Breast Cancer Flashcards
List the benign breast diseases:
Fibroadenoma
Adenoma
Mastitis
Breast cysts
Fat necrosis
Papilloma
Lipoma
Mammillary duct ectasia
List the breast diseases with malignant potential
Paget’s disease
Carcinoma in suit (ductile / lobular)
Phyllodes tumours
List the malignant breast diseases
Invasive breast carcinoma (lobular / ductal)
What are the features of fibroadenoma?
Highly mobile
Women of reproductive age
No malignant potential
Comprised of stromal and epithelial tissue
What are the features of adenoma?
Benign glandular tumour
Older women
Commonly referred to triple assessment
What are the features of papilloma?
40-50 age group
Commonly biopsied (appears similar to DCIS on imaging)
Commonly in subareolar region
What are the features of lipoma?
Soft and mobile
Only removed if significantly growing
What are the features of mastitis?
Inflammation of breast tissue
Commonly associated with infection (staph aureus)
Associated with cellulitis
Mostly in pre-menopausal women
What are the presenting features of mastitis?
Tenderness
Erythema
Swelling
Nipple retraction or discharge
How is mastitis classified?
Lactational mastitis (associated with cracked nipple and milk stasis)
Non-lactational mastitis (associated with central inflammation)
How can duct ectasia and non-lactational mastitis be differentiated?
Duct ectasia - older women, less marked inflammation
Non-lactational mastitis - pre-menopausal women, more marked inflammation
What are the management options for mastitis?
Early broad spectrum Abx (co-amoxiclav)
Lactational mastitis - continued drainage / feeding
What is a potential complication of mastitis and how is it treated?
Abscess
- confirm via USS
- Abx + needle aspiration
What are the features of breast cysts?
Epithelial lined fluid filled cavities
Typically in pre-menopausal age group
What are the presenting features of breast cysts?
Distinct smooth mass
+/- tenderness
What are the investigations of choice for breast cysts?
USS = definitive diagnosis
Mammography
Aspiration (disappears and free of blood = non-cancerous)
Cytology if still uncertain
What are the potential complications of breast cysts and how are they treated?
x2-3 more likely to develop breast cancer
Cyclical breast pain - treat with gamolenic acid or danazol
Fibrocystic changes > tenderness and asymmetry
What is the management of breast cysts?
Self-limiting
What are the features of mammillary duct ectasia?
Shortening and dilatation of major lactiferous ducts
Menopausal women
What are the presenting features of mammillary duct ectasia?
Green / yellow nipple discharge
Symmetrical slit-like nipple retraction
Palpable mass
What are the investigations indicated for mammillary duct ectasia?
Mammography (calcified lactiferous ducts)
What are the management options of mammillary duct ectasia?
Conservative management
What are the features of fat necrosis?
Acute inflammatory response > ischaemic changes => fat lobules
Due to trauma, surgery, radiological intervention
What are the presenting features of fat necrosis?
Asymptomatic
Can present with chronic fibrotic change
What are the investigations indicated for fat necrosis?
Core biopsy (r/o malignancy)
What are the management options for fat necrosis?
Self-limiting
Analgesia and reassurance
What are the features of Paget’s disease of the nipple?
Roughening, reddening, slit ulceration of nipple
Underlying malignancy in majority
What are the presenting features of Paget’s disease of the nipple?
Itching / redness of the nipple +/- areolar
Flaking of thickened skin
Painful and sensitive skin
Nipple > areola (eczema will spare nipple)
What are the investigations indicated for Paget’s disease of the nipple?
Biopsy
Mammogram
What are the indicated investigations for ductal carcinoma in situ?
Mammogram (microcalcifications often identified in screening programme)
Biopsy
What is the management of ductal carcinoma?
Complete wide excision
What are the indicated investigations for lobular carcinoma in situ?
Biopsy (typically identified incidentally)
What is the indication for bilateral prophylactic mastectomy?
BRCA1 / BRCA2 +ve lobar carcinoma in situ
What is the screening programme offered to women for breast cancer?
Women 50-70 offered mammogram every 3 years
OR
Women <50: prev cancer, 1st degree relative with cancer <50, have known BRCA1/2 or TP53 gene
What are the risk factors of developing breast cancer?
Female
Age
BRCA1/2
Family history (1st degree relative - BRCA/2)
Prev benign breast disease
Obesity
Alcohol
^ exposure to oestrogen (early menarche, late menopause, the pill, not breastfeeding, 1st pregnancy >30y/o, nulliparity, HRT)
What are the management options for invasive breast carcinoma?
Surgery - breast (wide local excision, mastectomy), axilla (sentinel lymph node biopsy, clearance)
Adj therapy - chemotherapy, 5-10 years: tamoxifen (SERM- premenopausal) / anastrozole (aromatase inhibitor - postmenopausal), 1 year: herceptin (MCAb - HER2 Y)
What forms of chemoprotection are offered to high-risk individuals?
Tamoxifen
Anastrozole
Risk-reducing / prophylactic bilateral mastectomy +/- bilateral oophrectomy
What are the 2WW referral criteria for breast cancer?
Unexplained breast lump / lump in axilla, 30 or above
Unilateral nipple changes, 50 or above
Skin changes suggestive of cancer
What is the purpose of USS in the investigation of breast lumps?
Used in women younger than 30 y/o
Distinguishes hard from soft e.g. cancer / fibroadenoma from cyst
What is the purpose of MRI in the investigation of breast lumps?
Used for screening in high risk individuals
Used to further assess size and features of a tumour
What receptors are involved in targeted breast cancer treatment?
Oestrogen (ER), Progesterone (PR), Human epidermal growth factor (HER2)
Where are the common sites of metastases in breast cancer?
Lung, Liver
Bone, Brain
What tumour marker is most commonly associated with breast cancer?
CA 15-3
