T6-L1: Breast Pathology

Question 1

Which women are eligible for Breast Screening?

Answer 1

Women ages 50-71 years. They are invited every 3 years for screening.

In some areas there is an age extension 47-73 years.

Question 2

What is the symptomatic presentation of breast cancer?

Answer 2

• A lump or thickening in the breast
  
  • A change in the nipple - blood or fluid, scaly, shape etc.
  • A change in how the breast feels or looks
  • Pain or discomfort in the breast or armpit
  • Swelling in the breast or armpit

Question 3

What makes up the Breast Triple Assessment?

Answer 3

1. Clinical Assessment
2. Imaging
3. Pathology

Each code the lesion from 1-5 from normal to malignant. Clinic uses a P code, Radiology an R code and Pathology a B code.

Question 4

What is a fibrocystic change?

Answer 4

Fibrocystic breast changes happen when women develop fluid-filled cysts along with areas of fibrosis in one or both breasts.

It is a constellation of benign, hormonally mediated breast changes including cyst formation, stromal fibrosis and mild epithelial hyperplasia without atypia. Coded as B2. It shows no increased risk for subsequent carcinoma development.

Clinical presentation: Lumpy, premenstrual painful breasts.

It usually affects women from 20-45 years. It is usually bilateral and multifocal.

Question 5

What is the presentation of fibroadenoma?

Answer 5

Fibroadenoma are common between 20-30 years. There are more common in afro-Caribbean women. They present with mobile painless well defined breast lumps. They can be asymptomatic or can present as a lump. When it undergoes infraction, they can get severe pain though this is rare. USS can show well defined homogenous, hypoechoic mass. Treatment includes surgical excision.

Question 6

What lines the ductules?

Answer 6

The glandular epithelium is composed of two distinct types of cells, the secretory or luminal cells and the myoepithelial cells.

Question 7

What is DCIS?

Answer 7

Ductal Carcinoma In Situ - Clonal proliferation of cells within breast parenchyma structures. It is a precursor of invasive carcinoma. Most commonly identified as microcalcifications on screening. Pure DCIS cannot produce metastasis. It has the potential to progress to invasion if left. Sometimes DCIS can present with a positive lymph node and so evidence of invasion.

DCIS is coded as B5a

Question 8

How do we grade tumours?

Answer 8

How to grade tumours 
	- T - Tubule formation 
	- N - Nuclear pleiomorphism
	- M - Mitosis formation 
Each gets a score from 1-3 depending on how extensive it is. 

The scores are added together to get a score. The more poorly differentiated the higher the grade. Grade 1 score 3-5. Grade 2 6-7 and grade 3 8-9.

Question 9

What is the epidemiology of Breast Cancer?

Answer 9

• Common cancer estimated 1 in 9 women will develop breast cancer in the lifetime
  
  • Arises anywhere in the breast parenchyma or accessory breaks tissue
  • Risk are linked to oestrogens
    Increased with early menarche, late menopause, obesity in postmenopausal women, OCP’s and hormonal therapy for menopause, alcohol.

Question 10

What breast markers can we use to aid treatment?

Answer 10

• ER and PR and nuclear stains.

- HER is a membrane stain

Question 11

What is LCIS classified as?

Answer 11

B3 - It is not a precursor to carcinoma like DCIS

Question 12

What is the most common epithelium breast cancer?

Answer 12

Invasive ductal carcinoma is the most common type of breast cancer (65-80%) followed by Invasive lobular carcinoma (15%).

Question 13

When looking at breast tumour what should you be thinking about its origin?

Answer 13

If it is primary or metastatic

Question 14

What can we use to measure prognosis of breast cancer?

Answer 14

Nottingham Prognostic Index