Breast Disease Flashcards
What are the different types of breast disease that can occur?
Inflammatory conditionsBenign epithelial lesionsStromal tumoursBreast carcinoma
Give some pathological breast changes that can occur
Development disordersInflammatory conditionsbenign epithelial lesionsStromal tumoursGynecomastia Breast carcinoma
What kind of development disorders can you get?
milk line remnantsaccessory axillary breast tissue
Give some inflammatory condition of the breast
acute mastitisduct ectasiafat necrosis
Give some benign epithleial lesions
fibrocystic changeepithelial hyperplasiapapilloma
Give some stromal tumours
fibroadenomaphyllodes tumourlipomahamartoma
What are some presentation of breast conditions?
PainPalpable massNipple dischargeSkin changesLumpinessMammographic abnormalities
Give some of the common age ranges for different breast conditions
Fibroadenomas- occur at any repro. age- often in
How are breast lesions investigated and diagnosed?
- Clinical - history, family history, examination2. Radiographic imaging- mammogram, ultrasound3. Pathology- fine needle aspiration cytology- core biopsy
Describe acute mastitis
- commonly due to staph. aureus- mainly occurs during lactation- erthymatous, painful breast, fever- can produce breast masses- treated by expressing milk and antibiotics
Describe duct ectasia
- 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
Describe fat necrosis
- 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
Describe gynaecomastia
Enlargement of the male breast- uni or bilateral- seen at puberty and in elderly- can mimic male breast cancer, especially if unilateral
What can gynaecomastia indicate?
Hormonal abnormalityLiver cirrhosisFunctioning testicular tumourAlcoholMarijuana useHeroin useAnabolic steroid use
Describe fibrocystic change
Are benign epithelial lesions and are VERY commonMass often disappears after FNAC
Describe epithelial hyperplasia
Benign epithelial lesions- proliferations of epithelial cells which fill and distend ducts and lobules- associated with a slight risk of cancer
Describe papilloma
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
Describe a fibroadenoma
Stromal tumourLooks like lumpy golf ballPresent with mass which is mobile- younger women- can mimic carcinoma clinically and mammographically
Describe a phyllodes tumour
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
What are some risk factors for breast cancer?
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)
How can breast cancers be classified?
- 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
Describe in-situ carcinoma
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
Describe ductal in-situ carcinoma
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
Describe invasive carcinoma
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
What are the two main types of invasive carcinoma?
Invasive ductal carcinoma, no specific typeInvasive lobular carcinoma
What are some other, less common types of invasive carcinoma?
- tubular (good prognosis)- mucinous - medullary- papillary
Where to metastases of breast cancer usually occur?
Lymph nodes - ipsilateral axillaDistant metasteses via blood vessels- lung, bone, liver, brain– BONE is the most common metastasis
Where are some odd sites that invasive lobular carcinoma can spread to?
- peritoneum- retroperitoneum- leptomeninges- GI tract- ovaries- uterus
What are the factors that determine the prognosis of breast cancer?
- in situ vs. invasive- tumour grade- tumour stage- gene expression aptters
What is gene expression patterns?
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.
What are the two main types of control in breast cancer?
Local and regional controlSystemic control
Give some examples of local and regional control
Breast surgeryAxillary surgeryPost-operative radiotherapy to the chest
Give some things that must be taken into consideration when offering axillary surgery
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.
Give some methods of systemic control
ChemotherapyHormonal treatment- tamoxifenHerceptin treatment
Describe tamoxifen treatment
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
Describe herceptin treatment
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
What is looked for in mammographic screening?
- asymmetric differences- parenchymal deformities- calcifications
What further investigations occur following finding abnormalities?
Further imagingFNACBiopsy
