WOMEN'S HEALTH - BREAST Flashcards
define carcinoma
cancer that begins in the skin or tissues that line/cover internal organs
6 types of breast cancer
- ductal carcinoma in situ (DCIS)
- lobular carcinoma in situ (LCIS)
- invasive ductal carcinoma (NST)
- invasive lobular carcinoma (ILC)
- inflammatory breast cancer
- Paget’s disease of the nipple
what is the most common BC type?
invasive ductal carcinoma
what is DCIS? prognosis?
precancerous/cancerous epithelial cells of the breast ducts, localised to that area
good prognosis if fully excised/adjuvant tx used
what is LCIS? who does it commonly present in?
precancerous condition typically occurring in postmenopausal women
often asymptomatic
where does invasive ductal carcinoma originate?
in cells from breast ducts
define invasive
cancer that’s spread beyond the layer of tissue in which it developed and is growing into surrounding healthy tissue
what does inflammatory breast cancer present similarly to? prognosis?
presents similarly to breast abscess/mastitis BUT won’t respond to abx
worse prognosis than other BCs
which women are those considered ‘high risk’ and so can receive annual BC screening? (from what age)?
from age 30 if..
- 1st degree relative with BC under 40
- 1st degree male relative with BC
- 1st degree relative with bilateral BC, first diagnosed under 50
- two 1st degree relatives with BC
presentation of inflammatory BC
- peau d’orange
- inversion
- warm, tender breast
presentation of Paget’s disease of the nipple
- scaly
- red
- dry
- eczema-like
what are the 4 NICE criteria for a two week wait referral for BC?
- unexplained breast lump in women >30
- unilateral nipple change in patients >50
- unexplained axilla lump in >30
- skin changes suggestive of BC
what referral type should be considered in women under 30 presenting with an unexplained breast lump
non-urgent referral
BC imaging assessment choice in women <40
USS
BC imaging assessment choice in women >40
mammogram
once a pt is diagnosed with BC following the triple assessment, what investigations should be offered? (2)
- USS of axilla
- ultrasound-guided biopsy of any abnormal nodes
what biopsy can be performed during BC surgery to assess for spread of cancer?
sentinel lymph node biopsy (biopsy of first lymph node to which cancer cells are likely to spread to)
surgical management for women with BC who are sentinel node +ve
axillary surgery
what reconstructive surgery options are available after breast-conserving surgery?
- partial reconstruction
OR
- reduction and reshaping
what reconstructive surgery options are available after mastectomy? (2)
- breast implants
- flap reconstruction
breast implants
a) advantages
b) disadvantages
c) SEs
a) simple, acceptable appearance
b) feels less natural, cold, less mobile, static
c) scar tissue distorting implant, leakage, breast pain, infection, sensation changes, implant position changing
what is there a risk of if the rectus abdominus muscle is used in breast reconstruction?
abdominal hernia
chemo uses alongside BC surgery
a) neoadjuvant
b) adjuvant
a) pre surgery to shrink tumour
b) post-surgery to prevent recurrence
which BC receptor type is hormonal tx indicated in?
what are the options in pre and postmenopausal women?
oestrogen receptor +ve
tamoxifen if premeno
anastrozole if postmeno
which BC receptor type is targeted tx indicated in? what are the options?
for HER2 +ve cancer
trastuzumab, pertuzumab, neratinib
when is radiotherapy used in BC? what are some SEs?
usually in pts who have had breast-conserving surgery to reduce risk of recurrence
SEs = fatigue, local skin and tissue irritation/swelling, fibrosis, shrinking of breast tissue
surgical tx for:
a) carcinoma in situ
b) invasive carcinoma
c) Paget’s
a) wide local excision or mastectomy
b) wide local excision or chemo, consider chemo if later stage
c) central excision (nipple and areola) or mastectomy
what are fibroadenomas and who are they common in
common benign tumours of stromal/epithelial breast duct tissue
common between 20-40yo
what do fibroadenomas respond to? therefore when do they tend to regress?
respond to oestrogen and progesterone… regress after menopause
typical presentation of a fibroadenoma
mobile, small, firm breast lump
painless
well-defined
round
up to 3cm
a) typical management of fibroadenoma
b) what if >3cm/painful/worried about malignancy?
a) doesn’t need removal
b) surgical excision
what is the most common cause of breast lumps?
breast cyst
what is a breast cyst and when do they most commonly occur?
benign, individual fluid-filled lumps
perimenpause - 30-50
presentation of a breast cyst
- smooth, well-defined borders, mobile
- painful
- fluctuate in size over menstrual cycle
investigations for breast cyst
exclude cancer - mammogram or USS then biopsy
fine needle aspiration of a breast cyst - what colour should it be?
straw coloured
what should be done if fine needle aspiration of a breast cyst is ‘straw-coloured’ and not bloody?
no further testing or tx required
management of breast cyst if it persistently refills/is bloody after fine needle aspiration
biopsy/excise
which benign breast lump puts women at a slightly higher risk of BC
breast cyst
what is fat necrosis?
benign breasts ump formed by localised degeneration and scarring of fat tissue
RFs for fat necrosis breast lump
- obesity
- trauma
- radiotherapy
- surgery
presentation of fat necrosis breast lump
- painless, firm, irregular
- may be skin dimpling/nipple inversion
investigations for fat necrosis breast lump and which is diagnostic
- USS/mammogram (may look similar to BC)
- fine needle aspiration/core biopsy and histology is diagnostic
management of breast lump caused by fat necrosis
conservative - resolves spontaneously over time
IF sx persist, surgical excision
what is a lipoma?
benign tumours of fat (adipose) tissue in any area of body > can be in breast
presentation of lipoma of the breast
soft, painless, mobile, NO skin changes
management of a breast lipoma
conservative and reassurance
what is a galactocele?
breast-milk-filled cysts in the breast
which women may get galactoceles?
lactating women, normally after stopping breastfeeding
cause of galactoceles
lactiferous duct is blocked > prevents gland from draining milk > milk builds up
signs and symptoms of a galactocele
in a woman who has recently stopped breastfeeding…
- firm, painless lump
- under areola
management of a galactocele
what if gets infected?
normally resolves without tx
if infected - abx
what is a duct/breast papilloma?
papilloma = growth (like wart)
can grow inside the ducts of the breast, often near the nipple
what age are duct/breast papillomas common in?
35-55yo
signs and symptoms of a breast/duct papilloma
- clear/blood-stained discharge from nipple (normally from single duct)
- breast lump IF duct large enough
pain and discomfort not common
diagnostic investigation for a duct/breast papilloma
ductogram
management of a duct/breast papilloma if
a) cells normal under microscope
b) cells abnormal under microscope
REMOVAL
a) vacuum assisted excision (VAE)
b) surgical excision
which BC types can duct/breast papillomas rarely be associated with?
DCIS/invasive papillary cancer
what is duct ectasia?
dilatation and shortening of the terminal breast ducts within 3cm of the nipple
RF for duct ectasia
increased age
presentation of duct ectasia
- nipple retraction
- creamy nipple discharge
management of duct ectasia (troublesome discharge) if
a) young
b) old
a) microdochectomy
b) total duct excision
who is typically affected by periductal mastitis?
young women, smokers
how does periductal mastitis present?
recurrent periareolar/subareolar infections
what does Paget’s disease of the nipple indicate?
underlying breast malignancy
which BC is Paget’s disease of the nipple most commonly associated with?
invasive carcinoma
investigations for Paget’s disease of the nipple (2)
- mammography/USS
- punch biopsy
marker for BC monitoring
CA153
