Womens Health - Breast Medicine Flashcards
What is Breast Cancer?
malignant neoplasm MC from inner lining of milk ducts or lobules that supply these ducts with milk.
Epidemiology of Breast Cancer
60-70 yrs peak incidence
100:1 - female
Aetiology of Breast Cancer
Genetic
Hormonal
Environmental
Lifestyle
Genetic : 5-10%
- BRCA1/BRCA2
- TP53,PTEN,STK11/LKB1,CDH1,CHEK2
- If 1st degree relative double risk.
Hormonal:
- oestrogen exposure prolonged
- early menarche (before 12), late menopause (over 55), late age at 1st birth (over 30) or nulliparity.
- exogenous hormone use: oral ccp, HRT.
Environment:
- Radiation to chest area
- benign breast conditions: atypical hyperplasia ,lobular carcinoma in situ.- malignant transformation
Lifestyle:
- Alcohol
- Obesity - potentially insulin resistance or increased oestrogen by adipose tissue?
- Physical inactivity
Classifications of Breast Cancer
Either Ductal or Lobular Carcinoma.
then subdivided into
hasn’t spread beyond local tissue : in-situ
or has spread beyond (invasive)
Invasive Ductal Carcinoma -MC - “No Special Type”
Invasive Lobular Carcinoma “Special Type”
Ductal Carcinoma in-situ “Special Type”
Lobular Carcinoma in-situ “Special Type”
Other Types of Breast Cancer - All Special Types
Medullary
Mucinous
Tubular
Adenoid cystic
Metaplastic
Lymphoma
Basal type
Phyllodes or cystosarcoma phyllodes
Papillary
What is Paget’s Disease of the nipple?
rare breast cancer
presence of malignant cells in the nipple-areolar complex.
affects epidermis of nipple and areola, leading to erythema, scaling and ulceration.
possible underlying insitu/invasive ductal carcinoma
epidemiology of pagets disease of nipple
mc - infants
Clinical Features of Pagets Disease of the Nipple
unilateral changes in appearance and texture of nipple and areola
sx:
- erythema,scaling, skin thickening
- itching, burning, pain in nipple and areola
- nipple discharge : poss bloody or serous
- nipple inversion or retraction
- ulceration or erosions in advanced cases.
why might pagets disease be misdiagnosed?
non-specific presentation
could get mixed up with
eczema or dermatitis
How would you investigate Paget’s disease of the nipple?
Imaging: evaluate breast tissue for underlying malignancy.
- Mammography
-Ultrasound
- MRI
- Skin Biopsy:
- punch or shave of nipple or areola. - histolopathological confirmation
On Skin Biopsy of Paget’s disease, what should you see?
pagets cells large round and pale-staining cells with abundant cytoplasm and large nuclei.
How would you manage Pagets Disease of the Nipple?
Surgery : Mainstay - 2 choices
- Breast-conserving surgery BCS - wide local excision. conserve breast remove disease. excise nipple-areola complex and margin of healthy tissue. then do radiation.
- Mastectomy - remove entire breast tissue. if invasive/in situ carcinoma in breast parenchyma. or multifocal disease.
if axillary lymph nodes, sentinel lymph node biopsy or axillary node dissection done same time.
Radiation: after BCS. not needed after mastectomy unless extensive disease in multiple positive lymph nodes.
Systemic Therapy: HRT or chemo if underlying breast cancer. check hormone receptor status, HER2 status and if lymph node or distant mets.
if ER-positive tumour give adjuvant hormone therapy.
HER-2 positive tumour: targeted therapy with trastuzumab.
What is inflammatory breast cancer?
cancerous cells block lymph drainage = inflamed appearance of breast.
1/10,000
Clinical Features of Breast Cancer
women over 50 with unilateral hard, painless lump in upper outer quadrant of breast. possible skin/nipple changes and axillary lymphadenopathy.
Local Sx:
- painless lump
- skin changes
- nipple changes
Regional Sx:
- Axillary lymphadenopathy
- Chest Wall Invasion
Distant Mets Sx:
- Bone Mets:
- Lung Mets :
- Brain Mets:
- Liver Mets:
