Breast Lumps Flashcards
What is skin tethering?
The lump is attached to the skin but can be moved in an arc without moving the skin. If the lump is pulled outside the arc, the skin indents.
What is skin fixation?
Where the lump cannot be moved without moving the skin.
Where is the most common area for breast cancer to occur?
The upper outer quadrant of the breast
What are the common types of breast cancer?
- Invasive ductal carcinoma is the commonest
- Invasive lobular carcinoma - second commonest
How does lobular carcinoma present?
Cells tend to infiltrate the surrounding tissues in a single file pattern. This may result in a thickening rather than a discrete lump and on mammography any abnormality may be very subtle. Most will have an MRI scan prior to surgical planning to define the extent of the cancer and identify multifocal and contralateral disease.
When are CT scans done in breast cancer?
NICE guidelines discourage the use of routine follow-up staging CT scans in breast cancer as there is no evidence that these have any impact on survival. This would only be done if the patient develops symptoms suggestive of metastatic disease.
What are the treatments available for breast cancer?
- Wide local excision with radiotherapy and mastectomy have the same survival rates
- Chemotherapy given to treat micro-metastases which is shown to improve survival rates (adjuvant therapy)
What are the indications for mastectomy?
- Radiotherapy contraindication: previous radiotherapy, Hodgkin’s lymphoma
- BRCA gene carrier - prophylaxis
- Large tumour to breast ratio
- Repeated unsuccessful lumpectomy
- Patient choice
- Local recurrence
- Multi-focal
- Widespread DCIS
When is chemotherapy indicated?
Neoadjuvant:
- For larger/inoperable tumours to facilitate surgery
- If the axillary lymph nodes are involved
Also:
- Chemotherapy + anti-HER2 therapy recommended for HER2+ cancers even for small tumours
- Triple negative cancers even in small tumours
What type of cancer would not benefit from chemotherapy?
ER+, PR+, HER2 -ve and node -ve cancer
What are Montgomery’s tubercles?
Sebaceous glands in the areola around the nipple. They are a normal finding but may be more pronounced during pregnancy.
What do you want to know about a breast lump?
- Site
- Shape
- Size
- Tender
- Consistency
- Fixity to skin or mobility
- Tethering to muscle
- Associated skin changes
What is a mammoplasty?
Breast reduction - therapeutic would involve removal of cancer also
What is a sentinel node biopsy?
Removal of the first draining axillary lymph node and look under microscope to identify if cancer has spread. If it has then can offer axillary node clearance.
What does a normal lymph node look like on an USS?
- Uniform thin cortex
- Fatty hilar (white middle bit)
