breast disease- malignant & benign Flashcards
list the 7 in situ breast malignancies
Carcinoma in situ, NOS*
Comedocarcinoma, noninfiltrating
Cribriform carcinoma in situ
Intraductal carcinoma and lobular carcinoma in situ
Intraductal carcinoma, noninfiltrating, NOS
Lobular carcinoma in situ, NOS
Noninfiltrating intraductal papillary adenocarcinoma
Paget’s disease and intraductal carcinoma of breast
Paget’s disease, mammary
list the 15 invasive breast malignancies
Adenoid cystic carcinoma Carcinoma, NOS Carcinoma undifferentiated, NOS Carcinosarcoma, NOS Cribriform carcinoma, NOS Infiltrating duct carcinoma, NOS Inflammatory carcinoma Lobular carcinoma, NOS Medullary carcinoma, NOS Mucinous adenocarcinoma Paget's disease and infiltrating duct carcinoma of breast Phyllodes tumor, malignant Secretory carcinoma of breast Squamous cell carcinoma, NOS Tubular adenocarcinoma
list the risk factors for breast cancer?
being female growing older- age gene mutations atypical ductal or lobular hyperplasia lobular carcinoma in situ atypical epithelial hyperplasia
\+birth of first child after 30 high alcohol consumption early menarche fam hx breast cancer prev breast cancer nulliparity postmenopausal obesity
state the 6 most common symptoms of breast cancer on presentation
dimpled or depressed skin visible lump nipple changes (inversion) bloody discharge texture change- peau d'orange colour change
ductal carcinoma
- typical findings
- diagnosis
-stellate solid mass
pleomorphic casting microcalcifications
-US useful if breasts mammographically dense
definitively via image guided core needle biopsy
ductal carcinoma in situ
- findings
- dx
- most commonly non palpable, seen at screening as malignant calcifications
- vacuum assisted core biopsy
Invasive lobular carcinoma
- findings
- histology?
- not normally palpable or apparent on imaging
- indian file pattern
list the treatment options in breast cancer? (7)
breast conserving surgery modified radical mastectomy \+breast reconstruction radiation therapy adjuvant system therapy (chemotherapy/hormonal therapy/targeted therapies)
breast conserving surgery
- what is it?
- consists of?
-wide local excision +/- oncoplastic surgery
after surgery radiation therapy is performed(5 days a week for 3-6 wks)
Modified radical mastectomy
-what is it?
-removes the entire breast, including overlying skin and axillary lymph nodes
modification= preservation of pec major
Radiation therapy
-indications
-involvement of more than 3 nodes, + tumour margins or tumours >5cm
Adjuvant systemic therapy
-what is it?
-basically polychemotherapy, chemical ooperectomy
most commonly used hormonal therapy?
Tamoxifen
in ER+ cancer
targeted therapies
- over expression of what can be targeted?
- name of drug for ^?
- other examples of therapies
- HER-2 over expression
- Herceptin (Trastuzumab) it is a recombinant humanised monoclonal antibody (RHMA)
-bevacizumab (RHMA against vascular endothelial growth factor, for mets
lapatinib (inhibits epidermal growth factor receptor and human epidermal growth factor receptor 2)
Fibroadenoma
- define
- on examination?
- risk of cancer?
- Dx
- differential Dx
-benign neoplasm of the breast
-rubbery/firm,
mobile,
smooth with distinct borders,
nontender
- tend to decrease in size after the menopause, very small
- US guided core biopsy
- Phyllodes tumour but these tend to be larger and occur in older women, this will require wide local excision
Mastalgia
- what is it?
- normal patter?
- management
- breast pain
- generally cyclic and during the immediate premenstrual phase of the cycle, generally bilateral
- if non cyclical then likely localised, unilateral and persistent
-mammogram for an over 35 yr old
reassure that it is physiologic
advise a well fitting bra might help
possibility of tamoxifen and topical NSAIDS helping
Cyst
- on examination?
- treatment?
-usually during late reproductive yrs palpable clearly defined soft mobile and smooth tender before menstruation
-can be diagnosed and treated via FNA
Papilloma
- what is it?
- signs of intracystic carcinoma, action?
-a benign intracystic papillary proliferation
might be assoc with bloody cyst fluid
-rare, fluid grossly bloody or residual mass after aspiration
US guided core biopsy
Nipple discharge
- difference between physiologic and pathologic?
- causes
- investigations?
- physiologic: clear, yellow and watery elicited from most women of reproductive age
pathologic: bloody discharge form a single duct
-intraductal papilloma
think malignancy if assoc palpable mass
paget’s disease (perceived as discharge)
-If pathologic
mammography, US, surgical excision
Mastitis
- what is it?
- causes?
- presentation?
- treatment?
-inflammation or infection of the breast
-puerperal mastitis, normally causes by staph aureus
non-puerperal, causes by S. aureus, Peptostreptococcus magnus and/or Bacteroides fragilis
-fever, erythema, induration, tenderness, swelling
-puerperal: flucloxicilin 500mg Oral every 6 hrs
continue breast feeding
re-examin every 3 days
non-puerperal: Augmentin 625mg orally every 8 hrs for 7 days
breast abscess
- presentation?
- dx?
- treatment
- complication of chronic abscess?
- flocculaent-bulginh mass usually located in the central area of the mastitis
- US will verify a fluid filled pus centre
-aspiration with an 18 gauge needle with LA, side aspirate to microbiology
if not effective then open surgical drainage under GA
-pariareolar fistula
if unresponsive think malignancy
adenolipoma
- what is it?
- presentation?
- benign neoplasm formed from adipose and glandular tissue
- smooth palpable mass
ductal hyperplasia
-what is it?
-benign histologic process but if atypical might be assoc with DCIS
Fat necrosis
-diagnosis?
-distinct mammographic pattern and secondary to trauma
