Lump Flashcards
Skin
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
Worrying features on ultrasound
Irregular shape
Ill-defined margin
Invades across normal tissue planes where benign masses tend to push them out of the way
Axillary nodes
ASSESSMENT ESSENTIAL - very important prognostic factor
Important for planning management - sentinel node biopsy / axillary node clearance
Sentinel Node Biopsy
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)
Ultrasound > stereotactic
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
Grading - how aggressive the cancer is
- The amount of gland formation
- The nuclear structures
- The mitotic features
ER positive? PR positive? HER2 positive?
Tx
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
Types
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.
Fibroadenoma - composed of both stromal and epithelial components
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.
Fibroadenoma tx
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’
Breast Cysts
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