Breast and Polyposis/Colorectal cancers Flashcards
Women < 30 years, YOUNG
‘breast mice’ = discrete, non-tender, HIGHLY MOBILE lumps
What to do if <3cm? >3cm?
___________
Most common in middle-aged women
‘Lumpy’ breasts which may be PAINful.
-syx ?worsen prior to menstruation
_____________
hard, irregular lump.
There may be associated nipple inversion or skin tethering
Most common Brest cancer?
_____________
Reddening and thickening (may resemble eczematous changes) of the nipple/areola
rash started on the nipple -> spreads outwards involving the areola
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Breast anatomy
NLM TLS
_____________
occurs during breastfeeding, HIGH risk of bacterial infection through cracks in
nipple. S aureus is most common pathogen.
________
70+M a/w
gradual loss of voice / 6 m
DDx?
Ax?
Fibroadenoma
W+W < 3cm
Breast fibroadenoma: surgical excision is usual if >3cm
_____________
Fibroadenosis
(fibrocystic disease, benign mammary dysplasia)
FibroadenoSISSSSSS - SISters !!!
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Breast cancer
Ductal No Special Type>
Lobular >
DCIS > LobCIS
___________
Paget’s disease of the breast - intraductal carcinoma
_________
FROM USMLE BOOK 2019 p635 - NLMTLS
Nipple,
LACTIFerous duct_Major duct = Paget, Abscess, Mastitis, IntraDuct-Papilloma=bloody
TERMinal duct_LOBular unit = Cancers - DCIS etc
Stroma = Fibroadenoma/Phyllodes tumour
_______________
Lactational mastitis
Treat with FLUCLOX and continue breastfeeding.
________
Aphonia describes the inability to speak. Causes include:
Recurrent laryngeal nerve palsy (TT/Tumour)
PSYCHOgenic
Tender lump around the areola +/- a GREEN CREAMY nipple discharge
Most common around the menopause around 50yrs
Dilatation of the large breast ducts
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’
____________
May present with BLOOD stained discharge
Hyperplastic lesions
Epithelial proliferation @ large mammary ducts
___________
Obese women, LARGE breasts
Assoc w/ TRAUMA
Initial inflammatory response, firm and round but may develop into a hard, IRREGULAR breast lump
___________
More common in lactating women
Red, hot tender swelling
__________
Uncomfortable fluctuant mass in breast
-varies with menstrual cycle
HALO sign @ mammograms
___________
Young SMOKER
- abscess Inflammation
- Mammillary duct FISTULA
Mammary duct ectasia
__________
Duct papilloma
NOT malignant or premalignant
_________
Fat necrosis
Rare and may mimic breast cancer so further investigation is always WARRANTED!!!!!!
__________
Breast abscess
________
Breast cyst
Needs excision - risk of breast cancer!!!
__________
PERIDUCTAL mastitis
-ABx, I+Drain
TNM breast staging
What chemo you give to node +?
What chemo you give to node -?
I.e. If you just remember T2, T4c, T4d
T1 <2cm
T2 2-5cm
T3 >5cm
T4a skin
T4b CW
T4c skin + CW
T4d INFLAMM
FEC-D chemo = for node +ve, and that
FEC chemo = for node -ve that requires chemo
What % of Fecal occult blood test is positive? I.E.What’s the PPV?
What’s % of Fecal occult blood test is. An adenoma?
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Mutation of APC gene (80%) cases, dominant
Typically over 100 colonic adenomas
Assoc:
Gastric fundal polyps (50%).
Duodenal polyps 90%
WHAT dyou get OSTEOMAS in?!?!
____________
STK11 (LKB1) mutation
Multiple BENIGN intestinal hamartomas
Episodic obstruction and intussusception
Pigmented lesions around mouth!!!
breast, ovarian, cervical,
pancreatic and
testicular cancers
___________
Mutation of PTEN gene
Macrocephaly
Multiple intestinal hamartomas
Multiple trichilemmomas
Breast
Uterine
Thyroid
____________
Germline mutations of DNA mismatch
MSH2 gene
FEWWWWWW colonic polyps
Colonic MUCINOUS right-sided tumours
Gastric/SBowel
Ovary
Endometrial/Bladder
5-15%
30-45%
______________
FAP
Gardener Syndrome get OSTEOMAS!!!
_________
Peutz -Jeghers - STK11 (LKB1)
Increased risk of GI cancers (colorectal cancer 20%, gastric 5%)
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Cowden dx - PTEN
_________
HNPCC Lynch = MSH2 gene
PF-MAL thyroid cancers
pale empty nuclei
Lymph node METSSSSSS predominate
Histologically:
papillary/colloidal filled follicles
Papillary thyroid cancer
Rarely encapsulated
PF-MAL thyroid cancers
solitary thyroid NODULE
encapsulated
capsular invasion NOTTTTTT seen.
follicular adenoma
PF-MAL thyroid cancers
Vascular invasion
encapsulated
capsular invasion NOTTTTTT seen.
Follicular cancer
C cells derived from neural crest and not thyroid tissue
Serum calcitonin levels often raised
Familial genetic disease accounts for up to ????% cases
Mets:
Lymph
Haematog
Nodal
Medullary carcinoma
Elderly females
LOCALLY invades
Resect
Palliate = isthmusectomy and RT.
Anaplastic carcinoma thyroid
