The Breasts

Question 1

Clinical presentation of breast diseases

Answer 1

Pain- less than 2% have cancer

Palpable mass- cysts, benign tumours, cancer

Nipple discharge- benign 95% of cases 5% malignant.

Mammographic abnormality- 2% screened asympmtomatic population

Question 2

Fibrocystic disease

Answer 2

Very common
Lumpiness in one or usually both breasts
Pain/tenderness in breasts
Hormone related changes
Cumulative process >30 years old
Calcification

Question 3

Fat Necrosis

Answer 3

Trauma to breast can result in localised haemorrhage and necrosis

Hard lump- mimics cancer clinically

Question 4

Mastitis

Answer 4

Inflammatory condition

Red, tender, warm

Blocked ducts- lactation mastitis

Encourage breastfeeding.

Smoking

Question 5

Tumours

Answer 5

Benign
fibroadenoma
papilloma

Malignant
ductal carcinoma
lobular carcinoma
Paget’s disease

Question 6

Diagnosis - triple assessment

Answer 6

Clinical impression
Radiology
Cytology/histology

One-stop clinics

Question 7

Papilloma

Answer 7

Wart-like growth in ducts

Bleeding/nipple discharge

Benign

Up to 2cm

Question 8

Fibroadenoma

Answer 8

Rubbery lumps

Reproductive age

Benign- need not be removed but many prefer it

Can increase in size in pregnancy

Question 9

Malignant Breast Cancer

Answer 9

Most common cancer in the UK
Incidence increases with age (average age at diagnosis 64yrs)

Hereditary breast cancer- BRCA mutation
x5 risk of breast cancer, x10 risk of ovarian cancer
Accounts for 5% of breast cancer

Question 10

Risk factors breast cancer

Answer 10

Age, Height -17%

Oestrogen
Early menache
Parity down 7%
Breastfeeding (down per 12mth) 4%

Lifestyle
Obesity -30%, physical activity dwn 20%, alcohol 10%, dietary fat 10%.

Question 11

Breast cancer clinical presentation

Answer 11

lump
skin dimpling
change in skin colour/ texture
change in how the nipple looks - pulling in of the nipple
clear or bloody fluid that leaks out of the nipple

Question 12

Diagnosis Breast Cancer

Answer 12

Breast cancer screening programme

Mammography every 3 years

Catching cancer early improves prognosis

Surgery for pre-invasive disease possibly of questionable benefit

Question 13

Ductal Carcinoma in-situ

Answer 13

Abnormality of milk ducts

Pre-malignant condition

Low grade > high grade > invasive

Question 14

invasive ductile carcinoma

Answer 14

Commonest type of breast cancer

Grades 1-3

Question 15

malignant breast cancer types

Answer 15

Ductal - DCIS, invasive ductal carcinoma

Lobular- LCIS, invasive lobular carcinoma

Paget’s disease- invasive or non-invasive

Question 16

malignant breast cancer treatment

Answer 16

Surgery +/- lymph node dissection
surgery types -
Lumpectomy
Wide local exicion
Mastectomy
Sentinel lymph node

Chemo/radiotherapy

Hormone therapy s eg. Tamoxifen, Herceptin

Question 17

Paget’s disease of the nipple

Answer 17

Affects skin of one nipple

Eczema-type rash, itchy, possible bleeding

Sign of underlying breast cancer