Breast diseases Flashcards
What are 5 important parts to cover in a breast history?
Lumps
Skin changes/distortion
Nipple discharge
Nipple inversion
Ulceration
Axillary lymphadenopathy
Why is mammography not useful in women under the age of 40?
In younger women the breasts are so dense and glandular that it can be difficult to see anything on mammography. Over the age of 40 the breasts become more fatty, and darker on mammography therefore it is easier to see any abnormalities.
What are the indications for mammography?
Breast screening programme between 47 and 73
Clinically suspicious lump in over 40 years
Residual lump after cyst aspiration
Single duct blood stained nipple discharge
Nipple skin change
What are the 4 contraindications to mammography?
Breast pain without a lump
Symmetrical thickening
Before commencing HRT
Women under 40 unless previous diagnosis of breast cancer.
What assessment should be done in women under the age of 24 with a breast lump?
USS
Biopsy may not always be needed
What assessment should be done in women between 25 - 39 with a breast lump?
Breast USS plus histology or cytology.
What assessment should be done in women over the age of 40 with a breast lump?
Mammography and USS and either histology or cytology.
What screening is offered and when for BRCA gene carriers?
Annual MRI between the ages of 25 - 60
What investigations would you do to look for implant rupture?
MRI will show silicone leakage
What type of biopsy is most commonly performed for breast lumps?
Core biopsy
What are the advantages of core biopsy over fine needle aspiration?
Core biopsy can give a histological diagnosis.
Accurate diagnosis of benign lesions
Differentiate between invasive cancer and DCIS
Tumour typing
What is a triple assessment in breast disease?
Clinical assessment
Radiological assessment
Pathological assessment
The aim is to show concordance across the assessment.
What is the median age of occurrence for breast cancer?
62
What are the main risk factors for breast cancer?
FHx
Nulliparous women
Early age of menarche
HRT use for 5 years or more
What ages are women invited for breast screening in the UK?
47 - 73 years every 3 years
How much has the screening programme reduced the mortality from breast cancer?
16%-29%
What is pre-invasive breast cancer?
An example of this is DCIS. This is where the cells lining the ducts have become cancerous but it has not spread beyond that. This is known as stage 0 cancer.
What are the 2 common histological subtypes of breast cancer?
Ductal and lobular
Which histological subtypes of breast cancer are typically high grade?
Medullary
What are the cells like in grade 1 tumours?
Well differentiated and low mitotic rate
What are the cells like in grade 3 tumours?
They look very abnormal and may have many more mutations in the genes.
Which receptors expressed on tumour cells are a poor prognostic marker of disease?
HER-2 receptor
What does it mean for treatment if a cancer is oestrogen receptor positive?
It will respond well to anti-oestrogen therapy, and the cancers themselves tend to be less biologically aggressive.
What is a triple negative cancer subtype?
They do not express any of the hormone receptors, and is a very aggressive cancer subtype.
What are the 2 types of surgery for breast cancer?
Mastectomy or lumpectomy
What are the indications for mastectomy over lumpectomy?
Large tumour relative to breast size
Patient choice
Multi focal disease
BRCA gene
When is axillary node clearance indicated?
The standard surgery when the disease has spread to the axillary nodes
What is a sentinel node biopsy?
Looks at whether the first node in the drainage chain has been affected.
When is radiotherapy used to treat breast cancer?
Given to the remaining breast after a wide local excision
Palliation for a large inoperable tumour
To treat the axilla
Reduce local recurrence rates
Which hormonal therapy is given in premenopausal women?
Tamoxifen
Which hormonal therapies are used in post menopausal women?
Aromatase inhibitors such as letrozole and anastrozole
How long should patients be treated with hormonal therapy?
10 years
When is trastuzumab used in breast cancer treatment?
In HER-2 expressing cancers.
What is paget’s disease of the nipple?
An eczematous change on the nipple due to underlying malignancy
Where is the most common site for metastases in breast cancer?
Bones, then lungs, then liver.
What is the cause of cyclical breast pain?
Worse prior to and better after a period
What is a fibroadenoma?
A common benign breast lump in women under 35
Most are less than 3cm and are mobile on examination.
When are breast cysts most commonly seen?
Women aged 40-60 years
What criteria ensure a breast cyst is benign?
The fluid is not blood stained
No residual lump
The same cyst does not continually refill
What is the most common organism to cause breast infection?
S.aureus
