Breast Flashcards
Breast cancer
Causes, types, sx, screening, ix, mx
Causes:
• Increased hormone exposure
• Early menarche or late menopause
• Nulliparity or late first pregnancy
• Oral contraceptives or Hormonal Replacement Therapy
• Susceptibility gene mutations
• Most commonly BRCA mutations (BRCA1/BRCA2)
• Advancing age
• Caucasian ethnicity
• Obesity and lack of physical activity
• Alcohol and tobacco use
• History of breast cancer
• Previous radiotherapy treatment
Types:
1. Invasive ductal carcinoma (IDC): This is the most common type, accounting for about 80% of all breast cancers. It starts in a milk duct, breaks through the wall of the duct, and invades the fatty tissue of the breast.
2. Invasive lobular carcinoma (ILC): This type begins in the milk-producing glands (lobules) and can spread to other parts of the body.
3. Ductal carcinoma in situ (DCIS): This is a non-invasive or pre-invasive cancer where the cells are confined to the ducts in the breast and have not spread into the surrounding breast tissue.
4. Lobular carcinoma in situ (LCIS): This is not a cancer but an area of abnormal cell growth that increases a person’s risk of developing invasive breast cancer later.
5. Inflammatory breast cancer (IBC): This is a rare but aggressive type of breast cancer that causes the lymph vessels in the skin of the breast to become blocked.
6. Triple-negative breast cancer (TNBC): This type lacks estrogen receptors, progesterone receptors, and does not have an excess of the HER2 protein on the cancer cell surfaces. It tends to be more aggressive and has fewer targeted treatments available.
7. HER2-positive breast cancer: This is a cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. It tends to be more aggressive than other types of breast cancer, but it may respond well to targeted therapies that can block HER2.
Sx:
• Unexplained breast mass in patients aged 30 and above, with or without pain
• In those aged 50 and older, nipple discharge, retraction or other concerning symptoms
• Skin changes suggestive of breast cancer
• Unexplained axillary mass in those aged 30 and above
Screening:
The programme invites women between the ages of 50 and 70 for breast screening every three years
Ix:
Triple assessment is used to investigate suspected breast carcinoma:
1. Clinical examination: of the breast and surrounding lymph nodes
2. Radiological examination: typically a mammogram, can also involve breast ultrasound and MRI
• If there are concerns of metastatic disease, a CT or PET scan may be done.
3. Biopsy: often a core needle biopsy or fine needle aspirate (FNA)
Staging involves the TNM system considering the size of the tumour (T), the spread to the lymph nodes (N), and the presence of metastases (M).
Mx:
• Surgical management: Wide local excision (WLE) or mastectomy, with sentinel node biopsies for invasive cancers and possible axillary node clearance for positive nodes. Breast reconstruction can be done concurrently or later.
• Radiotherapy: Adjuvant radiotherapy is commonly offered following WLE to reduce recurrence. It may also be given to patients with higher stage cancers post-mastectomy.
• Chemotherapy: Suggested for hormone receptor-negative and HER2 over-expressing patients. Neoadjuvant chemotherapy may be given to downstage tumours before surgery.
• Biological Therapy: Trastuzumab (Herceptin) may be given to HER2 positive patients, either as neoadjuvant therapy to downstage the tumour or as part of the overall treatment regimen.
• Hormonal Therapy: Anastrozole (aromatase inhibitor) for postmenopausal or Tamoxifen (ostrogen receptor antagonist) for premenopausal patients with oestrogen receptor-positive breast cancer.
• Bisphosphonates: May be used for reducing occurrence in node-positive cancers.
Breast abscess
Cause, sx, ix, mx
Cause:
The most common causative organism of lactational breast abscesses is Staphylococcus aureus, which enters the breast tissue via a crack in the nipple skin or through a milk duct. The accumulation of milk, called milk stasis, and trauma to the nipple skin from incorrect latch or pump use can contribute to the infection and subsequent abscess formation.
Sx:
• Fever or rigors
• Malaise
• Pain over an area of the breast
• Erythema over the affected breast area
• Possible presence of a fluctuant mass, which may not always be palpable
• History of recent or ongoing mastitis
Ix:
• Breast ultrasound: To visualise the abscess and guide the procedure for drainage
• Diagnostic needle aspiration: For both diagnostic and therapeutic purposes, i.e., to culture the causative organism and evacuate the abscess
Mx:
• Incision and drainage or needle aspiration (with or without ultrasound guidance)
• Antibiotic therapy: Oral or intravenous antibiotics, according to local protocols, targeted towards the most common causative organisms
Breast cyst
Cause, sx, ix, mx
Cause:
Occur due to the overgrowth of glandular and connective tissue, leading to blocked breast ducts and subsequent fluid accumulation.
Sx:
- breast lumps
- pain
- tenderness
Ix:
• Clinical breast examination: To identify any palpable abnormalities.
• Mammography and ultrasound: To visualize the internal structures and evaluate any identified lumps or abnormalities.
• Fine-needle aspiration or biopsy: To confirm the diagnosis of identified lumps or suspicious areas.
• Blood tests: To identify signs of infection or hormonal imbalances in certain cases.
Mx:
Surgical removal
