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Yr 5 GI & Breast > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What are the causes of breast lumps?

A

Cysts
Fibroadenomas
Malignancy

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2
Q

How do benign breast lumps typically present?

A 
3D
Mobile
Smooth
Regular borders
Solid/cystic feel
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3
Q

What are the components of a triple assessment?

A

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

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4
Q

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

A 
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
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5
Q

Who gets breast cysts?

A

35-50yo + peri-menopausal

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6
Q

What are the complications of breast cysts?

A

Small ↑risk of Ca

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7
Q

What do breast cysts feel like?

A 
Palpable smooth lump
Discrete
Not fixed
Occassionally painful
Often recurrent
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8
Q

How are breast cysts investigated?

A

Most resolve spontaneously
Refer
Aspiration:
-Blood stained→ Excision

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9
Q

What is the most common breast lesion?

A

Fibroadenoma

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10
Q

What are the risk factors for a fibroadenoma?

A

20-24yo

HRT

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11
Q

How do fibroadenomas arise?

A

From lobule
Composed of fibrous & epithelial tissue
No malignancy risk

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12
Q

What are the different types of fibroadenoma?

A
  • Simple: 1 cell type
  • Complex: Moderately differentiated
  • Giant/Juvenile: >5cm teenage girls
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13
Q

How are fibroadenomas investigated?

A

Triple assessment

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14
Q

How are fibroadenomas treated?

A

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

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15
Q

What are the Sx of fibroadenosis

A

AKA fibrocystic disease
Lumpy breasts
Painful
Sx worse pre-menstruation

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16
Q

What is duct ectasia?

A

Ducts become blocked & secretions stagnate

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17
Q

How does duct ectasia present?

A

Nipple discharge: Green/brown/bloody
Nipple retraction
Lump

18
Q

How is duct ectasia investigated?

A

Triple assessment
Microdochectomy = young
Total Duct Excision = older

19
Q

Who is duct ectasia most common in?

A

Menopausal women

20
Q

What are the risk factors for a breast abscess?

A 
Ultimately due to milk accumulation:
Lactating women
Trauma
Rapid weaning
Partial bottle feeding
Change in BF regimen
21
Q

How does a breast abscess present?

A 
Red
Hot
Tender
Axillary lymphadenopathy
Fever
22
Q

How is a breast abscess treated?

A

Encourage BF
Analgesia
Incision & drainage

23
Q

Who usually gets fat necrosis of the breast?

A

Obese w/large breasts

24
Q

How does fat necrosis of the breast present?

A

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

25
Q

How is fat necrosis investigated?

A

Triple assessment

26
Q

What are the risk factors for developing breast cancer?

A

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

27
Q

How is HER2 receptor breast cancer treated?

A

Trastuzumab (Herceptin)

28
Q

What is the breast cancer screening program?

A

50-70yo

Every 3years

29
Q

Which individuals outside of screening age are screened as well?

A

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

30
Q

What histology are most breast cancers?

A

Adenocarcinomas

31
Q

What makes a breast cancer non-invasive?

A

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

32
Q

What are the main types of carcinoma in situ?

A 
-Ductal: 
Associated w/fibrosis
Large ducts involved = nipple discharge
50% chance of becoming invasive
-Lobular:
Pre-menopausal women
VERY difficult to detect
Usually multifocal &amp; bilateral
30% chance of becoming invasive
33
Q

What are the main types of malignant breast cancers?

A

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

34
Q

What makes a breast cancer ‘invasive’?

A

Spread through basement membrane to other tissues

35
Q

How is a sentinel node biopsy carried out?

A

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

36
Q

Which sites does breast cancer commonly spread to?

A 
Lungs
Bone
Brain
Liver
Adrenals
37
Q

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

A 
Young/premenopausal
Large primary tumour
High grade tumour
OE + progesterone receptor -ve
\+ve LNs
38
Q

What receptors can be found on breast cancer cells?

A

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

39
Q

How is breast cancer treated?

A

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

40
Q

What are the SE of RT to the chest wall?

A 
Pneumonitis
Rib fracture
Pericarditis
Lymphodema
Brachial plexus injury
41
Q

Aside from Tx breast cancer when is Tamoxifen given?

A

ALL OE +ve disease

5years post-op Tx

Yr 5 GI & Breast (13 decks)

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