Breast Lecture 3 Flashcards
What is fibrocystic change?
Benign Breast condition Fibrosis Cysts Adenosis Apocrine metaplasia Ductal epithelial hyperplasia
What are fibroadenomae?
Circumscribed nodule in reproductive age
Benign breast tumour
Freely mobile, non-painful
What are intraduct papilloma?
Lactiferous ducts
Nipple discharge
What are tubular adenomas?
Less common than fibroadenomas
Appear the same
Uniform sized ducts
What are lactating adenomas?
Enlarging masses during lactation/pregnancy
Prominent secretory change
How do intraduct papillomae present?
Middle aged woman
Nipple discharge
Epithelial hyperplasia
How does breast fat necrosis present?
Hx trauma
Histiocytes with foamy cytoplasm
Lipid-filled cysts
Fibrosis/calcifications
What are Phyllodes tumours?
Fleshy tumours
Well circumscribed
Rare
How do breast carcinomas present on mammogram?
Soft tissue opacity
Microcalcification
What are the risk factors for breast cancer?
Female Old age Menstrual history Late/early first pregnancy Radiotherapy FH/PMH Hormone therapy Obesity Alcohol
What is the risk of breast cancer associated with epithelial proliferation?
2x RR
What is the risk of breast cancer associated with epithelial proliferation (atypical duct)?
4-5x RR
What is the risk of breast cancer associated with LCIS/DCIS?
8-10xRR
Which genes are associated with breast cancer and how strongly?
BRCA1 (20-40%)
BRCA2 (10-30%)
TP53 (<1%)
PTEN (<1%)
What are the non-invasive classifications of breast cancer?
Ductal carcinoma in situ
Lobular carcinoma in situ
What is In-situ carcinoma?
Pre-invasive (not a palpable tumour)
No metastatic spread
Risk of invasion
What is the risk of progression to cancer for low grade DCIS?
30% in 15 years
What is the risk of progression to cancer for high grade DCIS?
50% in 8 years
What is the risk of progression to cancer for LCIS?
19% in 25 years
What are the special types of breast cancer?
Tubular Carcinoma
Mucinous Carcinoma
Carcinoma with medullary features
Metaplastic carcinoma
How is breast cancer diagnosed?
Clinical exam Radioloy FNAC Needle core biopsy Wide local excision
What is the screening program for breast cancer?
Mammogram every 3y
Women 50-70y/o
What are microcalcifications?
Tiny deposits of calcium
Mostly harmless
Some may be precancerous tissue
To which nodes do breast cancers most likely spread?
Axillary nodes
Internal mammary nodes
Where does breast cancer most likely spread?
Bone
Lungs
Liver
Brain
What are the poor prognostic indicators for breast cancer?
Node status (best) Grade Type Age Lymphovascular invasion Estrogen/progesterone receptor Status HER2
What is the survival rate of breast cancer?
64% at 5 years
What is the scoring system used for breast cancer prognosis?
Nottingham Prognostic Index
What are the main molecular subtypes of breast cancer?
Luminal A
Luminal B
Triple -ve
HER2 type
What is Paget’s disease of the nipple?
Intraepithelial spread of intraductal carcinoma
Nipple/areolar pain/itching/scaling
Ulceration, Crusting, discharge
What is gynaecomastia associated with?
Hyperthyroidism Liver cirrhosis Chronic renal failure COPD Hypogonadism Hormone use
