Breast Medicine

Question 1

How do breast cysts occur?

Answer 1

Occur due to overgrowth of glandular and connective tissue, leading to blocked breast ducts and fluid accumulation.

Question 2

Sx of breast cysts?

Answer 2

Breast lump potentially w/distension

Question 3

What is mammary ductal ectasia and how does it occur?

Answer 3

Benign breast cdtn that occurs when milk duct in breast widens and its walls thicken.

Occurs due to inflammation and dilation of large breast ducts.

Question 4

Sx of duct ectasia?

Answer 4

Palpable peri-areolar breast mass
Thick nipple discharge
Mammographic similarities to cancer

Question 5

Ix for benign breast disease

Answer 5

1. Clinical examination
2. Mammography and USS
3. Fine-needle aspiration/biopsy
4. Blood tests - infx or hormonal imbalance

Question 6

What are some RF for breast cancer? (5)

Answer 6

• Early menarche or late menopause
• Nulliparity
• Oral contraceptives/ HRT
• Gene mutations (BRCA1/BRCA2)
• Advancing age
• Caucasian
• Obesity
• Alcohol

Question 7

What is the most common type of breast cancer?

Answer 7

Invasive ductal carcinoma (IDC) - starts in a milk duct then breaks through duct wall and invades breast fatty tissue.

Question 8

Sx of breast cancer?

Answer 8

• Unexplained breast mass - pts >30 yrs +/- pain
• If >50 yrs - nipple discharge or retraction
• Skin changes - i.e. peau d’orange
• Unexplained axillary mass

Peau d’orange- A dimpled condition of the skin of the breast, resembling the skin of an orange, sometimes found in inflammatory breast cancer.

Question 9

What is an example of secondary prevention of breast cancer?

Answer 9

NHS Breast Screening Programme.

Invites 50-70 yr olds for breast screening every 3 years.

Question 10

What is the triple assessment used to Ix sus. breast cancer?

Answer 10

1. Clinical examination of breast + lumph nodes
2. Radiological exam - mammogram, USS and MRI
3. Biopsy - Core needle biopsy or fine needle aspirate

Question 11

Tx for breast carcinomas?

Answer 11

• Surgical: WLE or mastectomy (w/ axillary node clearance if +ve or w/ sentinel node biopsy if invasive)
• Radiotherapy: following WLE
• Chemotherapy: HER2 over-expressing pt
• Biological: Trastuzumab (Herceptin) - HER2 +ve pt
• Hormonal therapy: Anastrozole (postmenopausal) or Tamoxifen (premenopausal) if oestrogen receptor-positive.
• Bisphosphonates

Question 12

What are fibroadenomas?

Answer 12

Benign tumours that consist of fibrous and epithelial tissue. They originate from lobules (milk-producing glands in breast).

Question 13

Sx of fibroadenomas?

Answer 13

• Firm, non-tender breast mass (<3cm)
• Rounded mass w/smooth edges
• Highly mobile upon palpation - “rubbery” consistency

Question 14

Ix for fibroadenomas?

Answer 14

Triple assessment:
1. Clinical examination
2. Imaging (usually ultrasound and/or mammogram)
3. Needle biopsy (fine needle aspiration or core biopsy)

Question 15

Tx of fibroadenomas

Answer 15

• Conservative - mostly don’t require tx
• Surgical excision - if causing significant sx

Question 16

What is ductal carcinoma in situ (DCIS)?

Answer 16

Early breast cancer - some cells in lining of ducts of breast tissue have started to turn into cancer cells. Pre-invasive and has not spread.

Question 17

What is significant upon examination for DCIS (ductal carcinoma in situ)?

Answer 17

Calcifications present in ducts on imaging.
However, mostly asx and picked up during breast screening.

Question 18

What is a papilloma?

Answer 18

Growth a bit like a wart that can grow inside the breast ducts often near nipple.

Question 19

What is Paget’s disease of the nipple?

Answer 19

Eczema-like changes to the skin of the nipple and the areola. Usually a sign of breast cancer.

Question 20

Sx of Paget’s disease of the nipple?

Answer 20

• Always starts in nipple then extends to areola
• Red, scaly rash - sore and inflamed
• Itchy or burning sensation