breast Flashcards
what is a fibroadenoma
the most common benign tumour of the breast
occurs in women under 30, rare after menopause.
Firm, mobile painless lump–> can be multiple. ‘breast mouse’ due to how mobile they are.
Ix: triple assessment (separate flashcard)
generally well circumscribed. Stromal and epithelial cells.
possibly related to hormonal sensitivity of breast tissue- tend to grow during pregnancy.
can be left in, but if bigger than 3cm then can be surgically removed.
what is fibrocystic change (fibroadenosis/ ANDI)
a general term used to cover lots of benign changes in he breast.
result of minor aberrations of normal response to normal cyclical hormone changes.
women 25-40 years
causes fibrosis and cyst formation
breast tenderness, pain, lumps and cysts in 2nd half of cycle.
Ix: triple assessment
Mx: reassurance, analgesics, aspiration / very rare excision.
risk factors for breast cancer + epidemiology
lifetime oestrogen exposures -Female, age, obesity (perif aromatisation), early menarchy, late menopause, COCPill, HRT > 10 years.
epidaemiology:
most common in the uk
1 in 8 for women
rare before 25 but occurs at any age
40-70 yrs often.
clinical features of breast malignancy
50% occur in upper outer quadrant, where most parenchymal tissue present
Hard, painless lump
teathered/ fixed to chest wall or skin
dimpling/ nipple inversion/ peau d’orange
ulceration/ fungation
palpable axillary nodes,
B symptoms
discuss ductal cancer
2 types- carcinoma in situ or invasive.
DCIS: dysplastic characteristics but basement membrane is intact–> no ability to met.
it can progress so should be excised.
detected on mammogram as they release calcium.
invasive- gone through adjacent tissue/ basement membrane–> has potential to met
discuss lobular cancer
2 types again
in situ
invasive- this is usually due to the cell loosing the E-Cadherin-catenin adhesion system- cells grow in long single file lines.
what is pagets disease of the nipple
DCIS cells in the epidermis
extension along the major ducts until they reach the nipple
enter deeper areas and spread to the nipple and areola
gives classic eczema appearance
need to biopsy for definitive diagnosis
can appear alongside invasive carcinoma
discuss triple investigation of breast lumps
Clinical history and examination
radiographical- mammography and ultrasound (mam > 35- ID calcification and densities, uss < 35- solid/ cystic do both but useful in diff populations)
pathological - needle/ core biopsy
reported as 1-5
1- inadequate sample
2- benign
3- equivocal- favour benign
4- equivocal- fav malignant
5- malignant OR DCIS– leads to confusion.
discuss the screening program for women
age 50-70 invited every 3 years
if needed- call back for ultrasound, exam, biopsy
management of breast cancer
surgery
if less than 4cm- wide local excision
- radiotherapy after WLE to reduce risk of occurance.
mastectomy if bigger
Hormone therapy if ER +
anastrozole (aromatase inhibitor)
tamoxifen if pre menopausal
HER2+- herceptin
prognostic factors of breast cancer
tumour stage- espesh lymph node status
tumour grade
histological subtype (tubular is better)
vascular invasion
excision margins
ER/HER2 status
sentinel node spread
discuss other types of breast cysts
can be due to blocked duct causing a lobule to become distended.
can be one or multiple
distinct smooth masses.
halo sign
can be left or drained once identified.
if on aspiration there is no blood and the lump disappears then that is a good sign.
what is neoplasia
a state of uncontrolled cell division
neoplasms are clonal- origonate from a single cell.
can be benign or malignant.
what are cancers arising from epithelium called
carcinoma
adenocarcinoma is if from a gland
if yu find a breast lump what is it likely to be in a young person vs an old person
young
fibroadenoma
fibrocystic change
carcinoma
older
carcinoma
fibroadenoma
fibrocystic change
