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Reproductive System > 23) Breast Disease > Flashcards

23) Breast Disease Flashcards

1
Q

What changes occur to the breast structure after menarche?

A

Increased number of lobules, increased volume of interlobular stroma

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2
Q

What changes occur to the breast structure during each menstrual cycle?

A

Cell proliferation and stromal oedema before menstruation and a decrease in size of lobules

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3
Q

What changes occur to the breast structure during pregnancy?

A

Increase in size and number of lobules, decrease stroma, secretory changes, acini bigger

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4
Q

What changes occur to the breast structure with increasing age?

A

Terminal duct lobular units decrease in size and number

Interlobular stroma replaced by adipose

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5
Q

What is the cause of cyclical and diffuse breast pain?

A

Physiological cause

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6
Q

What are some causes of non-cyclical and focal pain?

A

Ruptured cysts, injury, inflammation

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7
Q

What are some causes of a palpable mass in the breast?

A

Invasive carcinoma, fibroadenoma, cysts, normal nodularity

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8
Q

What are some causes of milk, spontaneous nipple discharge?

A

Endocrine disorders e.g. pituitary adenoma

Side effect e.g. OCP

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9
Q

What are some cause of bloody or serous nipple discharge?

A

Papilloma, duct ectasia, could be malignancy

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10
Q

What are the two things to look out for on a mammogram?

A

Densities and calcifications

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11
Q

What are some causes of densities on a mammogram?

A

Invasive carcinoma, fibroadenoma, cysts

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12
Q

What are some causes of calcifications on a mammogram?

A

Ductal carcinoma in situ, benign changes

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13
Q

At what ages do fibroadenomas usually present?

A

Any age during reproductive period, often < 30

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14
Q

At what ages do phyllodes tumours usually present?

A

In 6th decade

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15
Q

Describe the association between age and breast cancer:

A

Rare before 25 (except familial), incidence rises with age

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16
Q

What are some examples of disorders of development of the breast?

A

Polythelia (3rd nipple)

Accessory axillary breast tissue

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17
Q

When is acute mastitis likely to present and what is the cause?

A

During lactation

S. aureus infection due to nipple cracks and fissures

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18
Q

How does acute mastitis present?

A

Erythematous, painful breast
Pyrexia
May get breast abscesses

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19
Q

What is the cause of fat necrosis of the breast?

A

Trauma or surgery

20
Q

What is the most common breast lesion?

A

Fibrocystic breast changes

21
Q

How do fibrocystic breast changes present? (include histology)

A

Mass that mimics carcinoma

Histologically: cyst formation, fibrosis and apocrine metaplasia

22
Q

What causes fibrocystic breast change to disappear?

A

Fine needle aspiration

23
Q

What are some examples of stromal tumours of the breast?

A

Fibroadenoma, phyllodes, lipoma, leiomyoma and hamartoma

24
Q

How do fibroadenomas present? (include histology)

A

Mobile mass, can be multiple and bilateral and grow large

Histologically mixture of stromal and epithelial elements

25
Q

How do phyllodes tumours present? (include histology)

A

Masses that are mostly benign

Nodules of atypical stroma with epithelium

26
Q

What is gynaecomastia?

A

Enlargement of male breast that can be uni or bilateral

27
Q

What are some causes of gynaecomastia?

A 
Transient in puberty due to oestrogen peak 
Klinefelter's syndrome
Oestrogen excess - liver cirrhosis
Drug related
Gonadotropin excess - testicular tumour
28
Q

What are some risk factors for male breast cancer?

A

Klinefelter’s syndrome

Men treated with oestrogen for prostate cancer

29
Q

In what location is female breast cancer most common?

A

Upper outer quadrant

30
Q

What are some risk factors for developing breast caner?

A 
No pregnancy
Early menarche
Late menopause
Obesity/high fat diet
HRT
Radiation
Previous breast cancer
31
Q

What mutations are likely in hereditary breast cancer?

A

BRCA 1 and 2

p53

32
Q

What can those with BRCA mutations undergo to reduce risk of breast cancer?

A

Prophylactic mastectomy

33
Q

What is an in situ carcinoma of the breast?

A

Limited to duct and lobules by BM

34
Q

How does ductal carcinoma in situ present? (include histology)

A

Mammographic calcifications

Central necrosis histologically

35
Q

Describe Paget’s disease of the breast:

A

Cells extend to nipple skin without crossing BM and cause red, crusting nipple

36
Q

What is Peau d’orange?

A

Invasive carcinoma spreads to LN so lymph can’t drain. Breast swells and hair follicles pulled down into breast

37
Q

What are the types of invasive carcinoma of the breast?

A

Invasive ductal carcinoma
Invasive lobular carcinoma
Tubular and mucinous

38
Q

Where is breast cancer likely to metastasise?

A

Bone, lung, liver and/or brain

Axillary LNs

39
Q

Where is invasive lobular carcinoma likely to metastasise?

A

Peritoneum, retroperitoneum, leptomeninges, GIT, ovaries and uterus

40
Q

What determines the prognosis of breast cancer?

A 
In situ or invasive
TNM stage
Tumour grade
Histologic subtype (IDC worse)
Gene expression profile
41
Q

Why is investigating oestrogen and Her2 receptor status important?

A

Prognosis and specific treatment

42
Q

Describe the triple approach to diagnosis of breast cancer:

A

Clinical: history, family history and examination
Radiographic: mammogram and ultrasound
Pathology: fine needle aspiration cytology and core biopsy

43
Q

Describe the breast cancer screening programme:

A

Women aged 47-73, 2 view mammograms every 3 years

44
Q

What is the treatment for local breast cancer?

A

Mastectomy or breast conserving surgery

Axillary surgery after sentinel node sampling

45
Q

What are some treatments for systemic breast cancer?

A

Chemotherapy
Tamoxifen if oestrogen positive
Herceptin if Her2 positive

46
Q

How can breast cancer survival be improved?

A 
Early detection
Neoadjuvant chemotherapy
New therapies - Herceptin
Gene expression profiles
Prophylactic mastectomies in familial cases

Reproductive System (24 decks)

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