Breast Conditions Benign and Malignant Flashcards
how are results graded fro FNA
- C1 - Unsatisfactory
- C2 - Benign
- C3 - Atypia, probably benign
- C4 - Suspicious of malignancy
- C5 - Malignant
how are findings graded for core needle biopsies?
- B1 - Unsatisfactory / normal
- B2 - Benign
- B3 - Atypia, probably benign
- B4 - Suspicious of malignancy
- B5 - Malignant
–B5a - carcinoma in situ
–B5b - invasive carcinoma
what are the risk factos for breast cancer?
- HRT (combined: extra 19 cancers per 1000 oestrogen alone– 5 extra cancers per 1000 )
- Alcohol (>14 units per week)
- Weight
- Post Radiotherapy treatment for Hodgkin’s disease
- Previous breast cancer
- Family history of breast cancer
- Genetic: BRCA1 and BRCA2
- Early menarche and late menopause
- Late or no pregnancy
how does breast cancer present?
- Asymptomatic: Breast Screening (50-70 yrs)
- Symptomatic: Outpatient Clinic
Lump (36%)
Mastalgia (persistent unilateral pain) (17.5%)
Nipple discharge (blood-stained) (5%)
Nipple changes (Paget’s disease, retraction) (3%)
Change in the size or shape of the breast (1%)
Lymphoedema (Swelling of the arm)
Dimpling of the breast skin
how are breast problems investigated?
Triple Assessment:
History/ Examination
Imaging Mammography <40 years/ Ultrasound >40 years
Pathology: Cytology(FNA)/ histopathology (core biopsy)
what extra information can obtain from a core biopsy as opposed to FNA
invasive
ER, PR, HER2 status
what is the most common type of breast cancer?
80% Ductal Carcinoma
10% Lobular Carcinoma
how are tumours graded?
•Degrees of glandular formation, nuclear pleomorphism & frequency of mitosis
(each scored from 1-3)
Grade I: Score 3-5
GradeII: 6 and 7
Grade III: 8 and 9
what staging investigations are performed for breast cancer?
- Blood tests: FBC, UE’s, LFTs, Ca 2+/PO2-
- CXR
- AUSS - if indicated
- Bone scan (Nuclear Medicine)- if indicated
describe the TNM Classification
Radiotherapy is offered to all wide local excision patients as adjuvant therapy.
How long will a course of radiotherapy last for?
•40 Gy –50 Gy over 3 weeks or 5 weeks
what is the treatment of Vertebral Fractures/ Collapse
+/-Spinal Cord Compression?
Urgent radiotherapy
Surgical decompression
Steroids (Oedema)
List all the Benign Breat Diseases
ANDIs (aberration of normal development and involution)
- Fibroadenoma
- Breast Cyst
- Duct Papilloma
Hormonale Changes
- Mastalgia
- Nipple Discharge
- Gynaecomastia
Infective Changes
- Abscess
- Periductal Mastitis
- Fat Necrosis
How is a fibrodenoma investigated and when is a fibroadenoma excised?
- If proven on US and FNA cytology do not require excision
- Excision- if unable to obtain pathological diagnosis, increasing in size, deforming.
how is a breast cyst treated
- Aspirate after USS/mammography
- Residual lump – investigate as lump
how does a duct papilloma present?
What is the treatment?
- Can cause bloodstained nipple discharge
- Excision by Microdochectomy (Single Duct Excision) or Total Duct Excision
- Minimal malignant potential
what is a risk facor for periductal mastitis?
How is it treated?
- Common in female smokers
- Antibiotics
- Aspiration
- Incision and drainage
- Investigation of ALL persisting lesions
how would you treat a breast abcess
- Encourage continued breast feeding
- Cytology/ bacteriology
- Flucloxacillin +/- aspiration
- Co-amoxicillin
- Persistent abscess – aspiration/incision & drainage
- Persistent – investigation for underlying pathology
what drugs can help with gynaecomastia?
•Danazol or Tamoxifen can provide symptomatic improvement
what percentage of bloody nipple discharge is malignant?
•5-10% of patients with a bloodstained discharge will have an underlying malignancy
what are the differences between cyclical and non-cyclical Mastalgia?
CYCLICAL
- Premenopausal
- Average age 34
- Heightened awareness, discomfort, fullness, heaviness
- Classically – outer half of each breast
- Can be unilateral
NON-CYCICAL
- Older women
- Average age 43
- Pain can arise from chest wall, breast or outside breast
- Continuous/Random
- Burning/Drawing
when is imaging necessary with mastalgia
when it is unilateral
Mild/Moderate Symptoms of mastalgia treatment
Mild/Moderate Symptoms
- Reassurance
- Well fitting bra
- ?Topical NSAIDS
what drug treatments are used to relieve severe mastalgia
which tumours commonly metastisize to the breast?
•Carcinoma
–Bronchial
–Ovarian serous carcinoma
–Clear cell carcinoma of kidney
- Malignant melanoma
- Soft tissue tumours
–Leiomysarcoma
what’s the pathology of Paget’s?
- High grade DCIS extending along ducts to reach the epidermis of the nipple
- Still in situ carcinoma (ie non-invasive)
define invasive carcinoma
- Malignant epithelial cells which have breached the BM
- Infiltration of normal tissues
- Risk of metastasis and death
which condition can mimc carcinoma and become calcified?
Radial scar / Complex sclerosing lesion
which condition can present with
–Affects sub-areolar ducts
–Pain
–Acute episodic inflammatory changes
–Bloody and/or purulent D/C
–Fistulation
–Nipple retraction and distortion
what is the management?
Duct Ectasia
–Treat acute infections
–Exclude malignancy
–Stop smoking
–Excise ducts
