Tutorial 9 - Breast disease

Question 1

Indications for referral

Answer 1

􏰀 Discrete breast mass
􏰀 Persisting asymmetrical breast nodularity
􏰀 Nipple discharge, particularly if over 50 years old
􏰀 Severe mastalgia
􏰀 Nipple changes
􏰀 Strong family history of breast or ovarian cancer.

Question 2

Triple assessment

Answer 2

Clinical assesment (examination, history, risk factors, ect)
Radiology (US, mammogram)
Pathology (FNA)

Question 3

History

Answer 3

􏰀 Lump-duration, size, shape, tenderness and relationship to menses

􏰀 Pain-duration, unilateral or bilateral, cyclical or non-cyclical and severity

􏰀 Nipple discharge–timing of discharge, colour, unilateral or bilateral, single duct or multiple ducts and lactational state.

Question 4

RFs

Answer 4

􏰀 Female gender
􏰀 Increasing age
􏰀 Previous breast cancer (Invasive or ductal carcinoma in situ (DCIS))
􏰀 Previous atypical ductal hyperplasia (ADH) on biopsy
􏰀 Family history – particularly first degree relatives diagnosed with bilateral breast or ovarian cancer at a young age
􏰀 Factors that increase cyclical oestrogen exposure over the lifetime:
􏰁 Early menarche (<11y)
􏰁 First pregnancy after 35y of age
􏰁 Breast feeding is protective
􏰁 Delayed menopause (>53y)
􏰀 Prolonged use of the combined oral contraceptive pill (>10y)
􏰀 Prolonged use of hormone replacement therapy (>5y).

Question 5

breast screening for women

Answer 5

45-69 years every two years

Question 6

FNA and staging

Also do core biopsy

Open biopsy

Answer 6

C1 - Inadequate sample
C2 - Benign
C3 - atypical, prob benign
C4 - suspicious of malignant lesion
C5 - malignant

Question 7

Prognosis of breast cancer

Answer 7

􏰀 Primary tumour size
􏰀 Presence and number of involved lymph nodes
􏰀 Histological grade
􏰀 Nottingham prognostic index (NPI) – a score that combines size, nodal status and grade.

Question 8

Staging - AJCC

Answer 8

Stage - how far metastised
Tumor size T1-T4
Nodes N0-3
Metastaese MO-1

grade - appearance of cells