Breast Conditions Flashcards
Describe the condition of mastitis:
Acute inflammation of the breast, usually caused by staph or strep entering cracked nipple tissue
(Infection proliferates in stagnant breast milk and can cause abscess)
SSX:
- hard, painful & inflamed breasts
- axillary lymphadenopathy
Treatment:
- antibiotics
- if abscess: incision & drainage
Describe the condition of traumatic fat necrosis
Necrosis and granulation of adipose tissue caused by traumatic rupture of adipocyte cells
Presentation:
- can calcify & mimic presentation of a breast tumour
- can cause nipple retraction or skin fixation due to fibrous tethering
Incidence:
- more common in large, fatty breasts
Treatment:
- screening to rule out tumour
What are the different types of mammary dysplasia?
- Cyst formation
- dilation of ducts secondary to obstruction - Epitheliosis
- hyperplasia of ductal epithelium
- increased risk of breast cancer - Adenosis
- enlargement of lobules
- associated with menstruation & pregnancy - Fibrosis
- accumulation of fibrous tissue can result in a hard painless lump
- associated with ageing
Describe the condition of mammary dysplasia:
- lumps in breast
4 types:
- cyst formation
- epitheliosis (hyperplasia of ductal epithelium)
- adenosis (enlargement of lobules)
- fibrosis (accumulation of fibrous tissue)
Incidence:
- common between puberty and menopause
- linked to menstrual cycle
SSX:
- breast tenderness
- palpable lump (adenosis or fibrosis)
- painless swelling or local hardening (epitheliosis)
What are the differentials for a hard, painless lump?
Carcinoma (malignancy)
Fatty necrosis
Fibrosis (mammary dysplasia)
What are the differentials for a tender mass?
Mastitis
Adenosis (mammary dysplasia)
Cyst formation (mammary dysplasia - ruptured cyst)
What are the differentials for breast swelling?
Adenosis (mammary dysplasia) - can be painful or painless
Epitheliosis (mammary dysplasia) - painless
What are the 3 different types of breast carcinoma and their definitions?
Non-invasive (tumours have not crossed basement membrane of epithelium) - can be ductal carcinoma in situa or lobular carcinoma in situ
Invasive
(tumours have crossed basement membrane) - invasive ductal carcinoma or invasive lobular carcinoma
Metastatic spread (carcinogenic cells have spread through the lymphatic or circulatory systems)
What is the difference between breast neoplasia and breast carcinoma?
Neoplasia = new cell growth (can be benign or carcinogenic)
Carcinoma = cancer cells in breast (non-invasive, invasive or metastatic)
What is the most common breast carcinoma?
Invasive ductal carcinoma (80% of all breast cancers)
What are the symptoms of breast carcinoma?
Often asymptomatic and not palpable
SSX:
- hard firm lump with irregular margins
- axillary node enlargement (hard and fixed)
- nipple retraction / puckering
- nipple discharge
- skin colour change
- systemic SSX including weight loss, malaise, fever, loss of appetite
What are the treatment options for breast carcinoma?
Surgery:
- lumpectomy
- masectomy
Treatment:
- chemotherapy
- radiotherapy
Hormonal:
- LHRH blockers
- oestrogen receptor antagonists
- aromatase inhibitors
- monoclonal antibody therapy
What are the risk factors for breast carcinoma?
age previous or family Hx genetics mammary dysplasia (especially epitheliosis) lifestyle & hormonal factors
Which type of mammary dysplasia is associated with a higher risk of breast cancer?
Epitheliosis
What are the 3 types of breast neoplasia?
Benign tumours
- fibroadenoma
- papilloma
Primary malignant
- carcinoma
- sarcoma
Secondary malignant
- cancer that has spread to the breast tissue from elsewhere
What is the difference between a sarcoma and a carcinoma?
Carcinoma = cancerous cells grown from epithelial tissue (90%)
Sarcoma = cancerous cells grown from non-epithelial tissue (usually connective) (10%)
What are the 2 types of benign breast tumours, and the 5 types of malignant breast tumours?
Benign:
- fibroadenoma
- papilloma
Malignant:
- DCIS (ductal carcinoma in situ)
- LCIS (lobular carcinoma in situ)
- invasive ductal carcinoma
- invasive lobular carcinoma
- secondary malignant
What is the difference between a fibroadenoma and a papilloma?
Both benign tumours (breast neoplasia)
Fibroadenoma = epithelial tissue supported by connective tissue matrix
Papilloma = tumour in the duct formed by gland and fibrous tissue
what is the difference between a fibrosis and a fibroadenoma?
Fibrosis = type of mammary dysplasia where accumulated fibrous tissue causes a hard, painless lump
- hard to palpate
Fibroadenoma = a type of benign tumour composed of epithelial tissue & connective tissue stroma
- elastic & non-fixed to palpate
What are the basic actions of the 4 medications used to treat breast cancer?
- LHRH blockers
- block luteinising hormone releasing hormone - Oestrogen receptor antagonists
- block uptake of oestrogen - Aromatase inhibitors
- block the release of oestrogen - Monoclonal antibody therapy
- used for HER2 (human epidermal growth factor) cancer
- antibodies target HER2 receptors
