Breast Pathology

Question 1

What are the causes of breast lumps?

Answer 1

Cysts
Fibroadenomas
Malignancy

Question 2

How do benign breast lumps typically present?

Answer 2

3D
Mobile
Smooth
Regular borders
Solid/cystic feel

Question 3

What are the components of a triple assessment?

Answer 3

Breast Ex
Imaging: Mammogram >40yo OR USS <40yo
Needle biopsy: Cytology

Question 4

What are the indications for the different referral times for triple therapy assessment?

Answer 4

2WEEK:
- >30yo w/unexplained lump +/- pain
- >50yo w/Sx in 1 nipple- discharge, retraction, other concerns
6WEEK:
- <30yo w/unexplained lump +/- pain
2WEEK FOR CANCER:
-Skin changes
- >30yo w/unexplained lump in axilla

Question 5

Who gets breast cysts?

Answer 5

35-50yo + peri-menopausal

Question 6

What are the complications of breast cysts?

Answer 6

Small ↑risk of Ca

Question 7

What do breast cysts feel like?

Answer 7

Palpable smooth lump
Discrete
Not fixed
Occassionally painful
Often recurrent

Question 8

How are breast cysts investigated?

Answer 8

Most resolve spontaneously
Refer
Aspiration:
-Blood stained→ Excision

Question 9

What is the most common breast lesion?

Answer 9

Fibroadenoma

Question 10

What are the risk factors for a fibroadenoma?

Answer 10

20-24yo

HRT

Question 11

How do fibroadenomas arise?

Answer 11

From lobule
Composed of fibrous & epithelial tissue
No malignancy risk

Question 12

What are the different types of fibroadenoma?

Answer 12

• Simple: 1 cell type
• Complex: Moderately differentiated
• Giant/Juvenile: >5cm teenage girls

Question 13

How are fibroadenomas investigated?

Answer 13

Triple assessment

Question 14

How are fibroadenomas treated?

Answer 14

1/3 regress, 1/3 same, 1/3 enlarge
Watch & wait
>3cm = surgical excision

Question 15

What are the Sx of fibroadenosis

Answer 15

AKA fibrocystic disease
Lumpy breasts
Painful
Sx worse pre-menstruation

Question 16

What is duct ectasia?

Answer 16

Ducts become blocked & secretions stagnate

Question 17

How does duct ectasia present?

Answer 17

Nipple discharge: Green/brown/bloody
Nipple retraction
Lump

Question 18

How is duct ectasia investigated?

Answer 18

Triple assessment
Microdochectomy = young
Total Duct Excision = older

Question 19

Who is duct ectasia most common in?

Answer 19

Menopausal women

Question 20

What are the risk factors for a breast abscess?

Answer 20

Ultimately due to milk accumulation:
Lactating women
Trauma
Rapid weaning
Partial bottle feeding
Change in BF regimen

Question 21

How does a breast abscess present?

Answer 21

Red
Hot
Tender
Axillary lymphadenopathy
Fever

Question 22

How is a breast abscess treated?

Answer 22

Encourage BF
Analgesia
Incision & drainage

Question 23

Who usually gets fat necrosis of the breast?

Answer 23

Obese w/large breasts

Question 24

How does fat necrosis of the breast present?

Answer 24

Firm & round lump
Becomes hard & irregular
May appear bruised or dimpled

Question 25

How is fat necrosis investigated?

Answer 25

Triple assessment

Question 26

What are the risk factors for developing breast cancer?

Answer 26

↑age Prolonged oestrogen exposure Obesity BRCA1&2 (Tumour suppressor genes)

Question 27

How is HER2 receptor breast cancer treated?

Answer 27

Trastuzumab (Herceptin)

Question 28

What is the breast cancer screening program?

Answer 28

50-70yo | Every 3years

Question 29

Which individuals outside of screening age are screened as well?

Answer 29

Prev Cancer BRCA1&2, TP53 gene 1st degree relative w/cancer <50yo

Question 30

What histology are most breast cancers?

Answer 30

Adenocarcinomas

Question 31

What makes a breast cancer non-invasive?

Answer 31

Confined to ducts, or the acini of the lobules w/NO infiltration of basement membrane

Question 32

What are the main types of carcinoma in situ?

Answer 32

``` -Ductal: Associated w/fibrosis Large ducts involved = nipple discharge 50% chance of becoming invasive -Lobular: Pre-menopausal women VERY difficult to detect Usually multifocal & bilateral 30% chance of becoming invasive ```

Question 33

What are the main types of malignant breast cancers?

Answer 33

Ductal: MOST COMMON 75% Lobular Mucinous: Poorly defined borders but Good prognosis Tubular: Cells arranged as tubules, V good prognosis Medullary

Question 34

What makes a breast cancer 'invasive'?

Answer 34

Spread through basement membrane to other tissues

Question 35

How is a sentinel node biopsy carried out?

Answer 35

Radioactive technetium & blue dye injected around nipple Surgery hours later Identify 'bluest' node w/highest geiger count Removed & sent for histology

Question 36

Which sites does breast cancer commonly spread to?

Answer 36

``` Lungs Bone Brain Liver Adrenals ```

Question 37

What are poor prognostic indicators in someone w/breast cancer?

Answer 37

``` Young/premenopausal Large primary tumour High grade tumour OE + progesterone receptor -ve +ve LNs ```

Question 38

What receptors can be found on breast cancer cells?

Answer 38

Oestrogen- 75% Progesterone- 50% If +ve good prognosis as can be targeted for Tx

Question 39

How is breast cancer treated?

Answer 39

RADICAL- 1) Surgery: WLE/mastectomy w/sentinel biopsy WITH Adjuvant RT to chest wall post-mastectomy 2) Endocrine Tx: Suitable for ALL tumours w/OE +/- PR receptors = Tamoxifen Aromatase = Post-menopausal OE +ve disease HER2 +ve = Herceptin (mab) CHEMO PALLIATIVE

Question 40

What are the SE of RT to the chest wall?

Answer 40

``` Pneumonitis Rib fracture Pericarditis Lymphodema Brachial plexus injury ```

Question 41

Aside from Tx breast cancer when is Tamoxifen given?

Answer 41

ALL OE +ve disease | 5years post-op Tx