Lump

Question 1

Skin

Answer 1

Tethering - lump attached to skin, but can be moved in arc without moving skin (if pulled outside arc, the skin indents)

Fixation - lump cannot be moved without moving skin

Question 2

Worrying features on ultrasound

Answer 2

Irregular shape
Ill-defined margin
Invades across normal tissue planes where benign masses tend to push them out of the way

Question 3

Axillary nodes

Answer 3

ASSESSMENT ESSENTIAL - very important prognostic factor

Important for planning management - sentinel node biopsy / axillary node clearance

Question 4

Sentinel Node Biopsy

Answer 4

First lymphatic node to collect cancer - can be one or more found on biopsy

Sentinel node biopsy is a surgical procedure that identifies and removes the sentinel nodes - sent to pathology for analysis and staging of the cancer (results in 1 week)

Question 5

Ultrasound > stereotactic

Answer 5

No ionising radiation involved
The patient is less likely to faint
Biopsy needle can be seen in real time - satisfactory targeting

Local anaesthetic needed for both

Question 6

Grading - how aggressive the cancer is

Answer 6

1. The amount of gland formation
2. The nuclear structures
3. The mitotic features

ER positive? PR positive? HER2 positive?

Question 7

Tx

Answer 7

ER and PR expression - endocrine therapy e.g. tamoxifen

HER2 overexpression - anthracycline and taxane-based chemotherapies and directed therapies that will target HER2 (trastuzamab) but no endocrine based therapies

Question 8

Types

Answer 8

Invasive ductal carcinoma - most common

Invasive lobular carcinoma - second most common. Can be difficult to detect. May present as thickening rather than lump. Patients need MRI.

Question 9

Fibroadenoma - composed of both stromal and epithelial components

Answer 9

Most common benign lump
USS - solid mass, ovoid shape, well-defined margin

*For suspected fibroadenomas in patients under 25 a biopsy need not be performed if the clinical and ultrasound features and benign.

Question 10

Fibroadenoma tx

Answer 10

No tx

Excision if 4cm, growing, patient request

(Generally stay the same size however may change size in teenage girls / pregnancy. Postmenopausal women - ‘popcorn calcification’

Question 11

Breast Cysts

Answer 11

Benign and therefor do not need tx

Aspirate if symptomatic - can be many different colours. If blood stained - cytology.

Cysts do not turn into cancer

Safetynet