and management?
Benign breast lump that form from the lobules of the breast.
Most common breast lump in 18-25 year olds
Can be:
- Juvenile (kids)
- Common
- Giant (>4cm)
Most stay the same, 30% regress and 10% grow
A giat one may warrant a biopsy
Breast cysts, presentation?
Most frequently perimenopausal females
Soft, fluctuant swellings
On imaging they will usually show a ‘halo appearance’ on mammograph
Management of a breast cyst?
If symptomatic:
- Aspiration, will dissappear.
Presentation of duct ectasia?
Cheese like nipple discharge (green)
Retraction of nipple
No treatment needed, unless troublesome discharge
Younger will have microdochectomy
Older will have duct excision
Breast cancer can be three different types according to what?
Her positive
ER and HER Neg
ER and HER negative
What drugs do you use to treat ER positive breast cancer?
Tamoxifen
- Selective oestrogen receptor modulators
Anastrazole and letrozole
- Aromatase inhibitors
- Used in post menopausal as most oestrogen is produced through aromatase when post-menopausal.
What is sclerosing adenosis, how does it present?
Disorder of involution, causes distortion of distal lobular unit.
Breast lump or breast pain
Mammographic changes may mimic carcinoma
Breast epithelial hyperplasia Presentation, cause and management?
Varying presentation
- May be generalised lumpiness
- May have a discrete lump
Increased cellularity of terminal lobular unit,
Atypical features and a FH of BC means you need to closely monitor or resect as high risk of malignancy
How does fat necrosis present, management?
About 40% have a history of trauma, physical features similar to carcinoma
Need imagine and core biopsy
What is ductal papilloma presentation, management?
Nipple discharge, may have a mass if large, normally single duct in origin.
Microdochectomy
Types of Breast cancer?
- Invasive ductal carcinoma is most common (no special type).
- Causes pagets disease
Others are special type:
- Invasive lobular carcinoma
Then In situ:
- Ductal carcinoma in situ (can become invasive ductal).
- Lobular Carcinoma in Situ (isn’t really Breast cancer, doesn’t invade).
Others are also special type and quite rare, e.g. medullary breast cancer).
Management of breast cancer?
Surgery (majority)
Wide local excision or mastectomy.
Mastectomy
- Multifocal tumour
- Central tumour
- Large lesion in small breasts
- DCIS > 4
- Pt choice
Wide local excision
- Solitary lesion
- Peripheral
- Smaller lesion in large breasts
- DCIS <4cm
- Patient choice
Radiotherapy
- After wide local excision
- If 4 or more positive nodes
- T3/4 tumours
`Hormonal (ER+)
- Tamoxifen in pre and peri menipausal
- Aromatase inhibitors in Post menopausal
Biological (HER+)
- Herceptin
Chemo
- Sometimes to downstage disease
- Post surgery if axillary node disease
What system can you use for prognosis in breast cancer, what is it made up of?
Nottingham prognostic index
Tumour size x 0.2 PLUS the lymph node score:
- 1 is no lymph nodes
- 2 is 1-3
- 3 is >3
2-2.4 infers 94% survival
>5.4 is 50% survival
When should you refer for breast cancer?
2ww
- Aged 30 and over and have an unexplained breast lump with or without pain or
- Aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern.
Consider 2ww
- Skin changes
- Aged > 30 with axillary lump
Breast cancer risk factors?
BRCA1, BRCA2 genes - 40% lifetime risk of breast/ovarian cancer
1st degree relative premenopausal relative with breast cancer (e.g. mother)
nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs)
early menarche, late menopause (menarche not unopposed oestrogen)
combined hormone replacement therapy (relative risk increase * 1.023/year of use), combined oral contraceptive use
past breast cancer
not breastfeeding
ionising radiation
p53 gene mutations
obesity
previous surgery for benign disease (?more follow-up, scar hides lump)
