Week 8 - The Breast

Question 1

What is the clinical presentation of breast disease?

Answer 1

Pain - less than 2% have cancer

Palpable mass - cysts, benign tumours, cancer

Nipple discharge

Mammographic abnormality

Question 2

What benign diseases of the breast can you get?

Answer 2

Fibrosistic disease

Fat necrosis

Mastisis

Tumours

Question 3

What is fibrocystic disease?

Answer 3

• very common
• lumpiness on one or usually both breasts
• pain/tenderness in breasts
• hormone regulated changes
• cumulative process >30 years old
• calcification

Question 4

What can cause fat necrosis in the breast and what are the symptoms?

Answer 4

• trauma to breast can result in localised haemorrhage and necrosis
• hard lump - mimics cancer clinically

Question 5

What is mastitis?

Answer 5

• inflammatory condition
• red, tender, warm
• blocked ducts - lactation mastitis
• encourage breastfeeding
• smoking

Question 6

What benign tumours can arise in the breast?

Answer 6

Fibroadenoma

Papilloma

Question 7

What malignant tumours can arise in the breast?

Answer 7

Ductal carcinoma

Lobular carcinoma

Paget’s disease (invasive or non invasive)

Question 8

What is a papilloma in the breast?

Answer 8

• benign
• wart-like growth in ducts
• bleeding/nipple discharge
• up to 2cm

Question 9

What is a fibroadenoma in the breast?

Answer 9

• benign
• rubbery lumps
• reproductive age
• can increase in size during pregnancy

Question 10

What age is someone most likely to get breast cancer?

Answer 10

Incidence increases with age

Average age at diagnosis = 64 yrs

Question 11

What are the risk factors for breast cancer?

Answer 11

-hereditary (BRCA mutation - X5 risk of breast cancer and X10 risk of ovarian cancer)

• age, height
• oestrogen (early menache, breast feeding)
• lifestyle

Question 12

How can breast cancer present?

Answer 12

• lump
• skin dimpling
• change in skin colour or texture
• change in how the nipple looks, like the pulling in of the nipple
• clear or body fluid that leaks out of the nipple

Question 13

What is the most common type of breast cancer?

Answer 13

Invasive ductal carcinoma

Question 14

What is ductal carcinoma?

Answer 14

In situ:

• abnormality of milk ducts
• pre-malignant condition

low grade > high grade > invasive

Invasive:

• most common type of breast cancer
• grades 1-3

Question 15

How is breast cancer treated?

Answer 15

• surgery +/- lymph node dissection
• chemo/radiotherapy
• hormone therapy e.g. Tamoxifen, herceptin

Question 16

What surgical procedures can be undertaken to remove breast cancer?

Answer 16

• lumpectomy
• wide local excision
• mastectomy
• sentinel lymph node

Question 17

What is Paget’s disease of the nipple?

Answer 17

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

Question 18

What is the anatomy of the breast?

Answer 18

• stroma

- epithelium (ducts and lobules arranged in terminal duct lobular units)