Breast Flashcards
What pathological changes might be observed in the breast histology of someone with fibrocystic change?
Adenosis (± sclerosis) = more glands in lobules
Fibrosis
Cysts
Apocrine metaplasia (exocrine glands)
Epithelial hyperplasia
Papillomatosis (papillary projectes ie warts)
What forms the M score in triple assessment?
M= Mammogram findings, U = ultrasound findings M1- normal M2- benign M3- probably benign M4- probably malignant M5- malignant
What letters comprise someone’s triple assessment breast score?
P 1-5 (for palpation)
U 1-5 or M 1-5 (for mammogram or USS)
C 1-5 (after fine needle aspiration)
In the triple assessment, where are specimens taken from for the cytology score?
Name 3 sources
Breast tissue
Lymph node
Nipple discharge
What is not part of the triple assessment, fine needle aspiration or biopsy?
Biopsy
May get core biopsy or punch biopsy
What are the two views that are used in mammogram?
Mediolateral oblique
Craniocaudal
Who is offered breast screening?
Those aged 47-73
Every 3 years
Mammography
With breast carcinoma in situ, how do the features of ductal and lobular types differ?
DCIS- unilateral, unifocal, palpable clinically or radiologically
LCIS- bilateral, multifocal, not detectable clinically or radiologically often
Where in the breast do invasive carcinomas arise?
At the terminal duct lobular unit, where extralobular ducts meet intralobular ducts
Which types of invasive breast cancer are associated with a good prognosis?
Tubular
Mucinous (colloid)
Lobular
(No special type = relatively poorer prognosis)
What 3 features determine breast cancer grading?
- Degree of tubular and glandular formation
- Nuclear pleomorphism
- Mitotic count
When might you need to use MRI imaging to investigate a breast?
In lobular cancers- deep in breast without microcalcification so often can’t be detected on examination or mammogram
Dense breasts- HRT or pre-menopausal
Discordant clinical + radiographic findings (P2 U5 C3)
Which two imaging modalities are used for breast cancer staging?
CT- CAP
Bone scan
When would you stage the breast?
Locally advanced: skin or muscle involvement, node +ve
Inflammatory cancer
Recurrence
What is the difference in Rx given for pre and post menopausal women in neo-adjuvant treatment prior to breast conserving surgery?
Pre- chemo
Post- letrozole (aromatase inhibitor)
Neo-adjuvant is given prior to surgery
Who gets radiotherapy for breast cancer?
All who are having breast conserving surgery
+ Mastectomy patients with:
>5cm of disease
more than 4 nodes +ve
+ve margins once breast is removed
Herceptin in breast cancer targets…?
HER2 +ve cells
Monoclonal antibody given with chemotherapy
Monitor heart function
Breast cancer of what grade gets offered chemo?
Grade 3 (highest grade)
When considering chemo for breast cancer, what combinations of hormone receptor findings would make you consider offering it?
Triple negative (for ER, PR, HER2) Or HER2 positive
What lifetime risk of breast cancer warrants the offer of risk reducing mastectomy?
> 30%
In breast screening, how many people report on the mammograms
Double reporting
Looking at 2 views of the breast: mediolateral oblique + craniocaudal
What is duct ectasia and how does it present?
Blockage of lactiferous duct, leads to clogging
PC: greenish discharge
What are the T stages for breast cancer in TNM staging?
Tx- size cannot be assessed
Tis- DC (in situ)
T1 5cm
T4 Spread into chest wall or beyond
How can T1 stages of breast cancer in TNM staging be stratified?
T1mi
How is N staging stratified in the TNM staging of breast cancer?
Nx- can’t be assessed (ie previously removed)
N1- axillary lymph nodes +ve, but nodes are mobile
N2- A. axillary lymph nodes adhering to surrounding tissue
B. Internal mammary lymph node +ve (behind sternum)
N3- lymph nodes in axilla + internal mammary lymph nodes
Or elsewhere in the body
How is the M stage of breast cancer TNM staging defined?
M0- no metastases
M1- spread to other parts of the body
In the triple assessment of the breast, on palpation what does score P1-5 mean?
P1- normal P2- benign cyst or fibroadenoma P3- probably benign P4- probably malignant P5- malignant
Indications for MRI in suspected breast cancer?
Lobular cancers (often bilateral)
Dense breasts- young or on much HRT
Discordant PUC values
FHx- time to menstrual cycle
Why is a breast biopsy needed if a woman has already had cytology?
Biopsy tells definitive diagnosis- type of cancer or type of benign lesion, and grade etc
What does peau d’orange suggest in breast cancer?
Lymphatic obstruction/involvement
How does needle biopsy help differentiate breast cancer?
Whether it’s ductal or lobular in type
What is the cut off age for deciding between ultrasound and mammogram?
35 years
In suspected breast cancer, what are you looking for on nodes to indicate on USS that they are abnormal?
Enlarged cortex (middle bit) >2.5mm
Indicates node is reactive
NOT just node size (in Afro-Carribbeans may have naturally larger nodes)
Indications for breast MRI
Dense breasts in known cancer on contralateral side
Lobular carcinoma- as often bigger than seen on mammogram
Screening in high risk patients (BRCA +)
Previous Hodgkins
Implant pathology
Complications of axillary lymph node clearance in breast cancer?
Lymphoedema
Prolonged drainage
Infection
Frozen shoulder, numbness
Indications for radiotherapy following surgical Rx of breast cancer
After:
wide local excision for cancer or ductal carcinoma in situ.
post mastectomy with vascular and lymphatic involvement.
What investigation is needed if giving patient’s herceptin for HER2 positive breast cancer?
Echocardiogram- can cause myocardial damage
