Breast Disease

Question 1

What is normal breast tissue made up of?

Answer 1

Lobules made up of acini with intralobular stroma. Lobules surround ducts.

Question 2

How might breast cancer present?

Answer 2

Pain
Palpable mass
Nipple discharge
Change in colour or texture of skin
Nipple retraction/dimpling of skin

Question 3

What are the BRCA 1+2 genes?

Answer 3

They are tumour suppressor genes that normally inhibit neoplastic growth and are involved in DNA repair mechanisms. If they are mutated, then neoplasms are more likely.

Question 4

Name some risk factors for breast cancer.

Answer 4

• gender-females more likely
• younger at onset of menarche
• uninterrupted menses (less pregnancy)
• late menopause
• obesity
• HRT - contains exogenous oestrogen
• family history

Question 5

What is the Angelina Jolie effect.

Answer 5

It is a social learning theory where people are more likely to influenced by her as she has high status. Angelina Jolie had a double mastectomy after testing positive for the BRCA genes.

Question 6

What is the ‘triple approach’?

Answer 6

Used in the diagnosis of breast cancer:

1) clinical - history, family history examination
2) radiographic imaging - mammogram, USS
3) pathology - core biopsy, fine needle aspiration

Question 7

What type of cancer are the majority of breast cancers?

Answer 7

Adenocarcinoma

Question 8

What are the 2 types of adenocarcinoma in the breast?

Answer 8

In-situ (DCIS - ductal carcinoma in-situ)

Invasive

Question 9

What is DCIS?

Answer 9

Ductal carcinoma in-situ - when neoplastic cells are limited to ducts and lobules by the basement membrane and don’t invade. However this can be a precursor of invasive cancer.

Question 10

What is invasive breast cancer?

Answer 10

When neoplastic cells have invaded beyond the basement membrane and into the stroma, cells can invade into vessels and metastasise.

Question 11

What are the 4 types of invasive breast cancer?

Answer 11

• ductal
• lobular
• tubular
• mucinous

Question 12

What is peak d’orange?

Answer 12

Symptoms of invasive breast cancer that indicates the cancer has spread to the lymphatic system. Skin is orange and dimpled.

Question 13

What causes nipple retraction?

Answer 13

When a fibrous mass in the breast pulls the skin inwards.

Question 14

What is Paget’s disease?

Answer 14

A rare form of breast cancer where cancer cells collect in or around the nipple without crossing the basement membrane. Presents with unilateral red and crusting nipple (looks like eczema).

Question 15

What is mucinous carcinoma?

Answer 15

Type of invasive breast cancer where malignant cells are floating in pools of mucin. It is more common in elderly women, but the prognosis is usually quite good.

Question 16

What is the sentinel lymph node?

Answer 16

The lymph nodes in the axillary region that breast cancer is likely to spread to first.

Question 17

What is a sentinel lymph node biopsy?

Answer 17

Introperative mapping of the lymphatic system where dye and/or radioactivity is injected into the tumour to allow visualisation of the lymph nodes. If the sentinel nodes are negative, then remove of the axillary lymph nodes can be avoided.

Question 18

What is tamoxifen?

Answer 18

SERM (selective oestrogen receptor modulator) that can be used for treatment of oestrogen receptor positive breast cancers. It acts as an antagonist in the breast, inhibiting growth of cancer cells, but also acts as an agonist in the endometrium, therefore has a slightly increased risk of endometrial cancer.

Question 19

What is herceptin?

Answer 19

A monoclonal antibody that can be used to treat HER 2 receptor positive breast cancers. It binds to HER 2 receptors, blocking HER 2 signalling.

Question 20

Between what ages is breast cancer screening offered and how often do people have it?

Answer 20

47-83

Every 3 years

Question 21

How does breast tissue change as we age?

Answer 21

Very fibrous tissue is replaced by adipose tissue.

Question 22

What is fibrocystic change?

Answer 22

The most common benign breast disorder, presents with pain and nodularity, symptoms are greatest in the week before menstruation and are relieved by menstruation.

Question 23

What is cyclical mastaglia?

Answer 23

Pain in the breasts that is related to hormonal changes throughout the menstrual cycle.

Question 24

What is an intraductal papilloma?

Answer 24

Small, benign tumour that forms in the milk duct of the breast, can present with discharge from the nipple.

Question 25

What is mammary duct ectasia?

Answer 25

When someone has an extra duct in the breast that is often in the wrong place so can become inflamed and blocked, can cause nipple discharge, treatment is usually surgical excision of the duct.

Question 26

What is mastitis?

Answer 26

Cellulitis of the breast, presents with erythema and fever. Treated with antibiotics. Can be a medical emergency in breastfeeding mothers as they are unable to breastfeed so this has an impact on the child.