The breast

Question 1

Anatomy of the breast

Answer 1

stroma and epithelium

ducts and lobules arranged in terminal duct lobular units

Question 2

What are the clinical presentations of breast cancer?

Answer 2

pain, palpable mass (cysts, tumours, cancer), nipple discharge, mammographic abnormality
can occur in men as well as women
= breast cancer screening (50-70) 3 yearly, mammography

Question 3

Fibrocystic disease (benign disease)

Answer 3

very common
lumpiness in 1 or 2 breasts due to hormone related changes
>30 years
lumpiness due to calcification in the breast
cannot progress to tumour/cancer

Question 4

Fat necrosis (benign disease)

Answer 4

trauma to the breast can result in localised haemorrhage and necrosis
presents as a hard lump - mimics cancer but is not cancer/tumour

Question 5

Mastitis

Answer 5

inflammatory condition in breast tissue
red, tender and warm
caused by blocked ducts - lactation mastitis

Question 6

Name benign and malignant breast tumours

Answer 6

Benign - papilloma, fibro adenoma

Malignant - ductal carcinoma, lobular carcinoma, Paget’s disease

Question 7

Diagnosis of tumours

Answer 7

clinical impression
radiology
cytology - needle into lump to sample cells in tumour
histology
one stop clinics

Question 8

Papilloma

Answer 8

Benign tumour
wart like growth in ducts up to 2cm long (finger like projections on scan)
presents as bleeding and nipple discharge
surgery to remove

Question 9

Fibro adenoma

Answer 9

Benign tumour
rubbery lumps in breast, generally at reproductive age
do not need to be surgically removed however many prefer it to be removed
lumps can increase in size during pregnancy

Question 10

Breast cancer

Answer 10

Malignant tumour
most common cancer in UK
incidence increases with age (64 years plus is average)
hereditary BRCA mutation;
- x5 risk of breast cancer
- x10 risk of ovarian cancer
- most breast cancer not related to BRCA gene mutation
can be tested for BRCA gene mutation if…
personal history of breast cancer/ovarian cancer at young age, relatives with history of cancers, relatives with BRCA1/BRCA2 gene mutations

Question 11

Clinical presentation of breast cancer

Answer 11

lumps, skin dimpling, change in skin colour/texture, change in how nipple looks, clear/bloody fluid leaking out of nipple

Question 12

Ductal carcinoma in-situ (DCIS)

Answer 12

abnormality of milk ducts
pre-malignant condition
low grade>high grade>invasive

Question 13

Invasive ductal carcinoma

Answer 13

commonest type of breast cancer

graded 1 to 3 (3 being highest grade)

Question 14

Invasive lobular carcinoma

Answer 14

treatment:

• surgery +/- lymph node dissection (sentinel lymph node)
• chemo/radiotherapy
• drugs eg Tamoxifen, Herceptin
• lumpectomy
• mastectomy

Question 15

Paget’s disease

Answer 15

affects skin of one nipple
eczema-type rash, itchy, possible bleeding
sign of underlying breast cancer