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