Breast Disease Flashcards
Breast cancer screening
In England all women aged 50-70 are invited to have screening every 3 years
Mammogram
What are fibroadenomas?
Fibroadenomas are benign tumours of fibrous and epithelial tissue which arise from lobules.
Clinical features of fibroadenoma
young age of presentation
firm, non-tender mass
rounded with smooth edges
highly mobile
normally don’t grow beyond 3cm
Management of fibroadenoma
can be managed with surgical excision but many will also regress after menopause if conservatively managed
Investigations for fibroadenoma
although benign, triple assessment done to rule out sinister pathology
Ductal Carcinoma features
Most common form of breast tumour (75%)
Abnormal proliferation of ductal cells
The ductal cells lose their acinar structure and their nuclei become abnormally large
If the basement membrane is not breached then it is considered ductal carcinoma in situ (DCIS)
Lobular Carcinoma features
~15% of breast cancers
More likely to be bilateral and multi-centric
Abnormal proliferation of lobular cells, arranged in single rows.
–> Cells often small, bland and uniform
Frequently impalpable or not appreciable as a discrete lump
Medullary Carcinoma features
More common in younger patients and those with BRCA1 mutations
Composed of solid sheets of anaplastic cells with large pleomorphic nuclei, prominent nucleoli and frequent mitoses
Often significant lymphocytic infiltration surrounding the tumour
Often better prognosis than ductal tumours
Phyllodes Tumour features
Rare (<1%)
Composed of epithelial and stromal tissue which grows in a ‘leaf-like’ pattern
Also called cystosarcoma phyllodes
Most are benign (75%) and 25% malignant
Which gene abnormality is most related to familial breast cancer?
BRAC1 and 2
What is Paget’s disease of the nipple?
A rare condition of the nipple which is associated with underlying cancer
Clinical features of Paget’s disease of the nipple
Eczema-like rash on the skin of the nipple and areola: may be itchy, red, crusty and inflamed.
Nipple discharge which may be bloody.
Burning sensation. increased sensitivity or pain.
Nipple changes such as nipple retraction or inversion.
Some cases: palpable breast lump.
What is puerperal mastitis?
Inflammation of the breast, associated with lactation in postpartum women
Clinical features of puerperal mastitis
Painful, tender, red and hot breast
Systemic symptoms: fever, rigors, myalgia, fatigue, nausea and headache
Normally unilateral and typically presents 1wk postpartum
In some cases there may be development of a breast abscess which presents as fluctuant, tender mass with overlying erythema
What is cyclical mastalgia?
Cyclical mastalgia is breast tenderness that comes and goes with the monthly menstrual cycle.
May be associated with fibrocystic changes to the breast presenting as breast ‘lumpiness’ or duct ectasia.
Epidemiology of fat necrosis of the breast
More common in obese people
Usually following trauma to the breast
Clinical features of fat necrosis
Can vary from a firm, round lump to a hard, irregular lump.
Overlying skin inflammation/bruising
Usually found following trauma to the breast
Complications of breast surgery
Anaesthetic
–> Stroke, venous thromboembolism, myocardial infarction
Surgical
–> Pain, bleeding, infection, seroma, displeasure with cosmetic outcome
Axillary node clearance related injury
–> lymphoedema, damage to brachial plexus, axillary artery/vein injury
Risk factors for breast cancer
Increased hormone exposure
–> early menarche or late menopause, nulliparity or late first pregnancy, oral contraceptive or HRT
BRCA1/2 mutations
Advancing age
Caucasian ethnicity
Obesity & lack of physical activity
Alcohol and tobacco use
Hx of breast cancer
Previous radiotherapy treatment
Indications for urgent referral to breast assessment clinic
Urgent cancer referral pathway (2 week wait) for breast cancer if:
- They are >=30 w/ an unexplained breast mass (regardless of pain or not)
- They are >= 50 presenting w/ nipple discharge, retraction or other concerning symptom
- Consider referral if there are skin changes suggestive of breast cancer or if the patient is 30 years or older w/ an unexplained mass in the axilla
Management of oestrogen (ER) positive tumours
Premenopausal: Tamoxifen (oestrogen receptor antagonist)
Postmenopausal: Anastrozole (aromatase inhibitor)
Management of HER2 positive tumours
Trastuzumab (Herceptin) which is a monoclonal antibody against the extracellular domain of the HER2 receptor
Components of triple assessment of breast cancer
- Clinical examination: of the breast and surrounding lymph nodes
- Radiological examination: most commonly mammogram but can involve breast US and MRI
- Biopsy: typically a core needle biopsy or fine needle aspirate (FNA)
Side effects of tamoxifen
Hot flushes
Nausea
Vaginal bleeding and discharge
Weight gain
^ risk of DVT/PE
^ risk of endometrial cancer (weak agonist on endometrial tissue)
