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4 - Repro > Breast Disease > Flashcards

Breast Disease Flashcards

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1
Q

What are the different types of breast disease that can occur?

A

Inflammatory conditionsBenign epithelial lesionsStromal tumoursBreast carcinoma

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2
Q

Give some pathological breast changes that can occur

A

Development disordersInflammatory conditionsbenign epithelial lesionsStromal tumoursGynecomastia Breast carcinoma

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3
Q

What kind of development disorders can you get?

A

milk line remnantsaccessory axillary breast tissue

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4
Q

Give some inflammatory condition of the breast

A

acute mastitisduct ectasiafat necrosis

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5
Q

Give some benign epithleial lesions

A

fibrocystic changeepithelial hyperplasiapapilloma

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6
Q

Give some stromal tumours

A

fibroadenomaphyllodes tumourlipomahamartoma

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7
Q

What are some presentation of breast conditions?

A

PainPalpable massNipple dischargeSkin changesLumpinessMammographic abnormalities

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8
Q

Give some of the common age ranges for different breast conditions

A

Fibroadenomas- occur at any repro. age- often in

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9
Q

How are breast lesions investigated and diagnosed?

A
  1. Clinical - history, family history, examination2. Radiographic imaging- mammogram, ultrasound3. Pathology- fine needle aspiration cytology- core biopsy
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10
Q

Describe acute mastitis

A
  • commonly due to staph. aureus- mainly occurs during lactation- erthymatous, painful breast, fever- can produce breast masses- treated by expressing milk and antibiotics
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11
Q

Describe duct ectasia

A
  • dilation and inflammation of lactiferous ducts- lots of macrophages are present- common in 50s and 60s- can have a peri-alveolar mass and/or nipple discharge- can mimic carcinoma clinically
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12
Q

Describe fat necrosis

A
  • presents as mass, skin changes, mammographic abnormality- often have a history of trauma or surgery- can mimic carcinoma clinically and mammographically- adipocytes and inflammatory cells
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13
Q

Describe gynaecomastia

A

Enlargement of the male breast- uni or bilateral- seen at puberty and in elderly- can mimic male breast cancer, especially if unilateral

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14
Q

What can gynaecomastia indicate?

A

Hormonal abnormalityLiver cirrhosisFunctioning testicular tumourAlcoholMarijuana useHeroin useAnabolic steroid use

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15
Q

Describe fibrocystic change

A

Are benign epithelial lesions and are VERY commonMass often disappears after FNAC

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16
Q

Describe epithelial hyperplasia

A

Benign epithelial lesions- proliferations of epithelial cells which fill and distend ducts and lobules- associated with a slight risk of cancer

17
Q

Describe papilloma

A

Benign tumour which grow with finger-like projections- usually in lactiferour ducts near the nipple - intraduct lesions with multiple branching cores covered by myoepithelial and epithelial cells

18
Q

Describe a fibroadenoma

A

Stromal tumourLooks like lumpy golf ballPresent with mass which is mobile- younger women- can mimic carcinoma clinically and mammographically

19
Q

Describe a phyllodes tumour

A

Stromal tumour- present as mass/mammographic abnormality- occur in older women (>60)Have three varieties1. benign (most common)2. malignant3. borderlineNeed to be excised with a wide margin (prevent reoccurrence)Malignant behave aggressively, recur often and metastasise via the blood

20
Q

What are some risk factors for breast cancer?

A

Most are related to oestrogen exposure- gender- long interval between menarche and menopause- reproductive history- obesity- exogenous oestrogens- geographic influence- atypical changes on previous biopsy- genetics(BRCA1 and 2 tumour suppresor genes have a mutation)

21
Q

How can breast cancers be classified?

A
  • 95% are adenocarcinomas- divided into in-situ and invasive- can be ductal or lobular- tend to be in the upper outer quadrant of breast tissue
22
Q

Describe in-situ carcinoma

A

Neoplastic cells are linited to duct and lobules by the basement membrane- have both layers of epithelium- doenst invade into vessels- cells can extend to the nipple skin without crossing the BMe.g. Pagets disease of breast, unilateral red and crusting nipple

23
Q

Describe ductal in-situ carcinoma

A

Commonly presents as mammographic calcifications- clusters or linear and branchingSpreads through ducts and lobulesOften have central necrosis with calcification due to poor blood supply to the centre

24
Q

Describe invasive carcinoma

A

Invades beyond the BM into the stroma- can invade vessels, causing metastases- by the time the tumour is palpable, more than half with have metastases to the axillary lymph nodesHave two types

25
Q

What are the two main types of invasive carcinoma?

A

Invasive ductal carcinoma, no specific typeInvasive lobular carcinoma

26
Q

What are some other, less common types of invasive carcinoma?

A
  • tubular (good prognosis)- mucinous - medullary- papillary
27
Q

Where to metastases of breast cancer usually occur?

A

Lymph nodes - ipsilateral axillaDistant metasteses via blood vessels- lung, bone, liver, brain– BONE is the most common metastasis

28
Q

Where are some odd sites that invasive lobular carcinoma can spread to?

A
  • peritoneum- retroperitoneum- leptomeninges- GI tract- ovaries- uterus
29
Q

What are the factors that determine the prognosis of breast cancer?

A
  • in situ vs. invasive- tumour grade- tumour stage- gene expression aptters
30
Q

What is gene expression patterns?

A

Microarrays examine expression and it can correctly determine about 90% of women who would go on to develop metastases. This can help to determine treatment - if they are more likely to get metastases, they are more likely to be give chemotherapy and vice versa.

31
Q

What are the two main types of control in breast cancer?

A

Local and regional controlSystemic control

32
Q

Give some examples of local and regional control

A

Breast surgeryAxillary surgeryPost-operative radiotherapy to the chest

33
Q

Give some things that must be taken into consideration when offering axillary surgery

A

Can get post-operative lymphoedema which can be unsightly and uncomfortable both physically and mentally for the patient. Try not to avoid lymph nodes if possible.

34
Q

Give some methods of systemic control

A

ChemotherapyHormonal treatment- tamoxifenHerceptin treatment

35
Q

Describe tamoxifen treatment

A

Given if a high number of oestrogen positive receptors are found on assessment- any oestrogen binding to these receptors will excite the cell and cause it to grow- brown stain in the nuclei- tamoxifen is the antagonist to this receptor

36
Q

Describe herceptin treatment

A

Given if it is found that there is an overexpression of HER2 receptors- are human epidermal growth factor receptors therefore need to block to prevent growth of cellHerceptin is a monoclonal antibodu that interferes with the HER2 receptor- brown stain on the cell membrane

37
Q

What is looked for in mammographic screening?

A
  • asymmetric differences- parenchymal deformities- calcifications
38
Q

What further investigations occur following finding abnormalities?

A

Further imagingFNACBiopsy

4 - Repro (13 decks)

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