BREAST LESIONS

Question 0

Risk factors for breast cancer?

Answer 0

Age
FHx
Previous breast cancer
Previous benign breast lesions
Ovarian, endometrial cancer 
Chest irradiation 
Excess oestrogen exposure

Question 1

What are non-Proliferative breast lesions? Ix? Rx?

Answer 1

Mastalgia

Mastitis - breast inflammation or infection

• most important DDx is inflammatory carcinoma
• US to rule out abcess, requires drainage
• Rx: Flucloxacillin

Duct ecstasia

Fibroadenoma

• firm, mobile, smooth, regular borders, painless, asymptomatic
• US, biopsy, triple assessment if over 40
• Rx: observations, surgery if rapidly growing > 2-3cm, symptomatic

Question 2

Breast cancer lump features?

Answer 2

8/10 lumps not cancer

Firm, irregular, painless, immobile

Peau d’orange - tumour blocking lymph drainage -> lymphedema

Dumpling: tumour putting traction on suspensory ligaments

Lymph oedema of arm from blockage

Question 3

What is Paget’s disease of the nipple?

Answer 3

Adenocarcinoma involving skin and ducts -> nipple excoriation

Question 4

Investigations?

Answer 4

CBE EUC LFT
CORE BIOPSY > FNA
CA 15.3
+/- genetic testing for BRCA 1 2

Mammogram 
US 
Look for mets 
- CT chest, ABDO head
- WBBS

Question 5

What would you expect to see on mammogram of a breast malignancy?

Answer 5

Mammogram

• spiculated border
• stellate lesion
• increased density
• microcalcifications

Ultrasound

• irregular shape
• I’ll defined margins
• microcalcifications
• variable echo fencing

Question 6

When should you screen breast cancer?

Answer 6

Asymptomatic women every 2 years 40-70 years

If pt < 35 -> ultrasound
If pt 35-50 -> no PREf
If pt > 50 -> mammogram

If preg -> US useful

Question 7

Rx of breast cancer?

Answer 7

Early stage

• breast conserving therapy plus radiation
• mastectomy
• if pt lymph node positive -> axillary node dissection
• if pt lymph node negative -> sentinel node biopsy

ADJUVANT THERAPY

Locally Advanced
- neoadjuvant systemic therapy rather than primary surgery

Question 8

Features of fibrocystic changes?

Answer 8

Fibrocystic changes

• rf: obesity, nulliparity, late onset menopause, late age first childbirth
• pain, tenderness with nenstrual cycle
• US: hypoechoic mass, clearly demarcated borders
• Rx: primrose oil, bromocriptine, danazol

Question 9

When would you do genetic screening breast cancer?

Answer 9

High risk

• BRCA mutation identified
• 2 1st or 2nd degree relatives on same side of smoky with Br or Ovarian Ca plus Br CA < 40, ovarian < 50 or bilateral br Ca
• 3 1st or 2nd degree relatives on same side of family with br or ovarian cancer