Breast diseases Flashcards
what are the risk factors for developing fat necrosis
big breasts
trauma such as seat belt injury
warfarin therapy
what causes fat necrosis to develop
damage to adipocytes causing inflammatory response, in an attempt to remove fat fibrosis and scarring develops
how does fat necrosis present
mastalgia
breast lump
involution of the breast
what is duct ectasia
blockage and dilatation of lactiferous ducts
what puts you at risk of developing duct ectasia
smoking
peri/postmenopausal age
how does duct ectasia present
mastalgia
slit like nipple retraction
palpable mass behind nipple
purulent/blood stained discharge
how is duct ectasia managed
smoking cessation
duct excision
which benign breast disease presents in young women, cyclical sudden mastalgia with smooth discrete lumps
fibrocystic disease
describe the appearance of lumps in fibroadenomas
smooth, discrete and mobile
may be multiple lumps giving cobblestone appearance
what is the management of fibroadenoma
no management, will self-resolve
describe the clinical features of duct papilloma
older women - single lesion
younger women - multiple lesions peripherally
presents with lump and blood stained discharge
what is Phyllodes tumour
benign growth of stromal tissue
presents in peri-menopausal women
what 2 groups of women are at greatest risk of developing mastitis
women who are breast feeding
women with duct ectasia
what are the main causative organisms of mastitis
staph aureus
strep spp.
outline the clinical features of mastitis
mastalgia
erythema, tenderness, swelling of the breast
generally feeling unwell
what is the main complication of mastitis
breast abscess - painful hot lump
if mastitis develops whilst breast feeding, should the woman continue
yes as prevents milk stasis and infection cannot be passed onto the baby
what is the management of mastitis
encourage breast feeding and ensure complete draining
1g flucloxacillin QDS 7-10 days
2nd line is 450mg clindamycin TDS 7-10 days
if a breast abscess is suspected, how is it managed
US to confirm
admit for surgical drainage
what is gynaecomastia
development of breast tissue in men, ductal growth but not lobular
what causes gynaecomastia to develop
puberty idiopathic testicular tumours hypogonadism, liver cirrhosis drugs - spirnolactone, anabolic steroids, digoxin, GnRH analogues
how is gynaecomastia managed
usually no management required as most cases resolve within 2 years
treat underlying cause
if extreme, tamoxifen or danazol
when does screening take place for breast cancer
aged 50-70 every 3 years
what is the most common type of breast cancer
adenocarcinoma
what are the 3 receptors that can be expressed in breast cancer
ER
Progesterone
HER2
which receptors have a positive effect on outcome in breast cancer
ER and PR
list some poor prognostic indicators for breast cancer
<35 years old
HER2 positive
oestrogen receptor negative
lymph node positive
list some risk factors for developing breast cancer
<55 years old early menarche, late menopause nulliparity, first child after 35 years, no breast feeding Hx of breast cancer or radiotherapy HRT and COCP use smoking, alcohol, obesity
what gene mutations increase risk of developing breast cancer
BRCA 1 and 2 mutations
TP53 mutations
what are the 2 precursor lesions that can develop before invasive breast cancer
ductal carcinoma in situ
lobular carcinoma in situ
outline the pathology findings of DCIS
malignant cells confined within the basement membrane of acini/ducts
what mammogram findings are pathognomonic for DCIS
microcalcifications
out of DCIS and LCIS which one is usually asymptomatic
LCIS is usually asymptomatic as detected through screening
describe the appearance of a malignant breast lump
irregular, tethered, non-fluctuating
taller rather than wide
what are the skin changes seen with breast cancer
erythema
Peau d’orange
pagets disease - eczema like
what are the nipple changes seen with breast cancer
unilateral blood stained discharge
retraction
Pagets
how is a breast lump investigated
triple assessment
clinical history and examination
mammogram
biopsy for pathology
what are the characteristic findings of breast cancer on MXR
microcalcifications and usually pleomorphic
what is the benefit of ultrasound in breast cancer diagnosis
helps to characterise a lesion, malignant lesions are heterogenous, taller than wide and poorly circumscribed
what is the broad management of breast cancer
surgery +/- axillary node clearance
chemo or radiotherapy
endocrine therapy
what are the 2 options for breast surgery
breast conserving - wide local excision
non-conserving - mastectomy
which surgical option is generally preferred
breast conserving if tumour is <4cm in size
what is the main side effect of lymph node clearance following breast surgery
lymphoedema of the arm
damage to the brachial plexus
what are the main reconstructive options following breast surgery
implants
tissue flaps
nipple remodelling
what is a issue with implants
placed under the pec major and risk of rippling or migration
outline the main muscles that are used for flaps and their blood supply
latissimus dorsi - thoracodorsal artery
abdomen - inferior epigastric
buttocks - inferior gluteal artery
what are the 2 indications for radiotherapy in breast cancer
adjuvant as part of WLE to reduce tumour size
palliative
what are some side effects of radiotherapy (immediate and late)
immediate - erythema of area, tiredness
late - skin and lung fibrosis, IHD
what is the standard chemotherapy regime for breast cancer patients
CMF
cyclophosphamide, methotrexate and 5FU
when are endocrine therapies indicated in breast cancer
used in oestrogen receptive positive cancers
improves disease free survival
what are the 2 main endocrine therapies that are used in breast cancer
Tamoxifen - partial oestrogen agonist
Letrozole - aromatase inhibitor
which endocrine therapy is only used in post-menopausal women and why
Letrozole only used for post-menopausal women as induces the menopause
tamoxifen increases risk of which gynae cancer
endometrial
what are the side effects of endocrine therapies
DVT infertility weight gain osteoporosis hot flushes
when is immunotherapy recommended in breast cancer
used for HER2 +ve tumours
what are some examples of immunotherapy agents
trastuzimab and herceptin
what primary tumours commonly metastasise to the breast
bone
liver
lung
brain
