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Y3 Breast > Malignant Breast Conditions > Flashcards

Malignant Breast Conditions Flashcards

1
Q

what is a breast carcinoma in situ?

A

malignancy that is contained within the basement membrane

seen as a pre-malignant condition

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2
Q

what are the two types of breast carcinoma in situ?

A

ductal carcinoma in situ

lobular carcinoma in situ

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3
Q

what is the most common type of non-invasive breast malignancy?

A

ductal carcinoma in situ

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4
Q

what is ductal carcinoma in situ?

A

malignancy of the ductal tissue of the breast that is contained within the basement membrane

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5
Q

why ducts DCIS be treated?

A

will develop into invasive disease if not treated in about 1/3rd of patients

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6
Q

how is DCIS usually diagnosed?

A

screening mammogram

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7
Q

which investigation usually picks up DCIS? what does it show?

A

mammogram
micro calcifications that are either localised or widespread
then confirmed on biopsy

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8
Q

what is the management of DCIS?

A
  • localised DCIS -> complete wide excision

- widespread or multifocal DCIS -> complete mastectomy

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9
Q

what is lobular carcinoma in situ?

A

malignancy of the secretory lobules of the breast that is contained within the basement membrane

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10
Q

what are individuals with LCIS more at risk of?

A

developing invasive breast malignancy

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11
Q

how does LCIS usually present?

A
  • usually asymptomatic

- usually diagnosed as an incidental finding on biopsy (not associated with microcalcifications)

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12
Q

what is the management of LCIS?

A
  • low grade LCIS is usually monitored rather than excised

- bilateral prophylactic mastectomy can be performed if the individual has BRCA1/2 genes

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13
Q

what are the three classes of invasive carcinoma?

A
  • invasive ductal carcinoma
  • invasive lobbular carcinoma
  • other subtypes, such as medullary carcinoma or colloid carcinoma (IDCs)
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14
Q

what is the most. common type of invasive breast cancer?

A

invasive ductal carcinoma

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15
Q

where do most breast carcinomas arise?

A

in the terminal duct lobular unit

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16
Q

which age group is most commonly affected by invasive lobular carcinoma?

A

older women

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17
Q

what are the clinical features of invasive breast carcinoma?

A
  • can present asymptomatically via screening
  • breast lump
  • asymmetry
  • swelling
  • abnormal nipple discharge
  • nipple retraction
  • skin changes
  • mastalgia
  • palpable lump in the axilla
18
Q

what is the differential diagnosis for all suspected breast cancers?

A
  • benign tumours
  • breast cysts
  • infective causes
19
Q

what are the investigations for diagnosing invasive breast cancer?

A
  • Triple assessment

examination, imaging, histology or cytology

20
Q

what is the most important prognostic factor in breast cancer?

A
  • nodal status

- size, grade and receptor status also influences prognosis

21
Q

how is the prognosis of primary breast cancer calculated?

A

Nottingham prognostic index

22
Q

what is the classification used to classify the grade of breast carcinoma?

A

bloom-richardson classification

23
Q

the status of which receptors are check in women with breast malignancy?

A
  • oestrogen receptor (ER)
  • progesterone receptor (PR)
  • Human Epidermal growth factor Receptor (HER2)
24
Q

what is the age of women who receive breast screening in the UK? how does it work?

A

50-70 yrs

mammogram every 3 years

25
Q

what are the risk factors for developing breast cancer?

A
  • female sex
  • older age
  • mutations to certain genes - BRCA1/2
  • first degree relative
  • previous benign disease
  • obesity
  • alcohol consumption
  • longer exposure to unopposed oestrogen (early menarche, late menopause, nulliparous, late first pregnancy, oral contraceptives/HRT)
26
Q

what is Paget’s disease of the nipple?

A

rare condition of the nipple - involvement of the epidermic by malignant ductal carcinoma cells

27
Q

what is Paget’s disease of the nipple associated with?

A
  • most patient’s with Paget’s disease will also have an underlying neoplasm
28
Q

what is the clinical presentation of Paget’s disease of the nipple?

A
  • itching/redness in the nipple/areola
  • thickening and flaking of the skin on or around the nipple
  • roughened and slightly ulcerated nipple
  • area is painful and sensitive
  • flattened nipple
  • +/- yellowish or bloody discharge
29
Q

what is the differential diagnosis for Paget’s disease of the nipple?

A

dermatitis or eczema

30
Q

how can Paget’s disease be differentiated from eczema?

A

paget’s always affects the nipple first and then the areola as a secondary event
eczema nearly always involves the areola and spares the nipple

31
Q

what investigations are carried out when suspecting Paget’s disease of the nipple?

A
  • biopsy
  • full examination of the breast and axilla
  • mammograms, US or MRI breast
32
Q

what is the management of Paget’s disease of the nipple?

A

surgery

  • nipple and areola removed
  • if underlying malignancy, this will also be removed
  • if there is underlying breast cancer, may also need radiotherapy
33
Q

what are the different surgical options used to treat breast cancer?

A
  • breast conserving surgery
  • mastectomy
  • axillary surgery
34
Q

when is breast conserving surgery indicated?

A

small, localised tumours that are operable with no evidence of metastatic disease

35
Q

what is the most common form of breast conserving surgery?

A

wide local excision

- excision of tumour with 1cm margin of macroscopically normal tissue

36
Q

when is a mastectomy indicated?

A
  • multifocal disease
  • high tumour:breast tissue ratio
  • disease recurrence
  • patient choice (reducing risk)
37
Q

what is a sentinel node biopsy?

A

removal of the first lymph nodes into which the tumour drains

38
Q

what happens after the sentinel nodes are biopsied?

A

histologically analysed

39
Q

what is axillary node clearance?

A

removing all nodes in the axilla and sending them for histological analysis

40
Q

what are the possible common complications of axillary node clearance?.

A
  • paraesthesia
  • seroma formation (pocket of serous fluff)
  • lymphoedema in the upper limb

Y3 Breast (2 decks)

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