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Reproduction > Breast Week > Flashcards

Breast Week Flashcards

1
Q

where does the GP refer patients who present with a breast problem? (eg lump, breast pain, nipple discharge)

A

one stop breast clinic

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2
Q

what age group is offered breast screening and how often?

A

50-70 year olds

every 3 years

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3
Q

what is the most common cause of green discharge?

A

duct ectasia

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4
Q

what is duct ectasia?

A

when a lactiferous duct becomes blocked

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5
Q

how many lobules are found in a breast?

A

15-25 lobules

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6
Q

what do breast lobules contain?

A

a tubulo-acinar gland which drains via a series of ducts to the nipple

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7
Q

what fascia does the breast sit infront of?

A

the pectoralis fascia

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8
Q

what are the suspensory ligaments (of Cooper) of the breast made of? what is their function

A

thickenings of the fibrocollaginous tissue that the breast is made of
-connect the pectoralis fascia to the dermis, through adipose tissue

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9
Q

what is the expansion of the lactiferous duct near the nipple region called?

A

the lactiferous sinus

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10
Q

within a breast lobule, terminal ductules pass breast secretions to what duct?

A

intralobular collecting duct

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11
Q

what duct does the intralobular collecting duct pass breast secretions to?

A

lactiferous duct

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12
Q

what cells make up the nipple?

A

highly pigmented keratinised stratified squamous epitheijm

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13
Q

what is the function of sebaceous glands near the margins of a nipple?

A

to produce sebum to counteract chaffing (which can be caused by suckling)

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14
Q

what is the function of smooth muscle cells within the nipple?

A

nipple erection

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15
Q

what is the function of the lactiferous sinus?

A

acts as a small milk reseroir

-so baby gets milk instantly as it begins suckling

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16
Q

what kind of secretion do sebaceous glands use?

A

holocrine secretion

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17
Q

what is holocrine secretion?

A

the cells themselves undergo apoptosis and their cell contents (containing the section) are spilled out of the gland

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18
Q

why are sebaceous glands on the nipple different to normal sebaceous glands?

A

usually sebaceous glands secrete onto hair follicles

in the nipple the secretions are directly let out onto the skin surface

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19
Q

lipids are secreted into breast milk via which mechanism?

A

apocrine secretion

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20
Q

what is apocrine secretion?

A

secretory product is in a vesicle which is taken up to the cell membrane and then pinched off

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21
Q

proteins are secreted into breast milk via which mechanism?

A

merocrine secretion

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22
Q

what is merocrine secretion (exocytosis)?

A

secretory product is in a vesicle, this vesicle fuses with cell membrane and the vesicle is released

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23
Q

what is the main difference between apocrine and merocrine secretion?

A

apocrine - secretory vesicle contains some cytoplasm

merocrine - no cyoplasm

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24
Q

what happens to the secretory cells, ducts, and connective tissue in the breast following menopause?

A

secretory cells degenerate
ducts system remain
in connective tissue there is reduced collagen and elastin

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25
Q

what is the triple assessment which is done at the one-stop clinic?

A
  1. clinical (history + exam)
  2. imaging (US, mammography, MRI)
  3. pathology (ie fine needle aspirate, core biopsy)
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26
Q

what are the 5 results of an FNA?

A 
C1- unsatisfactory
C2- benign
C3- atypia but probably benign
C4- suspicious of malignancy
C5- malignant
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27
Q

what are the main disadvantages of FNA for a possible breast malignancy?

A

can’t see whether the malignancy is invasive or not

can’t tell what type of tumour it is

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28
Q

what are the 2 therapeutic surgical options for breast cancer?

A

wide local excision

mastectomy

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29
Q

what is a mastectomy?

A

removal of all breast tissue

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30
Q

what are the 6 results of a needle core biopsy?

A 
B1- unsatisfacory 
B2- benign
B3- atypia but probs benign
B4- suspicious of malignancy
B5a- carcinoma in situ
B5b- invasive carcinoma
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31
Q

what are the 4 main developmental anomalies of the breast?

A

hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple

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32
Q

when does the presence of accessory breast tissue become more evident?

A

hormonal states (eg pregnancy)

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33
Q

where is the most common place for an accessory nipple?

A

inferomammary fold

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34
Q

what are the 5 main non-neoplastic, non-inflammatory causes of breast lumps?

A 
gynaecomastia
fibrocystic change
fibroadenoma
hamartoma
sclerosing lesions
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35
Q

what is accessory breast tissue?

A

normal breast tissue in an abnormal place (can be anywhere along the milk line, from axilla to vulva)

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36
Q

what are the 3 main inflammatory breast pathologies?

A

fat necrosis
duct ectasia
acute mastitis/abscess

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37
Q

what is gynaecomastia?

A

breast development in the male

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38
Q

do ducts or lobules develop in gynaecomastia?

A

ducts grow

no lobar development

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39
Q

what are the 4 most common causes of gynaecomastia?

A
  • exogenous or endogenous hormones
  • cannabis
  • prescription drugs
  • liver disease
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40
Q

what is the common factor for the causes of gynaecomastia?

A

the different causes all stimulate oestrogen receptors

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41
Q

what age group of women get fibrocystic change?

A

20-50 years old (majority 40-50)

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42
Q

what are the 3 main risk factors of fibrocystic change?

A

menstrual abnormalities
early menarche
late menopause

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43
Q

what are the main symptoms of fibrocystic change?

A

smooth discrete lumps

sudden, cyclical pain

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44
Q

what is a breast hamartoma?

A

a lesion of normal breast cell types but in abnormal proportions

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45
Q

what is the usual age range for fibroadenomas?

A

teens to late 20s

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46
Q

are fibroadenomas painful or painless?

A

painless

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47
Q

is fibrocystic change painful or painless?

A

can be painful

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48
Q

what benign breast condition does sclerosing adenosis commonly co-exist with?

A

fibrocystic change

49
Q

is sclerosing adnenosis painful or painless?

A

painful

50
Q

what is the usual age range for sclerosing adenosis?

A

20-70

51
Q

what are the main 2 causes of fat necrosis of the breast?

A

local trauma

anticoagulation therapy

52
Q

why can anticoagulation therapy cause fat necrosis of the breast?

A

minor trauma can cause bleeding and subsequent damage

53
Q

what happens to the breast following fat necrosis?

A

fibrosis and scarring (contraction)

54
Q

what ducts are affected in duct ectasia?

A

sub-areolar ducts

55
Q

what is a fistula?

A

a pathological connection between to epithelial surfaces

56
Q

what is the main risk factor for duct ectasia?

A

smoking

57
Q

why do nipple changes occur with duct ectasia?

A

periductal inflammation and fibrosis with subsequent scarring
(this causes distorion due to contraction of the tissue)

58
Q

what is the treatment of duct ectasia?

A

treat acute infections
stop smoking
excise ducts

59
Q

what are the 2 main types of organisms involved in duct ectasia?

A

mixed organisms

anaerobes

60
Q

what are the 2 main types of organims involved in acute mastitis? (due to lactation)

A

staph aureus

strep pyogenes

61
Q

what is the usual age group for a phyllodes tumour?

A

40-50 years old

62
Q

what are the 3 groups of phyllodes tumour?

A

benign
borderline
malignant (sarcomatous)

63
Q

what is the usual age group for an intraduct papilloma?

A

35- 40 years old

64
Q

what ducts are usually affected by an intraduct papilloma?

A

sub-areolar ducts

65
Q

what are the 4 main non-epithelial breast malignancies?

A

malignant phyllodes tumour
angiosarcoma
lymphoma
mets

66
Q

what are angiosarcomas of the breast most commonly secondary to?

A

radiotherapy for prev breast carcinoma

67
Q

what is a (breast) carcinoma?

A

a malignant tumour of (breast) epithelial cells

68
Q

what do breast carcinomas arise from?

A

glandular epithelim in the terminal duct lobular unit (TDLU)

69
Q

a breast carcinoma is actually what type of carcinoma?

A

adenocarcinoma

70
Q

what is an adenocarcinoma?

A

a malignant tumour of glandular epithelium

71
Q

what are the 2 main types of precursor lesions for breast carcinoma?

A

ductal precursor lesions

lobular precursor lesions

72
Q

an in-situ-carcinoma is confined within what structure?

A

basement membrane

73
Q

an in-situ-carcinoma is non-obligate precursor of invasive carcinoma, what does this mean?

A

some will progress to the invasive form, some will not

74
Q

describe the pathway from normal ductal breast tissue to invasive carcinoma?

A 
normal
epithelial hyperplasia of usual type
atypical ductal hyperplasia
ductal carcinoma in situ
invasive carcinoma
75
Q

what determines whether a lobar precursor for breast carcinoma is called an atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS)?

A

ALH- less than 50% of lobule involved

LCIS- more than 50% of lobule involved

76
Q

lobular in situ neoplasisa (ie lobular precursor for breast carcinoma) are usualy E-cadherin negative- how has this happened?

A

one CDH1 gene has been deleted

the other CDH1 gene has been mutated

77
Q

ductal carcinomas in situ are usually unicentric, what does this mean?

A

single duct system affected

78
Q

if a ductal carcinoma in situ involves the nipple, what is it called?

A

Pagets disease of the breast

79
Q

is paget’s disease of the nipple invasive or non-invasive?

A

non invasive

still classes as a ductal carcinoma in situ

80
Q

what is a ductal carcinoma in situ ‘comedo’?

A

an area of necrosis within the ductal carcinoma in situ

81
Q

why do we treat ductal carcinomas in situ aggressively now?

A

because they are a precurors lesion for invasive carcinoma

82
Q

what indicates that a carcinoma in situ has become an invasive carcinoma?

A

the basement membrane has been breached

83
Q

what is the most commonly diagnosed cancer for men and women in the UK?

A

men- prostate

women- breast

84
Q

what are the 6 main risk factors (or groups of risk factors) for carcinoma of the breast?

A
  • age
  • reproductive history
  • hormones (eg OCP, HRT)
  • previous breast disease
  • lifestyle
  • genetics
85
Q

what about the reproductive history increases breast cancer risk?

A

early menarche
late menopause
smaller time breast feeding
nulliparity/age over 35 before first child

86
Q

what about the lifestyle increases breast cancer risk?

A 
high BMI
low levels of physical activity
alcohol consumption
poor diet
smoking
87
Q

why does your risk of breast cancer increase as your BMI increases?

A

due to increased oestrgen levels (because of the conversion in fatty tissues)

88
Q

what is the sentinel node?

A

the first node that drains the tumour

89
Q

what are the 6 groups of axillary lymph nodes?

A 
anterior
posterior
infraclavicular
central
apical
lateral
90
Q

what happens to the amount of differentiation of the tumour as the grade gets higher?

A

as grade gets higher, differentiation gets poorer

91
Q

what is the single strongest predictor of prognosis of breast carcinoma?

A

lymph node status

92
Q

if the breast carcinoma expresses ER, what does this mean clinically?

A

it will respond to anti-oestrogen therapy

ER- oestrogen receptor

93
Q

what are the 4 anti-oestrogen therapies for ER positive breast carcinoma?

A

oophrectomy
tamoxifen
GnRH antagonists
aromatase inhibitors

94
Q

if the breast carcinoma expresses HER 2 what does this mean clinically?

A

it will respond to herceptin

human epidermal growth factor receptor 2

95
Q

are ER + and/or HER + breast carcinomasgood or bad prognostic indicators?

A

good prognostic indicators

96
Q

which is more common- breast carcinoma originating in the ducts or in the lobes?

A

ductal type (80%)

97
Q

what investigation is used for the definite diagnosis of breast cancer?

A

core needle biopsy

98
Q

what is modified radical mastectomy?

A

`removal of entire breast and axillary lymph nodes but with preservation of the pectorais major muscle

99
Q

what is the advantage of skin-sparing mastectomy?

A

peserves the overlying skin leading to a superior aesthetic outcome with breast reconstruction

100
Q

what is the most common benign neoplasm of the breast?

A

fibroadenoma

101
Q

when during the menstrual cycle is cyclic mastalgia most painful?

A

just before menstruation

102
Q

what is the diagnosis and treatment of a cyst?

A

fine needle aspiration

103
Q

why must you palpate the area of a cyst after aspiration?

A

to be certain there is no residual mass

104
Q

what is the most common cause of spontaneous nipple discharge?

A

an intraductal papilloma or papillomas

105
Q

why should all intraductal lesions be excised even though they are benign?

A

so they can be histologically evaluated to ensure they arent an intraductal carcinoma

106
Q

how does pagets disease of the nipple usually present?

A

dry and scaly eczematous lesion

a weeping lesion on the surface of the nipple and areola

107
Q

what is the treatment of mastitis?

A

antibiotics (flucloxacillin) as soon as suspected

108
Q

what is the treatment of a breast abscess?

A

repeated aspirations

if not working- open surgical drainage under GA

plus antibiotics

109
Q

what is fat necrosis usually secondary to?

A

breast trauma

110
Q

what is a galactocoele?

A

a palpable milk-filled cyst

111
Q

how do you diagnose and treat galactocoeles?

A

FNA

112
Q

what is mondor’s disease?

A

phlebitis with subsequent clot formation in the superficial veins of the breast

113
Q

what is mondor’s disease usually associated with?

A

history of trauma to the breast, eg surgery

114
Q

what is the treatment of mondors disease?

A

will resolve spontaneosly in 8-12 weeks

115
Q

to ensure the same overall survival rates as mastectomy, what is needed in addition to breast conservation surgery?

A

clear margins greater than 1mm

breast radiotherapy

116
Q

what is oncoplastic surgery?

A

safe oncological surgery while avoiding tissue deformity

-breast contours reshaped at time of cancer resection

117
Q

what ribs is the breast base over?

A

2-6

118
Q

what fascia is the breast enclosed with?

A

superficial fascia

119
Q

what imaging is used to look at breast lumps in a patient under 40 compared to over 40?

A

under 40: US

over 40: mammography +/- US

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