Breast Lectures 3-4 Flashcards
What is a fibroadenoma?
Most common breast tumour in adolescent and young adult women
Benign
Proliferation of epithelial and stormal elements
What would a fibroadenoma feel like on palparion?
Well-circumcised, freely mobile. non-painful mass
What may happen to a fibroadenoma if left untreated?
May regress with age
In a fibroadenoma, if the ducts are distorted/ elongated, what type of growth pattern is this?
Intracanalicular growth pattern
In a fibroadenoma, if the ducts are not compressed, what type of growth pattern is this?
Pericanalicular growth pattern
Intraductal papilloma?
Benign tumour within breast ducts- can show epithelial hyperplasia
What is a symptom of intraductal papilloma?
Nipple discharge
What is fat necrosis of the breast?
Benign condition where the adipose tissue is damaged and ultimately leads to cell death and necrosis of the tissue of the breast
->can simulate carcinoma clinically and mammographically
What may be indicative of breast fat necrosis in the history?
Antecedent trauma
Prior surgical intervention
What would be seen histologically in breast fat necrosis?
Histiocytes with foamy cytoplasm
Lipid-filled cysts
What may be seen in breast fat necrosis on mammography?
Fibrosis
Calcifications
Egg shell- whatever that means
Phyllodes tumour?
Fleshy tumour, leaf-like pattern and cysts on cut surface
Can be benign, borderline or malignant
->less than 1% of breast tumours
How would metastases of a Phyllodes tumour spread?
Haematogenously
How common is breast cancer?
Commonest type of cancer in the UK
Female > Male but 390 approx. male breast cancer diagnosis per year in UK
Risk factors of breast camcer?
Gender
Age
Age at first pregnancy
Radiation
FH
Personal history
Hormonal treatment
Genetic factors
Obesity, alcohol
Which genes are most commonly the cause of hereditary susceptibility to breast cancer?
BRCA1
BRCA2
->BRCA1-20-40%, BRCA2- 10-20%
TP53, PTEN or other genes can cause it
Some breast carcinomas can be described as being in situ. What does this mean?
Abnormal cells are only found in the place where they first formed, the original place
What are two types of non-invasive carcinomas which are described as being in situ?
Ductal carcinoma in situ
Lobular carcinoma in situ
Describe breast tumours which are found in situ.
If preinvasive, does not form a palpable tumour
Only detected on x-ray
No metastatic spread
Risk of invasion depending on grade
What are some of the diagnostic procedures for breast tumours?
Clinical examination
Radiology- mammogram, ultrasound, MRI
Fine needle aspiration cytology
Needle core biopsy
Diagnostic excision
What will be described in the histology report of a breast tumour?
Invasive vs non-invasive
Histological type e.g. ductla vs lobular
Grade
Size
Margins
Lymph nodes
Oestrogen/progesterone receptor
Which is the more common histological type of breast cancer- ductal or lobular?
Ductal - 85%
Lobular- 15%
Where would local spread of breast cancer go?
Skin
Pectoral muscles
Where would lymphatic spread of a breast cancer go?
Axillary and internal mammary nodes
Where would blood spread of a breast cancer go?
Bone
Liver
Lungs
Brain
Paget’s disease of the nipple?
Rare condition associated with breast disease.
Causes eczema like change to the areola.
Symptoms of Paget’s disease of the nipple?
Pain or itching, scaling and redness
Mistaken for eczema
Can be ulceration, crusting and serous/bloody discharge from the nipple
What is the most common abnormality of the male breast?
Gynecomastia- increase in subareolar tissue
What can gynecomastia be associated with?
Hyperthyroidism
Liver cirrhosis
Chronic renal failure
Chronic pulmonary disease
Use of hormones- oestrogen, androgens and other drugs
How many women will be affected by breast cancer?
1 in 7
->most common cancer in women
Risk factors for breast cancer?
Age- increases with age
Previous breast cancer
Genetic- BRCA1, BRCA2
Early menarche
Late menopause
Late or no pregnancy
HRT
Excess alcohol
Weight
Post radiotherapy treatment for Hodgkin’s disease
Which age group get screened for breast cancer?
50-70
A lot of patients with breast cancer are asymptomatic and find out through screening.
However, what are some of the symptoms a patient with breast cancer may present with?`
Lump
Mastalgia- persistent unilateral pain
Nipple discharge- bloodstained
Nipple changes- Paget’s disease, retraction
Change in size or shape of breast
Dimpling of breast skin
Lymphoedema (swelling of arm)
Would you be more worried about a painful breast lump or a painless breast lump?
Painless breast lump
Anyone who presents with a breast lump requires triple assessment. What are the three parts?
Clinical- history and examination
Radiological- bilateral mammograms/ultrasound
Cytopathological- core biopsy
What would you need to cover in FH in someone presenting with a breast lump?
Previous breast problems
FJ
Drug history
Hormonal status
Let’s say the lump is in the right breast, which breast would you examine first?
Left- need to know what normal feels like first
If nipple discharge was bilateral, how likely is this to be breast cancer?
Less likely as bilateral, would be more likely to be something systemic
Is mammography more sensitive in older or younger women?
Older
->younger women have increased presence of glandular tissue so not as sensitive
What are the two pathological types of breast cancer?
Ductal carcinoma- 80%
Lobular carcinoma- 10%
Others- 10%
Do breast cancers in situ tend to be invasive or non-invasive?
Non-invasive
If breast tumour size is <2cm, what stage of breast cancer is this?
Stage 1
If breast tumour size is 2-5cm, what stage of breast cancer is this?
Stage 2
If breast tumour size is >5cm, what stage of breast cancer is this?
Stage 3
If breast tumour size is invading the surrounding skin, what stage of breast cancer is this?
Stage 4
What are the aspects of breast cancer management/treatment?
Surgery
+/- radiotherapy
+/- chemotherapy
+/- hormonal therapy
Two types of surgical procedure for breast cancer?
Mastectomy
Breast conservation surgery
->always try to do breast conserving therapy, studies show that if good margins and radiotherapy, survival is the same
What is meant by sentinel lymph node biopsy?
First node to receive lymphatic drainage, so the first node the tumour spreads to.
If negative, the rest of the nodes are also negative for the cancer spread.
What are some of the potential complications of axillary treatment?
Lymphoedema
Sensory disturbance
Nerve damage
Vascular damage
Radiation-induced sarcoma
