Breast Disease Flashcards
Fibroadenoma
‘breast mouse’ - lobular hyperplasia
age 25-35yo
firm/rubbery, smooth, defined, painless, mobile
thirds: regress, grow, no change
excise if: Sx, cosmesis, ?Dx
Fibroadenosis/fibrocystic change
localised fibrosis, inflammation, and cysts;
age 15-55, commonest 30-50yo
cyclical pain and swelling (hormones); multiple lumps
cysts and nodules
reassure, anti-inflamm, hormones, aspirate
*linoleic acid, primrose, OCP
Cysts
associated with fibrocystic change
commonest 40s (closer to menopause)
small, round, symmetrical/regular, smooth, fixed
can be painful; can be single or multi;
watery yellow-green fluid
USS + aspirate; ?hormones if multi/recurrent
Fat necrosis
post-trauma fibrosis and calcification
obese, middle-aged
firm, fixed, irregular, tender, skin thick/retract
?Cancer: triple assessment essential!
duct ectasia
dilated blocked ducts + stagnant secretion
common around menopause (40-50s)
(green) d/c, retraction, (tender) areolar mass, mastitis
excise, stop smoking
infective mastitis
abscess; often staph from infant nasopharynx
painful hot swelling
usually lactating women
Paget’s disease of the nippple
spread of intraductal carcinoma
red, thick, scaly skin +/- ulceration
punch biopsy all nipple rashes
Benign Breast Cancer
hamartomas: abnormal growth of normal cells
adenomas
papillomas: local hyperplastic proliferation +/- bloody d/c
phyllodes: periductal stroma; bulky - distortion +/- ulceration
lipoma: soft fatty lump
Malignant Breast Cancer RF + epidemio
invasive AC: 70% ductal, 10-15% lobular
Can be DCIS/LCIS: risk of future invasion -WLE or mastectomy (>3cm)
60% Sx, 40% screening; 1 in 9/10 lifetime risk
RF: FHx, genetics (5%), smoking, oestrogen, proliferative disease
Malignant Breast Cancer presentation
1) Sx:
lump: hard, irregular, growing, fixed, +/- pain
nipple: retraction, rash (Paget), d/c (bloody)
skin: tethering, dimpling (peu d’orange), Paget
2) mammography/screening (ages 47-73)
3) incidental histological
4) metastatic disease presentation e.g. bone pain
Malignant Breast Cancer Classification (receptors)
OE positive: peak 50yo; better Px
HER2 neg: luminal A; 50%; better Px
HER2 pos: luminal B; 20%; better Px
OE negative: peak 70yo; worse Px
HER2 neg: BRCA1 and high grade; 20%; poor prognosis
HER2 pos: 10%; poor prognosis
Triple negative: oe, progesterone, and HER2 negative
Triple Assessment (for all lumps)
history + examination
imaging: mammogram MLO + CC (USS If <40yo)
* mass, microcalc, distortion, asymmetry
biopsy: FNAC or core/Truncut, or excision or punch
score 1-5 (E/I/C) for each, and see if correlate
1= inadequate, 2= benign, 3= ?benign, 4= ?malignant, 5= malignant
then stage: normal/benign/indeterminate/suspicious/malignant
Malignant Breast Cancer spread
local: skin (tethering), pec mm (deep fixation), adj tissue
lymph: within breast, skin (Peu), axillary, clavicular, int. mammary chain
* int. mammary chain = tumour emboli risk
vasc: bone, lung, pleura, liver, brain, ovary
* Ovary = Krukenberg tumour
Malignant Breast Cancer staging
local:
1) mobile, breast only 2) mobile, ipsi ax nodes
3) muscle fixed, fixed ipsi nodes, skin>tumour
4) chest wall fixed, distal mets
TMN:
T1 <2cm; T2 2-5cm, T3 >5cm, T4: fixed/tethered
N1: mobile ipsi nodes; N2: fixed nodes
M1: mets
Malignant Breast Cancer treatment (surgical)
WLE: commonest; give local RDT; margins 1cm DCIS, 0.5cm invasive
Mastectomy: large (>4cm), central, multi, ulcerated
+RDT if T3-4, or 4+ axillary nodes
+reconstruction: implant, expander, prosthesis, DIEP/TRAM/LD flap
LN sampling: 4+ nodes; pos => RDT
LN clearance: best Dx + Tx but lymphoedema
Sentinel Bx: tracer + dye injection; pos => clearance
