Breast Medicine Flashcards by Eleanor chambers

What is fibroadenoma?

Benign tumour of the breast.

How well did you know this?

Not at all

Perfectly

What is the histology of fibroadenoma

● glandular epithelium and interlobular stroma of a terminal duct lobular units
● Well-circumscribed, non-encapsulated.
● Does not infiltrate into the parenchyma of the breast

How well did you know this?

Not at all

Perfectly

Give 4 differentials for a breast lump

Breast carcinoma.
Fibroadenoma.
Breast abscess.
Breast cyst.

How well did you know this?

Not at all

Perfectly

How does fibroadenoma present

Solitary, mobile breast lump with a regular border.

How well did you know this?

Not at all

Perfectly

How is fibroadenoma investigated

1st line - breast imaging (USS or mammogram)

Women <30: breast ultrasound.
● Smooth, well-circumscribed mass with uniform hypoechogenic
appearance.

■ Women >30 or highly suspicious for cancer: mammogram.
● Distinct, well-circumscribed mass.

How well did you know this?

Not at all

Perfectly

What is Mastitis?

inflammation of the breast tissue, typically due to infection.

Divided into lactational and non-lactational (duct ectasia)

How well did you know this?

Not at all

Perfectly

What is a Breast Abscesses?

An encapsulated accumulation of pus within the breast tissue due to infection

How well did you know this?

Not at all

Perfectly

What is the cause of Lactational mastitis

Combination of breastfeeding-related nipple trauma and milk stasis predisposes the breast to local infection.

How well did you know this?

Not at all

Perfectly

What is the cause of Duct ectasia mastitis

Blockage of lactiferous ducts due to squamous metaplasia leads to dilatation and inflammation.

Strongly associated with cigarette smoking

How well did you know this?

Not at all

Perfectly

How does duct ectasia mastitis present

Nipple discharge
Tenderness or pain
Nipple retraction or inversion
A breast lump (pressure on the lump may produce nipple discharge)

How well did you know this?

Not at all

Perfectly

What is the cause of breast abscess

Progression of untreated infective mastitis; walled-off collection of infection forms

How well did you know this?

Not at all

Perfectly

How do Mastitis and Breast Abscesses present?

● Symptoms include: fever, breast pain / tenderness (often during breastfeeding)
● Signs include: erythema, swelling, firmness.
● Duct ectasia is also associated with nipple discharge

How well did you know this?

Not at all

Perfectly

How is Mastitis investigated

usually a clinical diagnosis based on history and examination findings

How well did you know this?

Not at all

Perfectly

How is Breast Abscesses investiagted

breast ultrasound and diagnostic needle
aspiration.

How well did you know this?

Not at all

Perfectly

How is Lactational Mastitis managed

○ First Line: continued breastfeeding / milk expression plus simple analgesia
○ Second Line: >24 hour duration / severe pain - add PO flucloxacillin.

erythromycin when allergic to penicillin.

How well did you know this?

Not at all

Perfectly

What is most common bacterial cause of Mastitis

Staphylococcus aureus.

How well did you know this?

Not at all

Perfectly

How is Non-lactational Mastitis managed

First line: PO flucloxacillin

How well did you know this?

Not at all

Perfectly

How are Breast Abscess managed

First Line: needle aspiration and drainage plus flucloxacillin (dependent on local
policy).

How well did you know this?

Not at all

Perfectly

Why is the incidence of breast cancer thought to be increasing?

Western lifestyle.
Screening.
Increasing life expectancy.

How well did you know this?

Not at all

Perfectly

What percentage of women who have a mammogram will be called back for more tests?

4/100 will need more tests.

1/4 of these women will then be found to have cancer.

How well did you know this?

Not at all

Perfectly

Name 3 modifiable RF’s for breast cancer.

Alcohol intake.
Obesity.
Use of HRT/OCP.

How well did you know this?

Not at all

Perfectly

Name 3 non-modifiable RF’s for breast cancer.

Age of menarche/menopause
Breast density.
Genetics e.g. BRCA1/2

Approximately what percentage of breast cancers are ductal and what percentage are lobular?

Ductal (70%).
Lobular (10%).

What are the non invasive breast cancers

Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS)

Difference between invasive and non invasive breast cancer

Invasive = penetration through basement membrane

What are the invasive breast cancers

Invasive ductal carcinoma (commonest - 75%) Invasive lobular carcinoma Medullary carcinoma

What is Pagets disease of the nipple

Looks like eczema of the nipple/areolar Indicates breast cancer involving the nipple May represent DCIS or invasive breast cancer

Give 4 signs that you may find on clinical examination that are suggestive of breast cancer.

Palpable lump - irregular, hard, fixed, painless. Discharge from the nipple. Nipple in-drawing. Skin changes e.g. peau d’orange.

How is breast cancer graded

Nottingham criteria: ○ Gland formation ○ Nuclear atypia / pleomorphism ○ Mitosis counts (indicates rate of cellular reproduction)

What are the steps for metastatis

1. Invasion through basement membrane 2. Intravasation (entry into circulation) 3. Circulation 4. Extravasation 5. Colonisation

Common met locations for breast cancer

bones, liver, lungs and brain.

What is the screening program for breast cancer

3-yearly mammogram for women aged 50-71.

Breast cancer: what is the triple assessment?

Clinical examination e.g. palpation. Mammogram. Core needle biopsy.

If a patient has breast implants or high density breasts a mammogram can be difficult to interpret. What investigation can be done as an alternative?

MRI

Breast cancer: is a P1/2 lump that is described as soft, mobile and regular likely to be benign or malignant?

Benign. E.g. fibroadenoma.

Breast cancer: is a P4/5 lump that is described as hard, fixed and irregular likely to be benign or malignant?

malignant

What are the typical mammogram findings of malignant carcinoma

● Pre-invasive: unifocal / widespread microcalcifications ● Invasive carcinoma: 1. Irregular spiculated mass 2. Clustered microcalcifications 3. Linear branching calcifications.

Give 3 treatment options for patients with breast cancer.

1. Conservative surgery + radiotherapy. 2. Mastectomy + radiotherapy. 3. Mastectomy + reconstruction + radiotherapy (BUT can damage a lot of reconstructions). 4. Axillary lymph node removal - limited removal or clearance.

Why might a mastectomy be indicated as opposed to a lumpectomy in someone with breast cancer?

If the tumour is large relative to the size of breast. If there are multiple tumours. Patient preference.

What biopsy should you do to ensure that breast cancer hasn’t spread to the axillary lymph nodes?

A sentinel node biopsy.

Name 2 adjuvant treatments that can be given to women with oestrogen receptor positive cancer.

- Tamoxifen (pre-menopausal). - anastrozole - Aromatase inhibitors (post-menopausal).

What is triple-negative breast cancer

when the breast cancer cells do not express any of these three receptors worse prognosis Oestrogen receptors (ER) Progesterone receptors (PR) Human epidermal growth factor (HER2)

Name 2 adjuvant treatments that can be given to women with HER2 receptor positive cancer.

Trastuzumab (Herceptin)

Name 3 Breast Cancer Receptors

Oestrogen receptors (ER) Progesterone receptors (PR) Human epidermal growth factor (HER2)

What is in the criteria for high risk breast cancer

* BRCA1, BRCA2 genes - 40% lifetime risk of breast/ovarian cancer * 1st degree relative premenopausal relative with breast cancer (e.g. mother) * nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs) * early menarche, late menopause * combined hormone replacement therapy * past breast cancer * not breastfeeding * ionising radiation * p53 gene mutations * obesity * previous surgery for benign disease (?more follow-up, scar hides lump)

What is the two week criteria for breast cancer

* Unexplained breast or axillary lump in a woman aged >30. * Unilateral nipple changes in a woman aged >50. * Skin changes suggestive of breast cancer, any age.

What is a complication of axillary lymph node clearence

Chronic Lymphoedema

What is Intraductal Papilloma

a warty lesion that grows within one of the ducts in the breast. proliferation of epithelial cells

How does Intraductal Papilloma present

Nipple discharge (clear or blood-stained) Tenderness or pain A palpable lump

how is Intraductal papillomas managed

complete surgical excision.

How do breast cysts feel on examination

Smooth Well-circumscribed Mobile Possibly fluctuant

What are the options for reconstructing the breast after mastectomy?

Breast implants Flap reconstruction

Name side effects of radiotherapy

General fatigue from the radiation Local skin and tissue irritation and swelling Fibrosis of breast tissue Shrinking of breast tissue Long term skin colour changes (usually darker)