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Breast - YR3 > Malignant breast disease > Flashcards

Malignant breast disease Flashcards

1
Q

What is breast carcinoma in situ?

A
  • Contained within breast ducts - have not spread to surrounding breast tissue so not invaded basement membrane eg LCIS and DCIS
  • Rarely symptomatic
  • Precursor to invasive breast cancer
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2
Q

Most common type of non-invasive breast malignancy and types

A
  • DCIS
  • Malignancy of ductal tissue
  • Five major types - comedo, cribiform, micropapillary, papillary, solid types, mixed (most).
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3
Q

How is DCIS often detected?

A

Via screening - microcaclifications on mammogram
Then confirmed via biopsy

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4
Q

Management DCIS

A
  • Surgical excision - breast conserving surgery (wide local excision)
  • Or if multifocal - mastectomy
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5
Q

LCIS - what is it

A
  • Non-invasive lesion of secretory lobules
  • Contained within BM
  • Rarer than DCIS but greater risk of developing invasive breast malignancy
  • Usually pre-menopausal women
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6
Q

How is LCIS often diagnosed?

A
  • Not associated with microcalfications
  • Asymptomatic
  • Usually incidental on biopsy
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7
Q

Management LCIS

A
  • Depends on extent
  • Low grade - monitor rather than excise
  • Less associated with axillary node mets compared with DCIS
  • But does increase risk of later developing invasive breast cancer in either breast
  • Bilateral prophylactic mastectomy can be needed if BRCA1 or 2
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8
Q

Invasive carcinoma types

A
  • Invasive ductal (70-80%)
  • Invasive lobular (5-10%)
  • Others - medullary, micropapillary, metaplastic
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9
Q

IDC appearance vs ILC on microscope

A
  • IDC - nests and cords of tumour cells
  • ILC - diffuse stromal pattern of spread, detection more difficult, can be large by diagnosis time
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10
Q

Nottingham prognostic index formula

A

(Size x 0.2) + nodal status + grade
Nodes = number of axillary nodes involved:
* 0 nodes = 1, 1-4 nodes = 2, more 4 nodes = 3
* Grade based on Bloom-Richardson classification

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11
Q

What influences breast cancer prognosis?

A
  • Nodal status
  • Size
  • Grade
  • Receptor status
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12
Q

What is Pagets disease of the nipple?

A
  • Rare
  • Persistent roughening, ulcerating or eczematous change to nipple
  • 85-88% have underlying neoplasm either in-situ or invasive
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13
Q

Microscope appearance of Pagets disease of nipple

A
  • Involvement of nipple epidermis by malignant intraepithelial adenocarcinoma cells
  • Unknown pathophys but maybe malignant cells migrate from ducts to nipple surface or nipple becomes malignant
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14
Q

Symptoms of Pagets disease of nipple

A
  • Itching or redness in nipple +/- areola
  • Flaking and thickened skin on or around nipple
  • Sensitive and painful
  • Flattened nipple +/- yellow or bloody discharge can also be present
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15
Q

How can Pagets disease be differentiated from eczema?

A
  • Eczema involves areola and spares nipple
  • Pagets involves nipple and secondary involves areola
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16
Q

Investigations for Paget disease nipple

A
  • Triple assessment
  • Breast and axilla exam, mammogram US or breast MRI
  • Then biopsy
17
Q

Management Pagets disease of nipple

A
  • Surgery - nipple and areola removed
  • If associated with underlying malignancy - radiotherapy
18
Q

How does Herceptin work?

A
  • Type of immunotherapy - monoclonal antibody (Trastuzumab)
  • Binds to Her-2 receptor and halts cell cycle
  • Can induce immune response against bound tumour cell
19
Q

When is chemotherapy more beneficial?

A
  • Younger patients
  • Larger tumours
  • High grade disease
  • Local or distant spread
  • ER+ tumours gain little or NO benefit at all
20
Q

How to decide to give chemo?

A
  • Benefit balanced with toxicity
  • Gene expression assays - determine risk of recurrence, use if benefit is otherwise indeterminate
21
Q

What must often be done prior to breast surgery as cancers are often clinically non-palpable?

A
  • Localise - allow target excision
  • Can be done via image guided guidewire or magseed insertion
22
Q

When is risk reducing mastectomy potentially beneficial?

IE removing healthy breast tissue

A
  • Need counselling to discuss risks and benefits
    Patients with higher risks inc:
  • Strong FH breast/ovarian cancer
  • Testing +ve for genetic mutations eg BRCA1/2, PTEN, TP53
  • Previous breast cancer
23
Q

What is injected into breast to identify sentinal node?

A
  • Technetium 99 nanocolloid = gamma emitting radioisotope - identify using gamma probe
  • Blue dye
  • Solutions containing superparamagnetic iron oxide particles - identify using probe
24
Q

Important structures that can be harmed during axillary surgery

A
  • Axillary vein
  • Thoracodorsal pedicle (thoracodorsal nerve, artery and vein)
  • Long thoracic nerve - serratus anterior muscle, winging of scapula if damaged

Breast - YR3 (7 decks)

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