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ESA 4 - Repro > Session 11 - The breast > Flashcards

Session 11 - The breast Flashcards

1
Q
A
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2
Q

What does each lobule of the breast contain?

A

Alveoli, blood vessels and lactiferous ducts

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3
Q

What is responsible for milk let down?

A

myoepithelial cells

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4
Q

How much colostrum is secreted per day in the first week?

A

40 ml/day

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5
Q

What is the purpose of collustrum?

A

Provides protein, and immunoglobins for passive immunity

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6
Q

How long is mature milk produced post birth?

A

As long as the baby suckles

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7
Q

Name the 2 proteins found in mature milk

A

lactoglobulin and lactalbumin

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8
Q

Where does the synthesis of milk take place?

A

in the alveolar cells

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9
Q

Describe how breast tissue develops from bith to pregnancy

A

Birth - few lactiferous ducts only

Puberty - more oestrogen = more ducts and forming of alveoli

Pregnancy - high progesterone:oestrogen ratio develops alveoli more, hypertrophy of ductular-lobular-alveolar system and prominent lobules form. Alveolar cells differentiate to be able to produce milk in mid gestation.

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10
Q

What is the purpose of suckling?

A

Initiates and maintains secretion by a neuro-endocrine reflex by mechanically stimulating receptors in nipple.

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11
Q

What happens at birth to levels of hormones? What hormone does the breast become responsive to?

A

Oestrogen and progesterone fall

Breast becomes responsive to prolactin

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12
Q

Describe how suckling promotes release of milk

A

Mechanical stimulation results in impulses travelling to hypothalamus and reducing secretion of dopamine and vaso-active intestinal peptide, promoting prolactin secretion.

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13
Q

Describe the hormonal control of milk let down. How does this hormone release milk and what other important function does it have?

A

Let down caused by increase in secretion of oxytocin.

Oxytocin contracts myoepithelial cells surrounding alveoli, ejecting milk. Also keeps uterus clamped down on open placenta blood vessels

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14
Q

How does cessation of lactation occur?

A

If suckling stops, prolactin levels decrease. Also milk in breast builds up and causes turgor induced damage to ducts.

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15
Q

What happens to breast tissue as women get older? why is this good for mammograms?

A

Interlobular stroma replaced by adipose tissue. Mammograms easier to interpret

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16
Q

Where can 3rd nipples occur?

A

Along the milk line

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17
Q

What characteristics of pain in the breast suggest pathology? What could it be?

A

Non-cyclical and focal. Could be ruptured cysts, injury or inflammation

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18
Q

What are worrying features of a palpable mass? Would could it be?

A

If hard, craggy, and fixed. COuld be invasive carcinomas, fibroadenomas, cysts

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19
Q

When is nipple discharge concerning? What could it be?

A

If occurs spontaneously and unilateral

Could be pituitary adenoma or side effect of OCP

20
Q

During what ages and when are women invited for breast screening?

A

50-70 every 3 years

21
Q

What age do fibroadenomas occur most often>

A

<30

22
Q

what age do phyllodes tumours most likely occur?

A

60s

23
Q

What age does breast cancer most likely occur?

A

rare before 25, inidence increases with age.

77% occurs in women >50

24
Q

What organism causes acute mastitis?

A

Staphylococcus aureus

25
Q

What is acute mastitis? How is it treated?

A

Occurs during lactation due to nipple cracks and fissures. painful breast and often fevers. May be breast abscesses.

Treated by expressing milk and antibiotics.

26
Q

What is duct ectasia?

A

dilation and inflammation of lactiferous duct. May have peri-areolar mass and/or nipple discharge

27
Q

What can gynaecomastia indicate?

A

hormonal abormalities, cirrhosis of liver (oestrogen not broken down), fat people (adipocytes convert androgens to oestrogen), testicular tumour, drug use.

28
Q

Describe the histology of a fibrocystic change in the breast

A

cyst formation, fibrosis, apocrine metaplasia

29
Q

What is epithelial hyperplasia?

A

Epithelial cells get bigger and fill and distend ducts and lobules

30
Q

How might a papilloma of the breast present?

A

nipple discharge (may be bloody), or small palpable mass

31
Q

Describe the histology of a papilloma

A

Intraduct lesion consisting of multiple branching fibrovascular cores covered by myoepithelial and epithelial cells

32
Q

how would you identifty a fibroadenoma on inspection?

A

well defined boundaries, mobile mass

33
Q

What are phyllodes tumours?

A

stromal tumours

34
Q

How do phyllodes tumours present histologically?

A

nodules of proliferating stroma covered by epithelium. Stroma is more cellular and atypical than in fibroadenomas

35
Q

Is phyllodes tumours malignant or benign?

A

can be either

36
Q

Why does long interval between menarche and menopause, or reproductive history increase risk of breast cancer?

A

longer exposure to oestrogen

37
Q

How can you classify breast carcinomas?

A

in situ or invasive. Ductal or lobular.

38
Q

What is an in situ carcinoma? Is it malignant?

A

Neoplasm limited to ducts and lobules by basement membrane

Cannot metastise.

39
Q

What is an invasive carcinoma?

A

Carcinoma invaded beyond the basement membrane into the stroma.

40
Q

If a breast cancer is palpable, what does that mean?

A

More than half of patients will have axillary lymph node metastases

41
Q

Which lymph nodes are breast cancers most likely to spread to?

A

lymph nodes on ipsilateral axilla

42
Q

What factors determine breast cancer prognosis?

A

in situ disease or invasive carcinoma

Histological subtype - invasive ductal carcinoma, no specific type has poorer prognosis

Tumour grade

Tumour stage - TMN

43
Q

What is the triple approach to investigating and diagnosing breast cancer?

A

Clinical - history, exam, and genetics

Radiographic imaging - mammogram, USS

Pathology - Fine needle aspiration cytology and core biopsy

44
Q

When is tamoxifen effective for breast cancers?

A

when there is a high amount of oestrogen receptors found on cancer

45
Q

When is herceptin an effective treatment for cancers?

A

If there is a large amount of Her2 receptors found

46
Q

What surgeries can benefit a breast cancer patient?

A

Mastectomy or breast conserving surgery

Axillary surgery if cancer has spread

47
Q
A

ESA 4 - Repro (15 decks)

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