Session 7: Breast Cancer Flashcards
Physiological changes seen in breast tissue.
Prepubertal breast with a few lobules.
Menarche hits and there is an increase in lobules, increased volume of interlobular stroma.
During menstrual cycle after ovulation there is proliferation and stromal oedema. With menstruation there is a decrease in size of lobules.
In pregnancy there is an increase in size and number of lobules, there is a decrease in stroma, and there are secretory changes.
Physiological changes in increasing age of breast tissue.
Terminal duct lobular units decrease in number and size.
The interlobular stroma is replaced by adipose tissue.
How may breast conditions present?
Pain
Palpable mass
Nipple discharge
Skin changes
Lumpiness
Give examples of types of pain experience in breast conditions.
Cyclical or diffuse (most commonly physiological)
Non-cyclical and focal (might be a ruptured cyst, injury or inflammation)
Give examples of breast conditions that cause a palpable mass.
Normal nodularity
Invasive carcinomas
Fibroadenomas
Cysts
When are palpable breast mass most worrying?
When they are hard, craggy and fixed
What are the most worrying findings on mammographs?
Densities
Calcifications
What might densities suggest?
Invasive carcinomas
Fibroadenomas
Cysts
What might calcifications suggest?
Ductal carcinoma in situ (DCIS)
Benign changes
Women of which ages are invited to mammographic screening each year?
47-73 years of age
Most common benign breast tumour
Fibroadenoma
What kind of tumour is most common in <30 years?
Fibroadenomas
When are phyllodes tumours most present?
In 60s
They can be malignant
In which ages are breast cancer common?
Rare in young ages and especially younger than 25.
Incidence rises with age and 77% of all breast cancers occur in women >50 years
The average age of diagnosis is 64 years.
Explain acute mastitis.
Almost always occurs during lactation and is usually due to S. aureus infection from nipple crack and fissures.
The presentation is usually erythematous and painful, Patient is also pyrexic.
It may produce breast abscesses.
How is acute mastitis treated?
Expressing milk and antibiotics
What is fat necrosis in breast tissue?
An inflammatory condition which presents as a mass, skin changes or mammographic abnormality.
There is often a history of trauma or surgery.
It can mimic carcinoma both clinically and mammographically.
Explain fibrocystic change.
Benign epithelial lesions which are the most common breast lesions.
They may present as a mass or mammographic abnormality.
The mass often disappears after fine needle aspiration.
Can mimic carcinoma clinically and mammographically.
Histology of fibrocystic change.
Cyst formation
Fibrosis
Apocrine metaplasia
Give examples of stromal tumours.
Fibroadenoma
Phyllodes tumours
Lipoma
Leiomyoma
Hamartoma
Macroscopical features of fibroadenomas.
Present with a mass, usually mobile or mammographic abnormality.
Often called breast mouse as they are mobile and elusive.
Can be multiple and bilateral.
They might grow very large and replace most of the breast tissue.
They are well circumscribed, rubbery and greyish/white.
What is gynaecomastia?
Enlargement of male breast which can be either unilateral or bilateral.
What is gynaecomastia caused by?
Relative decrease in androgen effect or increase in oestrogen effect.
Can often be seen at pubery and in the elderly.
It can mimic breast cancer especially if it is unilateral.
However there is no increased risk of cancer.
What is the molecular classification of breast cancer?
Breast carcinoma can either be oestrogen receptor positive or oestrogen receptor negative.
If it is positive then you look at Her2 positive or negative.
If it is negative then you also look at Her2 positive or negative
There is a better prognosis of oestrogen receptor positive breast carcinoma.
