Breast disease

Question 1

3 descriptors of benign breast lumps

Answer 1

Mobile, Smooth, regular borders

Question 2

3 descriptors of malignant breast lumps

Answer 2

Hard, Irregular borders, fixed to underlying structures

Question 3

What is included in a triple assessment?

Answer 3

1. Clinical exam (by specialist)
2. Radiological exam (ultrasound - more commonly for younger patients due to denser breast tissue, or mammography)
3. Histological exam

Question 4

State 5 benign breast disease differential diagnoses

Answer 4

1. Fibrocystic breast disease
2. Fibroadenoma
3. Fat necrosis
4. Lipoma
5. Breast cyst

Question 5

Describe fibrocystic breast disease

Answer 5

1. Common to have breast lumps, tenderness and pain around the period (usually a week before)
2. Common in 20-50 year age group
3. Shows nodular or thickened area of breast tissue that usually resolved by mid-cycle
4. Caused by collection of fibrous tissue in breast and can be fluid filled (AKA cysts)

Question 6

Describe fibroadenoma

Answer 6

1. Most common benign tumour
2. Most commonly seen in women in their 2os
3. Around 2-3cm in size
4. Soft, painless, highly mobile (breast mouse)

Question 7

Describe fate necrosis

Answer 7

Benign inflammation of fat cells in breast tissue. Usually due to trauma and found in larger breasts
Often a painless lump with bruising, erythema, dimpling, signs of trauma so may need biopsy to confirm diagnosis

Question 8

Describe lipoma

Answer 8

Benign tumour of fat cells. Often soft, well circumscribed, smooth and non-tender. Found superficially (can be lobulated)

Question 9

Describe a breast cyst

Answer 9

Develop from the terminal duct lobular unit
More common in pre-menopausal women in 30s/40s. Difficult to distinguish from malignant lesions.
Fluid filled, round, palpable mass that may become painful (requires aspiration)

Question 10

Which sex hormones are associated with breast cancer development?

Answer 10

oestrogen, progesterone and testosterone

Question 11

Describe what peau d’orange

Answer 11

Where the skin overlying the breast has a pitted and swollen appearance like orange skin. This is due to lymphatic infiltration of inflammatory breast cancer

Question 12

Give 5 symptoms of breast cancer

Answer 12

Skin changes
Nipple discharge or inversion
Enlarged regional lymph nodes
Change in size or shape of breast
Oedema

Question 13

Describe carcinoma in situ

Answer 13

Where cancerous cells are found within a structure of the breast (e.g. ducts or lobules) but don’t breach the basement membrane

Question 14

Invasive carcinoma

Answer 14

Where cancerous cells breach the basement membrane so leave their structure and spread to the rest of the breast tissue

Question 15

Describe Paget’s disease of the breast

Answer 15

Rare breast cancer. Cancer of nipple/areolar complex which is associated with underlying carcinoma in situ or invasive carcinoma. Presents as eczematous lesion of nipple/areola or may have underlying lump

Question 16

Describe inflammatory breast cancer

Answer 16

Rapidly developing breast cancer that blocks the lymphatic drainage of the breast and leads to symptoms of swelling and redness (may also feel firm, hot to touch and painful)may be peau d’orange, skin thickening, nipple changes or lump

Question 17

Describe lobular carcinoma in situ

Answer 17

Abnormal cell growth confined to lobules of breast. Increases risk of future invasive breast cancer

Question 18

Describe ductal carcinoma in situ

Answer 18

Abnormal cell growth confined to ducts of the breast. Can become invasive if not removed

Question 19

What two factors does cancer staging take into account

Answer 19

1. The size of the cancer

2. Whether it has spread

Question 20

What does grading take into account

Answer 20

How well differentiated the cancerous cells are and how quick its growing

Question 21

Describe the 3 route of spread for cancer

Answer 21

Direct - locally into surrounding muscles and skin

Via lymphatic system - Axillary nodes (most common, intramammary, supraclavicular and tracheobronchial lymph nodes