breast Flashcards
Mobile, firm lump in a 27 year old woman
Fibroadenoma
Fibroadenoma may be mistaken for what?
Phyllodes tumour- fast growing fibroepithelial tumour
Fibroadenomas arise from what?
Breast lobule
Smooth, discrete fluctuant lump
Cyst
Management of fibroadenoma
Excise if >3cm
Investigation/management of breast cyst
aspirate, if blood stained or persistently refilling then biopsy and/or excise
Woman presents with a painful breast lump. A mammogram doesn’t rule out malignancy. What benign condition could it be?
Sclerosing adenosis
Does sclerosing adenosis increase risk malignancy?
Not premalignant lesion but may increase risk
What are the types of epithelial hyperplasia?
Ductal/Lobular
Typical/atypical
Does epithelial hyperplasia= increased risk breast cancer?
if atypical and FHx breast ca yes
Green discharge from nipple and tender lump around areola?
Mammary duct ectasia
What can occur if mammary duct ectasia ruptures?
Plasma cell mastitis (local inflammation)
Blood stained discharge from nipple
Duct papilloma
Eczematous reddening and thickening of areola/nipple
Paget’s disease- intraductal carcinoma
What is fibroadenosis/fibrocystic disease/benign mammary dysplasia?
Lumpy breasts
35-50yo
Spectrum of histological changes
May be normal overgrowth
Does fibroadenosis/fibrocystic disease/benign mammary dysplasia have increased risk Ca?
Only if marked epithelial hyperplasia
Obese woman with history of trauma to breast presents with a growing tethered lump
Fat necrosis (or cancer- image and biopsy)
Differentials for bloody discharge from nipple?
Duct papilloma
DCIS (incl paget’s)
Mammary duct ectasia
What is a common cause of mastitis?
Milk stasis
What is an important non-pharmacological step in the management of mastitis?
frequent and regular milk removal- may avoid need for antibiotics
Most common pathogen in masititis
staph aureus
Painful swollen lump in breast with red, hot overlying skin (and history of mastitis)
Abscess
Severe, deep, burning pain in mastitis might indicate what?
Ductal infection
When should you send a breast milk M,C and S in mastitis?
If severe, deep, burning pain (ductal infection), severe or recurrent mastitis or if hospital acquired infection
Management of breast abscess
Urgent referral to surgeon for USS, drainage and culture for Abx
Should women with mastitis/abscess continue breast feeding?
Yes if pain allows, if not then express milk
What is the oestrogeny risk factor for breast ca?
Uninterrupted oestrogen exposure
What might peau d’orange indicate?
Mastitis
Inflammatory breast cancer- v bad!
Where is oestrogen produced pre and post menopause?
Pre- ovaries
Post- fat/muscle/liver/skin/breast
How does tamoxifen work and who is it given to (pre/post menopause)
Given to all
Competitively binds to the oestrogen receptor site on the cancer
What is a pre-menopause hormonal therapy for breast ca?
Oophorectomy (stop oestrogen production)
What is a post-menopause hormonal therapy for breast cancer?
Aromatase inhibitors- block extra-ovarian oestrogen production e.g. anastrazole
what do HER2 receptors do?
Tell cancer to grow
How does herceptin work?
Blocks HER2 receptors
What type of therapy is herceptin?
Targeted
SE of herceptin?
cardiotoxic
What is the ‘best’ cancer to have in terms of ER/PR/HER positivity/negativity?
ER/PR positive- responds to hormone Rx
What is the ‘worst’ cancer to have in terms of ER/PR/HER positivity/negativity?
Triple negative - ER/PR/HER neg. Harder to treat. Often BRCA1
pros/cons of a HER2 positive cancer?
Aggressive cancer but responds to herceptin
Is phyllodes tumour malignant?
Can be benign/borderline/malignant but all have malignant potential so excise
In whom does phyllodes tumour present?
40-50yo
