Breast Cancer Flashcards
What causes skin dimpling?
Fibrosis in supporting connective tissue
What are some skin changes associated with breast cancer?
- skin dimpling
- pea d’orange
- ulcerations
What are some nipple changes associated with breast cancer?
- retraction
- erosion
- discharge
What 2 things are prominent veins on the breast suggestive of?
- breast cancer
- pregnancy
What are the characteristics of a breast cancer lump?
- irregularity
- hardness
- fixity
What is this?
peau d’orange
pitting = local advanced cancer invading dermal lymphatics –> oedema
What is this?
locally advanced breast cancer –> ulcerations
what is the most common presentation of breast cancer?
hard, painless lump
What % of cases experience breast pain?
10%
What are some symptoms of breast cancer?
- breast: change in size/shape
- armpit: swelling (lymphoedema), lumps
- skin: dimpling, ulceration,
- nipple: inversion, bleeding/discharge
What are important questions to ask during a focussed breast (cancer) Hx?
Which anatomical body parts must be examined thoroughly when conducting a breast examination?
- breast - normal, then lump
- axilla (lymph nodes)
- neck (lymph nodes)
Which lump characteristic is suggestive of malignancy?
lump tethered to skin
- implies infiltration of lesion to Cooper’s ligaments
What does a mobile lump suggest?
benign cancer (no infiltration to surrounding tissue, so mobile)
What does tenderness & redness of breast suggest?
Infective causes
What does transillumination of the lump suggest?
cystic lesions
Which 2 views of the breast do the images show (via mammography)?
1) lateral oblique 2) cranio-caudal
What are the white dots shown on this mammogram?
microcalcifications - pleomorphic
- these are not always suggestive of malignancy
–> require biopsy
morphology (based on size, regularity, etc)
- pleomorphic (varying shape, size, and density)
- rounded
- punctuate, or
- morphous
1) what imaging modality is this?
2) what abnormality does it show?
1) US
2) black shadow = malignant breast lesion
What does this US show?
fibroadenoma (benign lump)
- well-demarcated border
- shadow behind is less dense than in malignancy
What does this US show?
cyst (fluid-filled)
- whiter area behind black = cyst
- as sound waves travel faster through liquid
What is this procedure?
FNA
What happens if during FNA, the lump turns out to be fluid-filled cyst?
Fluid can be discarded UNLESS
- Fluid is uniformly blood-stained
- If after aspiration, there is still mass felt
–> must send to cytology
What procedure is this?
Core needle biopsy
- LA required
- incision made
- Trocut needle (spring-loaded) takes core out of lump
What % of cases seen in breast clinic are cancer?
10%
What are the causes of the majority of lumps seen in breast clinic?
How could a fibroadenoma lump be described?
well-circumscribed
What are the 2 types of carcinoma?
- in situ (has not yet invaded basement membrane)
- invasive
What the possible causes of a breast lump?
- benign mass (well circumscribed)
- cyst (well circumscribed) - imaging is diagnostic
- abscess - painful, hard lump
- fibroadenoma - can become infected (mainly in breastfeeding women)
- sphiculated lump - highly suggestive of malignancy - imaging is diagnostic
What are the benefits of doing an FNA?
- quick
- minimally invasive
- results in hours
Are these cells benign or malignant?
benign
- not overlapping, ordered arrangement
What does this show?
fibroadenoma
- proliferation of epithelial tissue
- cells: benign, rounded, regular (nuclei)
what does 1) image on left show 2) image on right show?
1) benign cells
2) pleomorphic nuclei (irregular) – malignant cells
apocrine epithlium
What does this show?
malignant - lobular carcinoma
What does cytology nomenclature C1-C5 mean for FNAs?
When is a core biopsy indicated?(over FNA)
- these aren’t done immediately (FNA is preferred as it has quicker results), as results take 1-2 days
What does the nomenclature B1-B5 indicate for core biopsies?
What are the advantages of doing core needle biopsy?
- can use immunoctyochemistry
- gives ER and PR positivity (seen in image below)
what % of carcinomas are
- ductal
- lobular
- other
What is the Nottingham Prognostic Index (NPI)
scoring given to breast cancer that accounts for:
- size
- grade
- lymph node mets
What is tamoxifen?
SERM
- acts on ERs
What is herceptin?
targets human epithedermal GFRs
What are the most common sites of metastasis from the breast?
bone, liver, lung
Which further investigations are required after a diagnosis of breast cancer?
FBC - useful to understand bone marrow involvement
LFTs - not useful to determine if cancer in liver
Tumour markers - if normal before intervention, then rises, can indicate bone mets
What can bone X rays show wrt to cancer mets?
osteolytic deposits (dark spots) OR
sclerotic deposits (white spots)
What does this isotope bone scan show?
dark spots = mets
What are the surgical interventions offered?
What does this mammogram show?
small, irregular, sphiculated lesion
What are the risk factors for breast cancer?
