Breast Flashcards
Discharge from nipple
- Surface
- From a single duct
- From more than one duct
Discharge from the surface
- Paget’s disease
- Skin disease (eczema, psoriasis)
- Rare causes (chancre)
Discharge from a single duct
- Blood-stained - Intraduct papilloma, intraduct carcinoma, duct ectasia
- Serous (any colour) - Fibrocystic disease, duct ectasia, carcinoma
Discharge from more than one duct
- Blood-stained : Carcinoma, ectasia, fibrocystic disease
- Black or green : Duct ectasia
- Purulent : Infection
- Serous : Fibrocystic disease, duct ectasia, carcinoma
- Milk : Lactation, rare causes (hypothyroidism, pituitary tumour)
Neoadjuvant treatment
Specific cancer treatment given before surgery. May be hormonal treatment, such as aromatase inhibitor, RT or CT.
Main objective : Downstage or shrink the tumour prior to surgery
Usage of tamoxifen in post menopausal patients
Good safety record but slightly increased risk of uterine cancer and DVT with long-term.
Aromatase inhibitors
Aromatase in a enzyme responsible for the conversion of androgens to oestrogens in the muscle, adipose tissue nd the breast. No function in premenopausal patients
Puckering of the skin
Highly suspicious of malignant lesion
TNM Classification
- Clinical assessment which takes account the tumour size, the lymph node status and the presence of metastases.
- Important because the prognosis relates to the stage at presentation
- Cons: Not accurate pre-operatively because depends on the clinical measurement of the tumour size and lymph node status
Mammogram - what is it?
X-ray of the breast tissue. Mammograms are of less value in women under 35 because women have dense glandular breast tissue
- Microcalcifications are very common and are seen in 85%.
Benign and malignant calcifications
- Benign are usually larger, coarser and round with smooth margins.
- Malignant are very small, morphological characteristics such as branching, and casting.
BIRADS
- Breast Imaging Reporting and Database System - takes into account morphological features, shape, size, density, number, distribution, ,location and associated findings.
Mammograms vs Xray
- Mass lesions and areas of parenchymal distortion
- Cysts are shown as transparent objects
- Benign solid lesions have well demarcated edges
Core biopsy
- A small core of tissue is removed from the lump or from the suspected area under US guidance using a cutting needle.
FNA not considered
- Small percentages of false positives.
2. Differentiate an invasive carcinoma from an in situ carcinoma
What is the difference between an in situ carcinoma and infiltrative carcinoma?
- TDLU - functional unit of the breast - consists of lobules and terminal ducts that drain milk via the duct system to the nipple
Breast conservation surgery
- Wide local excision (excision of the tumour with a 1 cm resection margin)
- More extensive excision of a whole quadrant of the breast (quadrantectomy)
Risk factor of local recurrence with BCS
- Completeness of the excision
- Lymphatic or vascular invasion
- An extensive in situ component
- Histological grade
- The age of the patients
Criteria for BCS
- Small non-centrally placed tumours
- Lower grade tumours
- Absence of lymphatic or vascular invasion
Tissue diagnosis of the axillary node status
- Axillary clearance
- Axillary node sampling
- Sentinel lymph node biopsy
Axillary lymph nodes
- Drains 95% of the lymph drainage of the breast
- On average, there are about 20 lymph nodes in the axilla.
- Divided into three groups in anatomical relation to the pectoralis minor muscle
Groups of axillary lymph nodes
Level 1 : Nodes which are situated lateral to the muscle
Level 2 : Nodes found under the origin of the muscle
Level 3 : Nodes are found between the medial border of the pectoralis minor , first rib and the axillary vein, high in the axilla
Axillary node clearance
- Removal of level II and III and mastectomy
2. Complications : pain and lymphedema
Axillary node sampling
Dissecting out a minimum of four separate nodes is considered to be representative of all axillary nodes
Sentinel node biopsy
The first lymph node draining the site of a cancer is known as the sentinel node
