Clinical Topic 11: Breast Disease Flashcards
Where do accessory nipples and accessory breasts commonly develop?
Along the milk line
Accessory nipples: Below the breast
Accessory breasts: Axilla
Breast Cyst: How common is it? What age can it occur? Does it change with anything? How does it feel? How is it treated?
- Most common cause of breast mass
- Occur any age, but uncommon post-menopausal
- Can fluctuate with menstrual cycle
- Well demarcated, firm and mobile
- Treated by Aspiration
Fibroadenoma How common is it? What age can it occur? Does it change with anything? How does it feel? How is it treated?
- 2nd most common cause of breast mass
- Occur from age 15-35 years old
- Changes with pregnancy and oestrogen therapy
- Feels like a breast mouse
- Treated by Excision if >3cm,
What are the three types of Fibroadenomas?
Simple, Giant (>10cm), Juvenile
Phylloides tumour: Size? Growth? What age can it occur? Do they have metastatic potential? How is it treated?
- A large fast growing tumour
- Common in ages 40-50 years old
- 25% are malignant, 10% are metastatic
- Treated by WIDE EXCISION
Fat Necrosis:
What is caused by?
How does it look and feel?
How is it treated?
- Caused by trauma
- Tender, ill-defined with skin retraction
- Treated by biopsy and clinical follow up
Galactocele:
What is it?
Where are the commonly found?
How is it treated?
- Milk filled cysts caused by lactiferous duct distention
- Commonly found in upper quadrant above Areola
- Treated by aspiration
Duct Ectasia: What is it? How common is it? What symptoms are classic? How is it treated?
- Blockage of Lactiferous ducts
- Common in older women
- Green-brown nipple discharge are classic
- Treated by biopsy / excision
Gynaecomastia: What is it? What is pseudogynaecomastia How common is it? What is caused by? How is it treated?
- Benign growth of glandular tissue of male breast
- Common in infancy, adolescence, adulthood
- Pseudogynaecomastia in obese individuals
- Caused by imbalance of oestrogen / androgens
- Treated by treating underlying cause, Tamoxifen, or surgery
What are red flags of nipple discharge?
If it is unilateral, spontaneous or bloody (think Intraduct Papilloma, DCIS, invasive cancer)
Mastitis: How common is it? What is caused by? What are the symptoms? How is it treated?
- Common in lactating female
- Caused by staph / streptococcus
- Dry, cracked areola, erythematous breast, breast pain
- Treated by heat, continuing breast feeding, ABX for 10-14 days
Breast Abscess:
What are the symptoms?
How is it treated?
- Breast swelling, tenderness, fever, purulent discharge
- Treated by USS guided aspiration and ABX
What are some risk factors for Breast Cancer?
- Increasing age
- Family History - BRCA1, BRCA2, TP53, ERBB2
- Duration of Oestrogen exposure (endo / exogenous)
- Early periods, late menopause
- Lack of breast-feeding
- HRT (doubled risk after 10 years)
- Obesity
- Alcohol
- Ionising radiation
What kind of mutations of BRCA1 and BRCA2?
Autosomonal dominant
What is Fibroadenosis? When is it most common?
‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation
Most common in middle-aged women
What are the three major types of breast cancer based on Hormone Receptors? Which is most common?
ER+ / HER2- (most common)
ER- / HER2-
HER2+ / ER+ or ER-
Outline Breast Cancer Screening
- Offered to all women aged 50-70 (47-73 in some areas)
- Women over 70 are encouraged to make own appointments
- Mammography every 3 years
What conditions present with:
- Green nipple discharge
- Blood stained nipple discharge
- Duct ectasia
- Duct papilloma
What does a “snowstorm” sign suggest on ultrasound?
Extra-capsular rupture of breast implant
What is the TNM staging for breast cancer?
T0: No evidence of primary T1: <2cm T2: 2-5cm T3: >5cm T4: Extension into chest wall, skin, or is inflammatory
N0: No nodal involvement
N1: Mobile nodes
N2: Fixed, matted nodes
N3: Internal mammary nodes
M0: No metastasis
M1: Metastasis
What are the “No Special Type” and “Special Type” breast cancers?
No Special Type:
- Invasive ductal carcinoma
Special Type:
- Invasive lobar carcinoma
- DCIS
- LCIS
What is the most common breast cancer?
Invasive Ductal Carcinoma
How is Paget’s Disease different to Nipple Eczema?
In Paget’s disease, nipple affected first -> then areola
In Nipple Eczema, areola affected first -> then nipple
Why might a patient have a Mastectomy over a Wide Local Excision?
- Multifocal tumour
- Central tumour
- Large lesion
- DCIS >4cm
Why might a patient a Wide Local Excision instead of a Mastectomy?
- Solitary tumour
- Peripheral tumour
- Small lesion
- DCIS <4cm
What are the recommendations for Radiotherapy in patients with Breast Cancer?
If Wide Local Excision -> offer radiotherapy
If Mastectomy -> offer radiotherapy if T3/T4, or 4 or greater lymph node involvement
What are the recommendations for Hormonal (Oestrogen) therapy in patients with Breast Cancer?
If ER+ and pre/peri menopausal -> Tamoxifen
If ER+ and post-menopausal -> Aromatase
What are the recommendations for Biological therapy in patients with Breast Cancer?
Only if HER2+
Trastuzumab (only if they do not have heart conditions)
What are the adverse side-effects of Tamoxifen?
Increased risk of endometrial cancer, VTE, menopausal symptoms
What screening tool is used to assess Prognosis of Breast Cancer?
Nottingham Prognostic Index
If hormonal therapy is indicated following surgery for breast cancer, how long should Tamoxifen be given for?
5 years
What are the recommendations for Chemotherapy in patients with Breast Cancer?
If node involvement -> FEC-D chemotherapy
If no node involvement -> FEC chemotherapy
If Herceptin is being given as adjuvant treatment for breast cancer, how long should it be given for?
Every 3 weeks for 1 year
Radiotherapy following surgery for breast cancer is usually given for how long?
5 days a week for 3 weeks
Mutations in a BRCA gene are responsible for what percentage of all breast cancers?
2%
Lobar in situ neoplasmas are commonly _focal, _lateral, and _crease after menopause
Multi-focal, bilateral and decrease after menopause
Hot flushes, moodswings, fatigue and headache are all side effects of which therapy for breast cancer?
Tamoxifen
Following discharge from oncology and surgical services after breast cancer treatment, patients should receive yearly mammograms for how long?
For 3 years. After 3 years, re-join National Breast Screening Programme
Intraductal papilloma produces what coloured discharge? Does it come from one duct, or multiple ducts?
Clear or bloody discharge
One duct
Periductal mastitis is common in which group of patients specifically?
Smokers
What is the “halo sign” on a mammogram associated with?
Breast Cyst
