Breast Tumours Flashcards by James Reilly

Examples of benign breast tumours

Fibroadenoma
Intraductal papilloma
Phyllodes tumour

How well did you know this?

Not at all

Perfectly

Characteristics of fibroadenoma

Small
Aka breast mouse as tumour is not tethered
Sharp edges
Most common type of benign breast tumour in young women

How well did you know this?

Not at all

Perfectly

Characteristics of Intraductal papilloma

Small
Under areola
Bloody discharge from nipple

How well did you know this?

Not at all

Perfectly

Characteristics of Phyllodes tumour

Large
Leaf-life projections
Rapid growing

How well did you know this?

Not at all

Perfectly

Examples of malignant breast tumours

Ductal carcinoma in situ (DICS)
Comedocarcinoma
Invasive ductal
Invasive lobular
Medullary
Inflammatory
Paget's disease of the breast

How well did you know this?

Not at all

Perfectly

Characteristics of ductal carcinoma in situ

From ductal hyperplasia

Cheesy discharge, confined to ducts

How well did you know this?

Not at all

Perfectly

Characteristics of comedocarcinoma

High grade ductal carcinoma in situ
Characterised by central necrosis
Cheesy discharge

How well did you know this?

Not at all

Perfectly

Characteristics of Invasive ductal tumour

A hard mass
Sharp edges
Most common
Very aggressive

How well did you know this?

Not at all

Perfectly

Does invasive lobular tumour present as unilateral or bilateral

Bilateral presentation

How well did you know this?

Not at all

Perfectly

Characteristics of medullary tumour

Well differentiated
Lacks desmoplastic reaction
Lymphatic infiltrate
Good prognosis

How well did you know this?

Not at all

Perfectly

Characteristics of inflammatory tumour

Invades the dermis and lymphatic system
Peau d’orange appearance
Retracted nipple

How well did you know this?

Not at all

Perfectly

Characteristics of Pagets disease of the breast

Epidermal infiltration of ductal carcinoma

Eczematoid nipple changes

How well did you know this?

Not at all

Perfectly

What is the most common breast tumour

Invasive ductal tumour (malignant)

How well did you know this?

Not at all

Perfectly

Which breast tumour is described:

High grade ductal carcinoma in situ that is characterised by central necrosis. Cheesy discharge also present

Comedocarcinoma (malignant)

How well did you know this?

Not at all

Perfectly

Which breast tumour is described:
Well differentiated tumour that lacks desmoplastic reaction. Lymphatic infiltrate also present.
What is prognosis like for this tumour?

Medullary carcinoma

Malignant tumour but good prognosis

How well did you know this?

Not at all

Perfectly

Which breast tumour is described:

Large with leaf-like projections. Also rapid growing.

Phyllodes tumour (benign)

How well did you know this?

Not at all

Perfectly

What is the most common type of benign breast tumour in young women

Fibroadenoma

How well did you know this?

Not at all

Perfectly

Investigations

Triple assessment:
1 Examination
2 Imaging
3 Biopsy

Physical examination for lumps and masses
Bloods
Radiology

How well did you know this?

Not at all

Perfectly

Blood tests done

FBC, WCC, U and Es, LFTs, TFTs

How well did you know this?

Not at all

Perfectly

Radiology assessments done

Mammogram, ultrasound scan,
fine needle biopsy under ultrasound guidance (core needle biopsy may be required)
Look for metastasis with CXR, CT scan and MRI scan

How well did you know this?

Not at all

Perfectly

What does CT and MRI stand for

Computerised Tomography

Magnetic resonance imaging

Risk factors for breast cancer

Female
Increasing age
Family history of breast cancer
Alcohol
Obesity
Genetic involvement
Increased oestrogen exposure

Give examples of genetic risk factors for breast cancer

BRCA 1 (chromosome 17)
BRCA 2 (chromosome 13)

Give examples of increased oestrogen exposure

Early menarche
Late menopause
Oral contraceptive pill use
Hormone replacement therapy
Decreased parity
Not breastfeeding

Complications

``` Death Metastasis Complications of chemotherapy regimen Complications of radiotherapy regimen Depression ```

What does treatment depend on

Cause of breast tumour | Whether it is benign or malignant

Conservative treatment

Patient and family education Refer to Macmillan nurses Offer genetic counselling Provide psychological assessment and support

*How is prognosis assessed

Nottingham Prognostic Index (NPI) | =(0.2 x invasive size) + lymph node stage + grade of tumour

Types of medical treatment

Adjuvant hormone therapy Chemotherapy and Radiotherapy regimens (vary depending on tumour) HER2 directed therapy (depending on type of tumour)

**Medical treatment: Hormone Therapy

Premenopausal women are treated with TAMOXIFEN Postmenopausal women are treated with ANASTRAZOLE (Aromatase inhibitor) (if a woman becomes menopausal during treatment, she will benefit from switching medications)

What is tamoxifen

Selective oestrogen receptor modulator

Why are postmenopausal women treated with anastrazole (not tamoxifen)

Anastrazole = Aromatase inhibitor | Trials like ATAC trial have suggested that aromatase inhibitors are superior to tamoxifen in postmenopausal women

Medical treatment: Describe HER2 directed therapy

Treatment with TRASTUZUMAB (Herceptin) | This is a monoclonal antibody against the extracellular domain of the HER2 receptor

Surgical treatment: primary aim

To remove the invasive and noninvasive cancer with clear margins

*Surgical treatment options

Lumpectomy followed by radiotherapy | Mastectomy (particularly for circumstances like multifocal breast disease)

Surgical treatment: what else is assessed (other than breast tumour itself)

Ipsilateral axilla should be assessed with ultrasound, fine needle aspiration or core biopsy Clinical staging of axilla should by assessed by sentinel lymph node biopsy. This is to avoid unnecessary axillary clearance in patients

Important questions in history

Size - Has it changed? Over what duration? Onset - when did they first notice? Is lumps size or discomfort related to menstraul cycle in any way? (progesterone) Pain? (SOCRATES)

Local associated symptoms of breast cancer

``` Nipple discharge/bleeding Nipple inversion Skin changes (on lump or elsewhere) ```

Systemic symptoms

General cancer symptoms - fever lethargy etc Gland swelling Pain elsewhere -spine, abdomen

Past medical Hx

Age at menopause | Age at first pregnancy

Family history

BRCA mutations Smoking Alcohol Recreational drug use

1st line assessment

Mammogram (low dose x-ray think)

Investigations after mammogram

MRI | Biopsy

Pros of breast cancer screening

Diagnose people sooner to improve prognosis and save lives High sensitivity on test Good treatment if diagnosed Informed consent of complications

Cons of breast cancer screening

Over diagnosis Exposure to radiation False positives

*Normal screening age for mammograms

50-70 (due to menopausal age) | Every 3 years (varies upon family history)

If cancer is suspected, how long until a patient should be seen be a specialist

Within 2 weeks

Most common breast cancer

Ductal carcinoma

Risk factors of breast cancer

``` Genetic Female Late menopause and early menarche Increasing age Not giving birth Not breast feeding ```

Common metastases locations

Brain, Bone, Liver, Lung