Breast Disease Flashcards
what are the main cytological investigations in regards to breast disease?
- fine needle aspiration
- US guided fine needle aspiration
- nipple scrape
- nipple discharge (straight onto slides)
- core biopsy
what is the cytology score given to breast tissue after a FNA?
C1 - unsatisfactory C2 - benign C3 - atypia (likely benign) C4 - suspicious (likely malignant) C5 - malignant
what is the main advantage of a core biopsy over a FNA for breast cancer?
core biopsy shows tissue structure and allows typing/staging of tumour
what are some of the benefits of carrying out a FNA in breast lesions?
- curative if there is a cyst
- can identify malignancy (but not type)
- is quick, cheap and well tolerated
what are some of the disadvantages of carrying out a FNA in breast lesions?
- not 100% accurate
- can miss lesions
- can’t identify type or stage of malignancy
- can be difficult to interpret
- can cause pain, bleeding
when is a core biopsy of the breast tissue carried out?
- when there is a suspicion of malignancy
- when there are structural changes in the breast
- to classify a tumour prior to surgery
what are the most important signs in the breast that point to breast cancer?
mass in breast on examination
microcalcifications on mammography
name a few benign conditions that may present in the breast
fibroadenoma
duct ectasia
fat necrosis
intraduct papilloma
what are the features of a benign lump in the breast?
soft
mobile
well circumscribed
encapsulated
which cell type in the breast is most likely to become cancerous?
luminal epithelium of the lactiferous ducts
define non-invasive and invasive in the context of breast cancer
non-invasive - myoepithelium intact
invasive - myothelium affected
what is the classification of breast cancer, based on structure affected and their invasiveness?
lobular carcinoma in situ
ductal carcinoma in situ
invasive lobular carcinoma
invasive ductal carcinoma
name a few risk factors for developing breast cancer
- older age
- female
- early menarche
- late menopause
- late pregnancy
- HRT/COCP
- radiotherapy
- family history
- previous history
- genetic (BRCA 1 and 2)
- lifestyle (obesity, smoking)
histologically, which type of breast cancer is the most common?
ductal carcinoma
which organs is breast cancer most likely to spread via the blood?
bone
lungs
liver
brain
how are findings on mammography graded for malignancy?
M1 - unsatisfactory M2 - benign M3 - atypia (probably benign) M4 - suspicious (probably malignant) M5a - malignant non invasive M5b - malignant invasive
how do Her2 positive breast tumours tend to behave?
they are often more aggressive, but react well to Herceptin treatment
how do ER/PR negative breast tumours tend to behave?
they do not respond well to hormonal treatment
why do estrogen receptor positive and progesterone receptor positive breast cancers have a better prognosis?
because they respond to hormonal therapies
what are the 5 molecular subtypes of breast cancer?
- luminal A
- luminal B
- triple negative/basal
- Her2 positive
- normal breast like
what is the management of breast cancer?
staging surgery (mastectomy, WLE +/- lymph nodes) radiotherapy hormonal therapy chemotherapy
what do the molecular subtypes of breast cancer reflect?
estrogen receptor status
progesterone receptor status
Her2 status
Ki67 protein levels
what is Paget’s disease of the nipple?
intraductal carcinoma affecting the epidermis of the nipple and areola
what skin condition can Paget’s disease of the nipple be mistaken for?
eczema
what is the incidence of breast cancer?
breast cancer affects 1 in 8 women
what is the main aim of FNA and core biopsy in breast cancer?
FNA - looks at cells
core biopsy - looks at tissue
name a few signs/symptoms of breast cancer
- painless lump
- thickening of skin of breast
- nipple inversion
- nipple discharge
- abnormal shape/size of breast
- peau d’orange
- crusting of nipple (Paget’s disease)
what are the less common types of invasive breast cancer?
medullary
tubular
mucinous
papillary
when is a sentinel lymph node biopsy taken in breast cancer?
when ultrasound of sentinel lymph node is normal
how is the axilla managed in breast cancer, depending on sentinel lymph node biopsy result?
biopsy negative (no tumour in sentinel lymph node) - no treatment to axilla biopsy positive (tumour in sentinel lymph node) - surgery/radiotherapy to remove all axillary lymph nodes
what is the action of tamoxifen in breast cancer?
blocks cell growth stimulation by oestrogen
what is the action of herceptin in breast cancer?
monoclonal antibody - blocks Her2 receptor
what are the first line imaging techniques to carry out in women who present with a lump/mass?
mammography (over 40 unless strong suspicion/FH)
ultrasound (under 40)
what is the benefit of doing an ultrasound for a breast lump?
helps identify whether it’s solid or cystic
what does the triple assessment involve in breast disease?
- clinical examination
- imaging (mammography/US)
- FNA cytology/core biopsy
what are the commonest angles mammography pictures are taken at?
mediolateral oblique (MLO) craniocaudal (CC)
when is an MRI carried out for breast problems?
for recurrent disease
if lesion not identified by triple assessment
problems with breast implants
screening for high risk women
how is the sentinel lymph node identified for breast cancer metastasis assessment?
through lymphoscintigraphy (nuclear scan)
who is invited to take part in breast cancer screening? what does it involve?
women between 50-70
mammography every 3 years
