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Y2 MECHANISMS OF DISEASE > Triple Assessment of Breast Lumps > Flashcards

Triple Assessment of Breast Lumps Flashcards

1
Q

What structures of the breast are represented by 1-8?

A
  1. chest wall
  2. pectoralis major
  3. lobule
  4. nipple
  5. areola
  6. lactiferous duct
  7. adipose tissue
  8. skin
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2
Q

What is the role of the breast lobules?

A

they are the functioning part of the breast that make milk during breast feeding

all lobules drain into lactiferous ducts and out through the nipple

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3
Q

What 2 different types of breast tissue are visible here?

A

the light pink area is stroma

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4
Q

Where are ducts and lobules located?

A
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5
Q

What is shown in the following images?

A
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6
Q

What is the NICE recommendation when GPs are referring patients presenting with breast lumps?

A

refer using suspected cancer pathway (appointment within 2 weeks) if the patient is 30 or older and has an unexplained breast lump

consider referring if the patient is under 30

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7
Q

What % of breast lumps are due to benign breast disease?

A

around 80%

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8
Q

What is a lipoma and a fibrocystic change/cyst?

A

a lipoma is a lump arising from fat in the breast

a cyst arises from ducts or lobules and may cxause a lump

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9
Q

What is a fibroadenoma/hamartoma?

A

regions composed of stroma and epithelial elements (biphasic)

benign cause of breast lumps

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10
Q

From which cells do breast carcinomas arise?

A

from epithelial cells or cells of lobules/ducts

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11
Q

What are the 3 stages in the triple assessment of breast lumps?

What procedures are carried out at each stage?

A
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12
Q

What are the 5 features of a breast lump that should be observed on clinical examination?

A
  1. is it mobile or fixed?
  2. is the lump well-defined?
  3. is it smooth or irregular?
  4. firmness
  5. location of lump
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13
Q

What features tend to be observed on clinical examination if a breast lump is malignant?

A
  1. it is fixed and does not move around
  2. it is not-well defined and feels irregular
  3. it is more firm and hard
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14
Q

Why does the location of the breast lump need to be recorded on clinical examination?

A

sometimes patients will present with multiple lumps

the location needs to be known so that the imaging team knows which lump to focus on

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15
Q

How is the location of a breast lump recorded?

A

each breast is divided into quadrants

the ultrasound needs to be performed on the quadrant where the lump is present

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16
Q

What 3 nipple symptoms need to be looked for on clinical examination?

A
  1. nipple inversion that has not always been present
  2. rash
  3. discharge
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17
Q

What 4 skin changes need to be looked for on clinical examination?

A
  1. tethering/retraction
  2. oedema
  3. peau d’orange
  4. ulceration/fungating lesion
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18
Q

What is meant by tethering/retraction of the skin?

A

where the skin is being pulled in by something underneath it

this is a sign of advanced cancer

19
Q

What is meant by peau d’orange?

A

skin changes that make the skin look like orange peel

this is a sign of potentially advanced breast cancer

20
Q

What are the 5 stages in the clinical P code?

What is the purpose of this code?

A

it gives the imaging team and pathologists a clear guide as to how worried the clinician is about the lump

P1 - normal

P2 - benign lesion

P3 - atypical, probably benign lesion

P4 - atypical, probably malignant lesion

P5 - malignant

21
Q

How does fat and fibroglandular breast tissue appear on ultrasound?

A

fat is hypoechoic and appears white

fibroglandular breast tissue is echogenic and appears black

22
Q

Which of the following ultrasounds is more likely to be malignant and why?

A

left - benign:

lesion appears circular, regular, well-defined

right - malignant:

lesion appears less defined and the edges merge with the adjacent fatty tissue

23
Q

What is a mammogram?

How do fat and solid masses appear?

A

it is an X-ray of the breast from several angles

fat is radiolucent so appears black

solid masses are radio-opaque so appear white

24
Q

Which of the mammograms shows a lesion that is likely to be malignant?

Why?

A

left - benign:

there is a well circumscribed, solid white area

right - malignant:

white area is more irregular and looks stellate

it is possibly pulling in the skin on the surface

25
Q

What are the 5 stages in the imaging R code?

A
  • R1 Normal
  • R2 Benign lesion
  • R3 Atypical, probably benign lesion
  • R4 Atypical, probably malignant lesion
  • R5 Malignant
26
Q

What is the main pathology procedure performed to look at breast lumps?

A

core biopsy

this involves taking a core of tissue from the region of concern

it is done under X-ray or ultrasound guidance to ensure the region of interest is not missed

27
Q

What is involved in a fine needle aspiration (cytology)?

A

aspiration of loose cells from the lesion using a fine needle

you can tell if the cells are cancerous or not, but cannot tell how they relate to the surrounding cells

28
Q
A
29
Q

What are the advantages of cytology over biopsy?

A
  1. it is a cost-effective procedure
  2. minimal trauma to patient
  3. high acceptance rate
  4. rapid assessment and results
30
Q

What are the disadvantages of cytology over biopsy?

A
  1. you cannot identify the location of malignant cells and whether they have spread
  2. lack of specific diagnosis for most benign lesions
31
Q

What are the 5 stages in the pathology B code?

A
  • B1 Normal
  • B2 Benign lesion
  • B3 Atypical, probably benign lesion
  • B4 Atypical, probably malignant lesion
  • B5 Malignant
32
Q

What are the 5 stages in the pathology C code?

A
  • C1 Insufficient
  • C2 Normal or Benign lesion
  • C3 Atypical, probably benign lesion
  • C4 Atypical, probably malignant lesion
  • C5 Malignant
33
Q

What is shown?

How can you tell?

A

fibroadenoma

it has a well-defined edge and is made up of stroma and epithelial cells

34
Q

What is the role of the BRCA genes?

A

they encode tumor suppressor proteins

these are critical for cells to repair damaged DNA

35
Q

What happens if there is a mutation in a BRCA gene?

A

the tumor suppressor proteins are not made or do not work properly

this means that DNA damage in cells is not repaired properly and there is a higher chance of the cell becoming cancerous

36
Q

What is significant about women who carry the BRCA gene mutations and the age at which they get breast cancer?

A

there is a peak incidence at a lower age

there is a 70% chance of developing breast cancer by 80

37
Q

What is meant by an ER positive breast cancer?

A

80% of breast cancers are ER positive

oestrogen plays a key role in the development of breast cancer and stimulates the growth of tumours that express oestrogen receptors (ER positive)

38
Q

What type of targeted treatment can be used in ER positive breast cancers?

How does it work?

A

endocrine therapy using tamoxifen

this blocks the oestrogen receptors, meaning that oestrogen cannot act on the tumour cells

this stops the tumour cells from growing and improves prognosis

39
Q

What is Her2 and how is it related to breast cancer?

A

it is a human epidermal growth factor receptor

Her2 gene is amplified in 20-25% of breast cancers and predicts poorer prognosis as it drives tumour growth

40
Q

What targeted treatment is used in Her2 breast cancers?

How does it work?

A

Trastuzamab (Herceptin) is an antibody that targets and blocks the Her2 receptors

this prevents tumour growth and improves prognosis

41
Q

What are the 2 types of surgical options in breast cancer?

A

wide local excision:

this is removal of the tumour and a surrounding ring of local tissue

mastectomy:

this involves removing the whole breast

radiotherapy must be given after local excision to keep the recurrence risk as low as in mastectomy

42
Q

What are the 2 types of surgical options if breast cancer has spread to the lymph nodes?

A
  1. sentinel lymph node biopsy
  2. axillary node clearance
43
Q
A

Y2 MECHANISMS OF DISEASE (36 decks)

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