Surgery - Breast Flashcards
What are the major types of benign breast lump?
Fibroadenosis/Fibrocystic Change
Fibroadenoma
Cysts
What is Fibroadenosis/Fibrocystic change?
Combination of localised fibrosis, inflammation, cyst formation, hormone driven breast pain
How does Fibroadenosis/Fibrocystic change present?
Between menarche/menopause
‘lumpy breasts’
cyclical pain/swelling
What is Fibroadenoma?
Benign overgrowth of one lobule of the breast, usually solitary
How does Fibroadenoma present?
25-35
Painless, or v. localised pain
Highly mobile, firm, smooth lumps that evade palpation
What are Breast Cysts?
Cavities lined by flattened epithelium derived from the ductal unit, filled with watery fluid
How do Breast Cysts present?
Perimenopausal women
Round symmetrical lumps, occasionally w/ pain
What is the most common type of breast cancer?
Invasive adenocarcinomas
- 90% invasive ductal carcinoma
- 5% invasive lobular carcinoma
- 5% lobular/ductal in-situ
What is the role of oestrogen receptors in breast cancer treatment?
Oestrogen receptor +ve or -ve
-+ve has a better prognosis
HER2 & progesterone receptors are therapeutic targets
How common is breast cancer?
Lifetime risk of 1 in 8
Incidence increases w/ age
5% related to BRCA1/2
40% detected on screening
What are the pathological consequences of breast cancer?
Paget’s disease of the nipple
Local spread
Lymphatic spread
Vascular spread
Describe Paget’s disease of the nipple
Spread of intra-ductal carcinoma leading to eczematous changes around nipple
Describe local spread
Into overlying skin –> tethering/nipple retraction
Intro pectoral mm –> deep fixation of tumour
Describe lymphatic spread
Can prevent lymphatic drainage –> Peau d’orange
Axillary/clavicular nodes commonly involved
Describe vascular spread
Distal dissemination commonly to bone, lung, ovaries
What are the risk factors for carcinoma of the breast?
Genetic factors (PH, FH, BRCA) make up 25% of risk Environmental factors make up 75% of risk -early menarche/late menopause -nulliparity (late age of first child) -not breast feeding -HRT -obesity -smoking
Describe the diagnosis of a breast lump
Triple assessment
- clinical examination
- breast imaging (USS + mammography if >35)
- cytology (FNAC if cystic, biopsy if solid)
How does a typical carcinoma appear on mammography?
Spiculated mass lesion with associated microcalcification
What is the drawback of FNAC cytology?
Cannot distinguish b/w in situ and invasive cancers
What is the advantage of core biopsies?
Tissue architecture preserved
Invasion and grading determined
How should fibroadenosis/fibrocystic change be managed?
Reassurance
Anti-inflammatories
Topical evening primrose oil
Hormone manipulation (COC)
How are fibroadenomas managed?
1/3 regress, 1/3 stay the same, 1/3 enlarge
- generally don’t require treatment
- remove if >4cm
How should breast cysts be managed?
Drain w/ USS guidance
-if fluid suspicious sent away from cytology
What is fat necrosis?
Occurs following trauma to breast
-mimics neoplastic disease
