BREAST Flashcards
What cells make up the nipple?
keratinised stratified squamous epithelium
What makes up the triple assessment breast clinic?
clinical: history and exam
imaging: US if <35 or mammography +/- US if >35
pathology: FNA, core, biopsy
Why is a core biopsy more useful than FNA?
A core biopsy provides full histology (as opposed to fine needle aspiration (FNA) which only provides cytology), allowing differentiation between invasive and in-situ carcinoma.
Explain the histology scores for core biopsy
B1 = normal B2 =benign B3 = uncertain (probably benign) B4 = suspicious B5 = benign (a = in-situ, b = invasive)
What imaging is done in a woman under 40?
ultrasound due to the density of the breast tissue in identifying anomalies
What imaging is done in a woman over 35?
mammography
Where do breast carcinomas arise from?
the terminal duct lobular unit
What are the two types of breast carcinoma and how can they be differentiated?
ductal (e-cadherin positive)
lobular (e-cadherin negative)
Give another presentation of ductal carcinoma in-situ
paget’s disease
Risk factors for breast carcinoma
increasing age early menarche, late menopause, not breastfeeding nulliparous or first child after 35 COCP or HRT high BMI smoking alcohol genetics
What do oestrogen-receptor positive breast carcinomas respond to?
oophrectomy
tamoxifen (pre-menopausal)
aromatase inhibitors (post-menopause)
GnRh antagonists
What is HER2?
human epidermal growth factor receptor 2
What do HER2-positive breast carcinomas respond to?
herceptin
What is the most common benign neoplasm?
fibroadenoma
How can cysts be diagnosed and treated?
FNA
Which benign breast lump can mimic a carcinoma?
sclerosing adenosis
What characterises sclerosing adenosis?
radial scars
complex sclerosing lesions
Which benign breast conditions predispose to malignancy?
cyst (small risk) epithelial hyperplasia (greatly increased)
Which condition presents with green nipple discharge?
duct ectasia (blocked duct)
Treat mastitis
flucloxacillin
Which drugs cause gynaecomastia?
spironolactone cimetidine digoxin cannabis finasteride gonadorelin analogues e.g. Goserelin, buserelin oestrogens, anabolic steroids
Smooth lump with pain on period
fibrocystic change
Bloody nipple discharge
intraductal papilloma
Commonest cause of spontaneous nipple discharge
intraductal papilloma
How does fibroadenoma present?
Mobile, firm breast lumps
no increased risk of malignancy
Manage fibroadenoma
diagnose
reassure
excise if >3cm
inoperable breast cancer
radiotherapy
manage node positive breast cancer
FEC-D chemotherapy
A 35 year old woman is worried about a painful lump in her breast. Her mother had breast cancer at the age of 65 years. She is 32 weeks pregnant with no past medical history. She is not taking any medication. She smokes five cigarettes per day.There is a 2 cm lump in her right breast that is tender on palpation. There is also redness of the overlying skin.
Which is the most appropriate management?
A. Bilateral mammogram
B. No further investigations until after delivery
C. Start oral cefalexin
D. Surgical excision of lump
E. Triple assessment
E. triple assessment
–> although it is likely an infection, she needs to exclude malignancy
What additional therapy is given if a women has a WLE for breast carcinoma?
whole breast radiotherapy to prevent recurrence
