Breast Cancer Flashcards
What is a bereavement?
A period after a loss
What is mourning?
A period after a berievement
What is grief?
The emotional reaction we go through during bereavement and mourning.
What are the five stages of grief?
Shock and denial
Anger - at themselves and at healthcare system
Bargaining
Depression - can last a year, give hope and can make it better
Acceptance
What three categories can breast lumps be divided into histologically?
Non-proliferative disorders - no increased risk
Proliferative disorders without atypia - mild to moderate risk
Atypical hyperplasias - substantial increase in risk
When do breasts grow?
Puberty - Breast enlargement, sometimes initially unilateral, is the fist obvious sign of puberty in girls. Breast buds may initially be unilateral.
Puberty breast development = thelarche
What is the most common benign breast disease?
Fibrocystic change.
This usually affects women aged 20-50 and appears tone hormonal in aetiology. Most often presents with pain and modularity.
When is breast disease rarely pathological?
If changes are bilaterally symmetrical.
If symptoms are greatest about 1 week before menstruation and decrease when it starts.
Examination may reveal an area of thickening or nodularity, poorly differentiated from the surrounding tissue and often in the upper outer quadrant of the breast.
What is cyclical mastalgia?
Tenderness and nodularity in the premenstrual phase that resolves as menstruation starts.
Breasts are active organs that change throughout the menstrual cycle. It affects 2/3 of menstruating women.
What are most palpable benign breast lumps?
FIroadeomas
Cysts
A benign mass is usually three-dimensional, mobile and smooth. It has regular borders and is solid or cystic in consistency.
In whom are cysts most common?
Most common between 35-50.
They are palpable as discrete lumps and may be recurrent.
They cannot be reliably be distinguished from solid tumours on examination.
What are fibroadenomas and in who are they most common?
Benign tumours that are common in young women, with incidence peaking at 20-24
They are the most common type of breast lesions.
Fibroadenomas arise in breast lobules and are composed of fibrous and epithelial tissue. They present as firm, non-tender, highly mobile, palpable lumps. Hormones seem to be involved in aetiology and HRT increases incidence.
What is mammary duct ectasia?
Unknown aetiology
Dilation of major ducts, filled with creamy secretion with periductal inflammation.
May be asymptomatic or -nipple discharge (bloody, serous, creamy white or yellow
- retracted nipple
- acute inflammation
- recurrent chronic inflammation with abscess formation
Treatment: Surgical excisions the major duct. Correction of nipple retraction.
What infections could occur in breasts?
Mastitis
Generalised cellulitis of the breasts
Treated with antibiotics
Can be a medical emergency
Breast abscess
Present with point tenderness, erythema and fever
Generally related to lactation
Non-lactational abscess more frequent in smokers
Caused by staph or strep
When do you refer?
Refer via two week wait to a breast clinic if:
Aged > 30 and unexplained breast lump with or without pain
Aged > 50 with any symptoms in one nipple only: Dischage, retraction, other changes of concern.
Consider a referral if:
skin changes that suggest breast cancer,
>30with unexplained axilla lump
Non-urgent referral if:
<30 and unexplained breast lump with or without pain.
What physiological changes are seen in breast tissue?
Prepubertal breasts - few lobules
Menarche - increase in number of lobules and increased volume of interlobular stroma
Menstrual cycle - follicular phase lobules quiescent, after ovulation cell proliferation and storms oedema, with menstruation see decrease in lobules
Pregnancy - increase in size and number of lobules, decrease in stroma, secretory changes.
Cessation of lactation - atrophy of lobules but not to former level
Increasing age terminal duct lobular units decrease in number and size, interlobular stroma replaced by adipose tissue
How can breast conditions present?
Pain Palpable masses Nipple discharge Skin lumps Lumpiness Mammographic abnormalities
What breast conditions cause palpable mass?
Normal nodularity
Invasive carcinoma
Fibroadenomas
Cysts
Most worrying if hard, craggy and fixed
What breast conditions can cause nipple discharge?
Milky - endocrine disorders. e.g. pituitary adenoma; side effects of medication e.g. OCP
Bloody or serous - benign lesions e.g. papilloma, duct ectasia; occasionally malignant lesions
Most concerning if spontaneous and unilateral
