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Reproductive System > Breast > Flashcards

Breast Flashcards

1
Q

Breast Cancer: prognosis

A
  • PT. RELATED & TUMOUR RELATED - younger pt. has worse prognosis
  • NODE STATUS = BEST PROGNOSTIC INDICATOR
  • TUMOUR SIZE (< 2cm)
  • TYPE
  • GRADE
  • AGE
  • LYMPHOVASCULAR SPACE INVASION
  • OESTROGEN & PROGESTERONE RECEPTORS - if +ve, they’re strong indicators of response to hormonal therapies; -ve tumours don’t respond
  • HER-2 - 20 - 30% +ve respond to trastuzumab
  • PROLIFERATIVE RATE of TUMOUR
  • GENE EXPRESSION PROFILING - 4 subtypes, can
  • NOTTINGHAM PROGNOSTIC INDEX based on TUMOUR SIZE, GRADE, NODAL STATUS
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2
Q

Breast Cancer: presentation

A

ASYMPTOMATIC - picked up on breast screening (50 - 70 yrs every 3 yrs)

Symptomatic - outpatient clinic for triple assessment of clinical examination, imaging, FNA cytology

* LUMP = FIXED HARD MASS, ABNORMAL CONTOURS
* MASTALGIA = PERSISTENT UNILATERAL PAIN, generally breast cancer not painful - hx = cyclical, persistent, unilateral, bilateral
* NIPPLE DISCHARGE = BLOOD-STAINED/BLEEDING
* NIPPLE CHANGES = PAGET'S DISEASE, INVERSION, RETRACTION
* AREOLA = COLOUR/APPEARANCE CHANGE e.g. CRUSTING
* BREAST SIZE/SHAPE CHANGE
* LYMPHOEDEMA = arm swelling, due to metastasis to lymph nodes, blocks lymphatic drainage - lymph cannot drain from periphery
* REDNESS or PITTING/DIMPLING of BREAST SKIN = PEAU D'ORANGE
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3
Q

Breast Cancer: risk factors

A

Breast cancer:
• GENDER (F > M)
• AGE (increasing age)
• MENSTRUAL Hx (EARLY MENARCHE + LATE MENOPAUSE increases risk)
• AGE at 1ST PREGNANCY (late in life w/o lactation - increases risk; LATE/NO PREGNANCY)
• RADIATION e.g. investigations, rx for cancer, lymphoma, post-RT rx for Hodgkin’s lymphoma
• FHx (esp. 1st degree relatives)
• PMHx e.g. previous breast cancer
• HORMONAL Rx (HRT, some contraceptive pills)
• GENETIC FACTORS (BRCA1, BRCA 2, OTHER GENES)
• OTHER FACTORS = OBESITY, LACK of PHYSICAL ACTIVITY, ALCOHOL (> 14 units/week)

Disease recurrence:
• LYMPH NODE INVOLVEMENT

  • TUMOUR GRADE
  • TUMOUR SIZE
  • STEROID RECEPTOR STATUS (negativity - ER/PR -ve)
  • HER2 STATUS (positivity - HER2 +ve)
  • LYMPHOVASCULAR INVASION (LVI)

1ST 3 = NPI (prognostic indicator)

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4
Q

Breast Cancer: histological classification

A

non-invasive - DCIS, LCIS (pre-invasive - not palpable + does not breach duct membrane)

* DCIS = FOCAL - excision w/ wide margins can be curative
* LCIS = MULTIFOCAL - MONITOR &amp; FOLLOW-UP PT. as cannot remove all affected tissue

• NO METASTATIC SPREAD RISK of INVASION DEPENDS on GRADE

invasive - invasive ductal carcinoma (80%), invasive lobular carcinoma + its variants (10%), special types (10%) e.g. tubular carcinoma, mucinous carcinoma

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5
Q

Breast Cancer: investigations/diagnosis

A

Screening every 3 yrs w/ mammography for those whoa re 50 - 70yrs

CLINICAL - Hx + examination

RADIOLOGY - bilateral mammogram, USS, MRI

CYTOPATHOLOGICAL - FNAC, NEEDLE CORE BIOPSY (grading, invasion, tumour type, hormonal receptors)

WIDE LOCAL EXCISION w/ ADEQUATE MARGINS

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6
Q

Breast Cancer: management

A

DIAGNOSE DISEASE

STAGE DISEASE = BLOODS (FBC, U+E, LFTs, Ca2+/PO2-), IMAGING (CXR, CT CHEST/ABDO/PELVIS), no reliable tumour markers - TNM STAGING

DEFINITIVE Rx:

MDT APPROACH
SURGERY - WLE +/- LYMPH NODES, BREAST CONSERVATION SURGERY, MASTECTOMY, SURGERY to AXILLA
+/-RT
+/-CHEMOTHERAPY
+/- HORMONAL THERAPY (trastuzumab, tamoxifen, letrozole)

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7
Q

Breast Cancer: spread

A
  • LOCAL = SKIN, PECTORAL MUSCLES
  • LYMPHATIC = AXILLARY, INTERNAL MAMMARY NODES
  • BLOOD = BONE, LUNGS, LIVER, BRAIN
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8
Q

Male breast: gynaecomastia

A
  • Most common clinical & pathological abnormality of male breast
  • INCREASE in SUBAREOLAR TISSUE
  • BOTH BREASTS CAN BE AFFECTED
  • ASS W/:
    • HYPERTHYROIDISM
    • LIVER CIRRHOSIS
    • CHRONIC RENAL FAILURE
    • CHRONIC PULMONARY DISEASE
    • HYPOGONADISM
    • HORMONAL USE e.g. oestrogens, androgens, other drugs e.g. digitalis, cimetidine, spironolactone, marijuana, tricyclic antidepressants
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9
Q

Male breast: carcinoma

A

• SAME PRESENTATION AS FEMALES - tends to be LATE STAGE INVASIVE DUCTAL CARCINOMA due to LACK of FIBROADENOMATOUS BARRIER bwtn nipple & chest wall

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10
Q

Paget’s disease of nipple

A
  • Result of INTRA-EPITHELIAL SPREAD of INTRADUCTAL CARCINOMA
    • Large pale-staining cells w/I epidermis of nipple
    • LIMITED to NIPPLE/EXTEND to AREOLA = PAIN, ITCHING, SCALING, REDNESS - can be MISTAKEN for ECZEMA
      ○ Can also have ULCERATION, CRUSTING, SEROUS/BLOODY DISCHARGE
    • BILATERAL = ECZEMA, INFLAMMATION
    • UNILATERAL = CARCINOMA
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11
Q

Breast development (in utero)

A
  • MAMMARY CRESTS/RIDGES APPEAR during 4TH WEEK - they EXTEND from AXILLARY REGION to INGUINAL REGION + usually DISAPPEAR EXCEPT in PECTORAL REGION
    • PRIMARY MAMMARY BUDS - SECONDARY BUDS - LACTIFEROUS DUCTS & THEIR BRANCHES (COMPOUND ACINOALVEOLAR GLANDS - multiple branchings from 1 point)
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12
Q

Age-related changes of breast

A

Pre-puberty:
• Neonatal breast contain LACTIFEROUS DUCTS + NO ALVEOLI
• LITTLE BRANCHING of ducts occurs until puberty
• SLIGHT BREAST ENLARGEMENT reflects FIBROUS STROMA & FAT GROWTH

Puberty:
• LACTIFEROUS DUCTS BRANCH
• ALVEOLI FORM (solid, spheroidal masses of granular polyhedral cells)
• LIPIDS ACCUMULATE in ADIPOCYTES

Post-menopausal:
• PROGRESSIVE ATROPHY of LOBULES & DUCTS
• FATTY REPLACEMENT of GLANDULAR TISSUE

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13
Q

Mammography

A

STANDARD VIEWS

* MEDIOLATERAL OBLIQUE (MLO)
* CRANIOCAUDAL (CC)

INDICATIONS:

* > 40YRS
* < 40 YRS if STRONG SUSPICION of CANCER, FHx RISK > 40%

SMALL DOSE of RADIATION

CANCER SEEN AS:

* MASS
* ASYMMETRY
* ARCHITECTURAL DISTORTION
* CALCIFICATIONS
* SKIN CHANGES
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14
Q

USS

A
  • DIFFERENTIATE: SOLID from CYSTIC; BENIGN from MALIGNANT
  • 1ST LINE IMAGING if < 40YRS
  • NO RADIATION
  • IMPROVES SPECIFICITY of IMAGING (if using w/ mammogram)
  • But DOESN’T PROVIDE SAME INFO as MAMMOGRAM (so need to do both)
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15
Q

MRI

A

NDICATIONS:

* RECURRENT DISEASE
* IMPLANTS (silicone appear white - can check for leaks)
* INDETERMINATE LESION following TRIPLE ASSESSMENT
* SCREENING HIGH RISK WOMEN

• HIGH SENSITIVITY + POOR SPECIFICITY (lots of issues incl. benign issues can show up)

DISADVANTAGES:

* CLAUSTROPHOBIC, NOISY, LENGTHY, IV CONTRAST
* EXPENSIVE
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Reproductive System (16 decks)

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