Breast Flashcards
What type of biopsy is used to investigate breast lumps?
Core needle biopsy or mammotome
What is Paget’s Disease of the Nipple?
Inflammatory breast cancer causing erythematous eczema-type rash over the nipple.
May also have a sub areolar lump (ductal carcinoma in-situ).
How do you differentiate between Paget’s disease of the nipple and nipple eczema?
Breast eczema usually begins on the areolar, Paget’s disease usually begins at the nipple.
If unsure, give 2 weeks of steroids and if it persists do a punch biopsy.
What is a ductal carcinoma in situ?
irregular (no pattern) cells within the milk ducts, basement membrane has not been breached as cells only sit in ducts.
Usually asymptomatic.
What is a Lobar carcinoma in situ?
abnormal, small, round, lobular cells in a regular pattern. No infiltration of basement membrane.
What is meant by an ‘invasive’ ductal carcinoma?
Cancer originates in milk ducts and then spreads to the fatty tissues and into/through the basement membrane.
What is meant by an invasive lobular carcinoma?
Cancer originating in the milk-producing glands and spreads through the basement membrane and to other tissues in the body.
What is a Phyllodes tumour?
smooth, rapidly growing tumour (faster than fibroadenoma), often found in 40-60 y/o women
may be benign, borderline, or malignant
made of fibrous and epithelial tissue
How do you differentiate inflammatory breast cancer from an infection?
Unresponsive to 2 weeks of abx = refer to secondary care.
Peri-menopausal women presenting with nipple inversion, breast tenderness, and thick sticky discharge is likely what?
Mammary duct ectasia.
There may also be a lump felt in the area.
What is Stuart-Treeves Syndrome?
Long term lymphoedema leads to lymphangiosarcoma.
What is a fibroadenoma, what is the mx?
Benign tumour made of fibrous and glandular parts, they are usually firm and mobile.
If >3cm can be removed, but no need to follow up as they do not carry the risk of becoming cancerous.
What causes a breast angiosarcoma?
10-20 years after radiotherapy,
OR, primary (younger pts).
What is the Triple assessment for breast cancer? How is this scored?
Clinical assessment, imaging, histology.
Each stage is ranked 1-5:
- normal
- benign
- indeterminant
- suspicious
- malignant
E.g., fir physical exam it is P1-5.
When is it preferred to do a breast USS rather than mammogram?
- <35 (breast tissue too dense)
- pregnant
- ?infective collection (assess cystic vs solid)
In what breast cancer might chemotherapy be used after mastectomy?
Triple negative - hormonal and targeted therapies won’t work
Why might radiotherapy be used in breast cancer pts alongside surgery?
Those who opt to have breast preserving surgery i.e., lumpectomy, to ensure nothing was missed.
What antibiotic is used 1st line for inflammatory mastitis?
Flucloxacillin
An Intra-ductal papilloma may present with what?
nipple discharge (may be blood stained), associated with a small lump (wart-like growth).
Is an intraductal papilloma malignant?
No but is a RF for development of cancer.
What is a radial scar? How does it appear on mammogram?
- Benign breast growth
- star or rosette shaped lesion with a translucent centre.
What is a RF for periductal mastitis? What is a possible cx?
Smoking: reduces vitamin A which causes chronic ductal inflammation.
Cx: fistula formation
What are the criteria for prescription of abx in mastitis?
- Nipple fissure
- +ve breast milk culture
- Sx do not resolve after 24-48 hours
- systemically unwell
What is first and second line for cyclical mastalgia?
1) NSAIDs
2) Refer to specialist for danazol (androgenic medication)
