Fibroadenoma PBL

Question 1

What are the two main types of mutation?

Answer 1

Point mutations - change in a single base pair
Block mutations - change in a segment of base pairs

Question 2

What are the types of point mutations? (4)

Answer 2

Substitution
Insertion
Deletion
Inversion

Question 3

What are the types of block mutations? (5)

Answer 3

Duplication
Inversion
Deletion
Insertion
Translocation

Question 4

What are the different mutation types? (that relate to the different outcomes of coding)

Answer 4

Missense - point substitution, produces a different amino acid than normal, protein have altered properties or non-functional
Silent - point substitution, does not code for a different amino acid
Nonsense - point substitution, codes for stop codon, premature termination of protein = non-functional or impaired function normally

Question 5

How does the breast change in pregnancy?

Answer 5

Growth
Increase in oestrogen and progesterone - ductal proliferation, glandular tissue invades adipose
Increase in vascularity and blood flow
Greatest growth in first 22 weeks
Tenderness
Enlarged and darker nipple and areola

Question 6

How does the breast change during breastfeeding?

Answer 6

Enlarged
Conversion from proliferative to secretory
Oxytocin released from nipple stimulation from baby maintains lactation
Increased firmness

Question 7

How does the breast change during the menstrual cycle?

Answer 7

Swelling, pain and soreness
Lumps from enlarged glands
Oestrogen increases before ovulation - lactiferous ducts and glands to grow
Progesterone increases after ovulation - ducts and glands grow

Question 8

What are controllable risk factors for breast cancer? (5)

Answer 8

Obesity -
mainly adipose tissue produces oestrogen post menopause. Oestrogen can encourage breast cancer growth in O receptor positive cells
Alcohol -
Toxic metabolites of alcohol can damage DNA.
Alc increases Oes levels
Alc increases risk of hormone receptor positive breast cancer
Hormonal contraception - increased O and P
HRT - increased O and P
Inactivity - exercise limits insulin growth factor levels in blood. increase in adipose, increases oestrogen

Question 9

What are uncontrollable risk factors for breast cancer?

Answer 9

Family history/inheritance - faulty BRCA 1 and/or 2 gene (TSGs)
Radiation - women with faulty BRCA1/2 who had chest xray before 30 more likely to develop BC than those who don’t
Breast density - higher density higher risk - more breast cells less fat
Age of periods - Increased risk if started period early before 12 yr. Increased risk if late menopause after 55yr. Longer exposure to oestrogen
Previous cancer
No children or late children - lower risk in women who have had kids. lower risk the earier you’ve had kids

Question 10

What is the chance of developing BC if inherited the harmful BRCA 1 and BRCA2 genes?

Answer 10

Harmful BRCA1 - 55-72% women will develop BC
Harmful BRCA2 - 45-69% women will develop BC

Question 11

What is the most common type of benign breast tumour?

Answer 11

Fibroadenoma

Question 12

What is DCIS?

Answer 12

Ductal carcinoma in situ
Abnormal cells in lining of breast duct
Not invasive or pre-invasive

Question 13

What is stage 0 breast cancer?

Answer 13

Breast carcinoma in situ non-invasive breast cancer
Abnormal cells in breast tissue two types:
DCIS and paget disease

Question 14

What is Paget disease?

Answer 14

Abnormal cells in the skin of the nipple, may spread to areola
Eczema like changes to the skin

Question 15

What is stage 1 breast cancer?

Answer 15

Very early stage of invasive cancer
Small, localised to breast tissue
Two subgroups: 1A - up to 20mm no cancer in LN
1B - less than 20mm and small clusters cancer cells in LN OR no tumour in breast and small clusters cancer cells in LN

Question 16

What is stage 2 breast cancer?

Answer 16

Cancer in limited region of breast
IIA - tumour up to 20mm and spread to axillary LN OR tumour 20-50mm but no spread to ax LN
IIB - tumour 20-50mm and spread to LN OR tumour larger than 50mm but not spread to LN

Question 17

What is stage 3 breast cancer?

Answer 17

Spread further through breast or larger than earlier stages
IIIA - with/without tumour in breast, cancer in 4-9 LN OR tumour larger than 50mm and spread to 1-3 LN
IIIB - spread to behind chest wall behind breast and/or to skin
IIIC - tumour any size in breast OR no tumour but spread to 10+ ax LN

Question 18

What is stage 4 breast cancer?

Answer 18

Most advanced stage
Spread to nearby LN and distant part of body beyond breast

Question 19

What are carcinomas and adenocarcinomas?

Answer 19

Carcinomas: tumours that start in the eptithelial cells
Adenocarcinoma: specific to the breast, tumours in the cells in the ducts or lobules

Question 20

What is the difference between in situ and invasive breast cancer?

Answer 20

In situ: pre-cancer that starts in the milk duct and not spread to the rest of the breast
Invasive: any cancer that has spread to the surround breast tissue

Question 21

What is the most common breast cancer?

Answer 21

Invasive ductal carcinoma - 70-80%

Question 22

What is triple negative breast cancer?

Answer 22

Aggressive invasive breast cancer
Cancer cells don’t have Oestrogen or Progesterone receptors (ER and PR) and don’t make (or very little) HER2 protein
They test negative on all three tests

Question 23

What is inflammatory breast cancer? Prevalence?

Answer 23

1-5% breast cancer
Cancer cells block lymph vessels to the skin, causing inflammation

Question 24

What are the referral pathways and timescales?

Answer 24

GP performs clinical breast exam
Patient referred to breast clinic for further examination
Non-urgent referrals: 4-6 weeks
Urgent referrals: 2 weeks

Question 25

What are the types of screening for breast cancer?

Answer 25

Mammogram (breast x-ray): before lumps can be palpated or before symptom presentation
MRI: used alongside mammograms for women at high risk
US: more effective than mammogram for more dense breast tissue women <35

Question 26

What are the types of biopsy for breast lumps?

Answer 26

Fine needle aspiration:
only for palpable masses, less invasive than core needle biopsy, small chance of infection, only withdraws little fluid, gives limited information
Core needle biopsy:
preferred as extracts larger sample, shows tumour type and grade
Surgical biopsy:
excisional - entire mass removed
incisional - part of mass removed
used if inaccessible via needle biopsy

Question 27

What is the triple assessment consisted of for breast lump concerns?

Answer 27

Examination - clinical and physical (palpation)
Imaging - MRI, X-ray, US
Biopsies - fine needle aspiration, core needle biopsy, surigical

Question 28

What is fibroadenoma?

Answer 28

Round or ovoid, rubbery and moveable solid masses
Made up of glandular and stromal (connective) tissue
Three types:
Simple - most common 1-3 cm,
Complex - typically in older women, grow rapidly
Giant - very large, can cause breast asymmetry

Question 29

What is the prevelance of fibroadenomas?

Answer 29

Most prevalent in women age 14-35
High incidence in black women
Fibroadenoma makes up 33-50% of biopsies of benign breast disease.

Question 30

How may fibroadenomas be removed

Answer 30

Cryoablation - removal by freezing
Lumpectomy - lump is surgically removed

Question 31

Why may fibroadenomas need to be removed?

Answer 31

If there is concern over the lump
The lump is causing discomfort or pain