Breast Cancer Flashcards
type of glands in breast?
apocrine
lymphatic drainage of breast?
99% drains to axilla
small bit goes to internal mammary/parasternal nodes
main presenting features of breast cancers?
lump
pain
nipple discharge
skin/nipple change
risk factors for breast cancer?
previous breast disease
fam history (BRCA1, BrCA2, P53)
drug history
whats involved in triple assessment?
examination
imaging (mammogram/US/MRI)
tissue biopsy (FNA/core/vacuum assisted)
who gets mammograms and who gets US?
> 40 = mammogram
<40 = US
symptomatic men also get mammogram
how often can mammogram be done?
once a year
need a good reason to do one again if ones been done in past 6 months (due to high radiation)
when is US used?
not used for general screening
in women <40 if they have a reason to get a scan (eg a lump)
also used in combination with mammogram in symptomatic patients
can also be used to guide biopsy or drainage of cyst/abscess
when is MRI used?
only really used if theres a big discrepancy between examination/mammogram/US
also used for screening in BRCA +ve people (reduces added risk of repeated radiation)
good detail, picks up everything regardless of tissue density
why is FNA not the best biopsy?
doesnt show whether in situ or invasive
core vs vacuum biopsy?
both can show whether cancerous cells have invaded basement membrane
vacuum needs US guidance (not sure if core does too)
vacuum can remove whole lesion but is much more expensive
most common cause of discrete lump?
fibroadenosis or benign breast change
triple assessment if <40?
examination + US + core biopsy
triple assessment if >40?
examination + mammogram + US + core biopsy
most common benign breast diseases in <25?
juvenile hypertrophy
fibroadenoma
most common benign breast diseases in 25-40?
mastalgia
cyclical nodularity
most common benign breast disease in 35-55?
cysts
duct ectasia
sclerosing lesions
types of congenital breast disease?
extra nipples
accessory breasts (usually in axilla)
absence of hypoplasia of breast (including asymmetry)
chest wall abnormalities
what is juvenile hypertrophy?
uncontrolled growth of breast tissue in the absence of any endocrine abnormality
some may require surgery
most common benign neoplasm?
fibroadenoma
presenting features of fibroadenoma?
most common in 15-25
painless, smooth, firm and very mobile lump
what is phylodes tumour?
rare fibroepithelial neoplasm with rapid growth
can become malignant cytosarcoma and metastasise via blood
needs wide local excision with clear margins
most common cause of breast abscess?
staph aureus (usually related to lactation)
management of breast abscess?
US guided percutaneous drainage, antibiotics, continue breast feeding
if not resolving in 2 weeks then do excisional biopsy to rule out inflammatory breast cancer
what is duct ectasia?
major sub-areolar ducts dilate and shorten during normal involution as part of normal ageing
ducts often clog up causing infection, discharge and abscesses
who is duct ectasia worse in?
smokers
management of duct ectasia?
reassure
manage infections
stop smoking
features of creast cysts?
usually smooth discrete lumps
can be painful
characteristic halo on mammogram
distended, fluid filled lobule on US
management of breast cysts?
conservative
what is duct papilloma?
isolated wart like structure within major subareolar ducts
presents as single duct watery or bloodstained nipple discharge
not premalignant
how are duct papillomas managed?
should be removed as can undergo atypical change (although not actually pre-malignant)
total duct excision
microductectomy (in young patients who wish to breastfeed at a later age)
presenting features of duct papilloma?
older women
warty thing inside duct
may feel lump but not always
usually see lump on US
biggest risk for breast cancer?
oetrogen exposure
most common breast cancer type?
ductal
which BRCA mutation is more common and dangerous?
BRCA1
how is wide local excision done?
excise tumour with 1cm margins
radiotherapy given to everyone post surgery
is radiotherapy given after mastectomy?
if high risk
best prognostic indicator of long term survival?
status of axilla lymph nodes
age for screening?
50-70
