Breast Flashcards
(28 cards)
<p>Define breast cancer in situ.</p>
<p>Breast cancer in situ is cancer that is confined to the duct or lobule in which it originated and does not extend beyond the basement membrane.</p>
<p>Explain the aetiology/risk factors of breast cancer in situ.</p>
<p>Family history of breast cancer<br></br>Benign breast disease on prior biopsy<br></br>Hereditary breast ovarian cancer syndrome<br></br>Li-Fraumeni syndrome: Mutation of P53 gene<br></br>Cowden's syndrome: Mutation of PTEN<br></br>Klinefelter's syndrome: 47, XXY</p>
<p>Summarise the epidemiology of breast cancer in situ.</p>
<p>In the US, it has been estimated that in 2018 there will be 63,960 new cases of breast carcinoma in situ. DCIS comprises 85% and LCIS 15% of in situ carcinomas of the breast.</p>
<p>Recognise the presenting symptoms of breast cancer in situ. Recognise the signs of breast cancer in situ on physical examination.</p>
<p>Nipple discharge<br></br>Breast lump<br></br>Eczema-like rash on breast<br></br>Ulceration</p>
<p>Identify appropriate investigations for breast cancer in situ and interpret the results.</p>
<p>Mammogram<br></br>FNA</p>
<p>Define duct ectasia.</p>
<p>Duct ectasia is a condition in which occurs when a milk duct beneath the nipple widens, the duct walls thicken and the duct fills with fluid. This is the most common cause of greenish discharge.</p>
<p>Explain the aetiology/risk factors of duct ectasia.</p>
<p>Aging, mostly women approaching menopause but some women develop this after menopause.<br></br>Inverted nipple<br></br>Smoking</p>
<p>Summarise the epidemiology of duct ectasia.</p>
<p>Women approaching menopause generally get duct ectasia because as they age, the milk ducts under the areola get shorter and wider. It can very rarely occur in men.</p>
<p>Recognise the presenting symptoms of duct ectasia. Recognise the signs of duct ectasia on physical examination.</p>
<p>Dirty white, greenish or black nipple discharge from one or both nipples<br></br>Tenderness in the nipple or surrounding breast tissue<br></br>Erythema<br></br>A breast lump or thickening near the clogged duct<br></br>Inverted nipple</p>
<p>Identify appropriate investigations for duct ectasia and interpret the results.</p>
<p>Breast exam<br></br>Mammogram<br></br>USS<br></br>Sample of discharge for culture/cystoscopy<br></br>FNA</p>
<p>Define fibrocystic breasts.</p>
<p>Fibrocystic change of the breast is a non-specific term, commonly understood as a continuum of physiological changes that expand to the pathological spectrum. It is a condition characterised by 'lumpy' breasts, associated with pain and tenderness that fluctuate with the menstrual cycle.</p>
<p>Explain the aetiology/risk factors of fibrocystic breasts.</p>
<p>Late-onset menopause<br></br>Later age at first childbirth<br></br>Nulliparity<br></br>Obesity<br></br>Oestrogen replacement therapy</p>
<p>Summarise the epidemiology of fibrocystic breasts.</p>
<p>It is difficult to determine the exact incidence of this condition, given that there is no clear definition or diagnostic criteria and that it is often a diagnosis of exclusion. The estimated incidence rate of fibrocystic changes increases with age, peaking at 40-44 years old before incidence decreases.</p>
<p>Recognise the presenting symptoms of fibrocystic breasts on physical examination. Recognise the signs of fibrocystic breasts on physical examination.</p>
<p>Mastalgia<br></br>Diffuse symmetrical lumpiness through both breasts<br></br>Age 30 to 50 years<br></br>Nipple discharge<br></br>Palpable breast mass</p>
<p>Identify appropriate investigations for fibrocystic breasts and interpret the results.</p>
<p>Mammography<br></br>Breast ultrasound<br></br>Cyst aspiration<br></br>Breast biopsy</p>
<p>Define intraductal papilloma.</p>
<p>Intraductal papillomas of the breast are benign lesions.</p>
<p>What are the two types of intraductal papilloma?</p>
<p>Central</p>
<p>Peripheral</p>
<p>What is the central type of intraductal papilloma?</p>
<p>The central type develops near the nipple. They are usually solitary and often arise in the period nearing menopause.</p>
<p>What is the peripheral type of intraductal papilloma?</p>
<p>On the other hand, the peripheral type are often multiple papillomas arising at the peripheral breasts, and are usually found in younger women. The peripheral type is associated with a higher risk of malignancy.</p>
<p>Explain the aetiology/risk factors of intraductal papilloma.</p>
<p>PMHx of breast cancer or a high-risk breast lesion.<br></br>Genetic factors, such as a mutation of the BRCA1 or BRCA2 gene.<br></br>Childhood radiation exposure to the chest.</p>
<p>Summarise the epidemiology of intraductal papilloma.</p>
<p>There is an incidence of 2-3%. It is the most common cause of bloody nipple discharge in women aged 20-40 years old.</p>
<p>Recognise the presenting symptoms of intraductal papilloma. Recognise the signs of intraductal papilloma on physical examination.</p>
<p>Bloody nipple discharge<br></br>Breast enlargement<br></br>Lumps<br></br>Pain or discomfort</p>
<p>Identify appropriate investigations for intraductal papilloma and interpret the results.</p>
<p>Galactogram<br></br>FNA<br></br>Mammogram/Breast USS</p>
<p>Define metastatic breast cancer.</p>
<p>Breast cancer is considered metastatic breast cancer (MBC) if the disease has spread beyond the breast and ipsilateral lymph nodes (axillary, internal mammary, infra- and supraclavicular).</p>
Explain the aetiology/risk factors of metastatic breast cancer.
Female sex
Age >50 years
Family history of breast and/or ovarian cancer
BRCA1 and BRCA2
Summarise the epidemiology of metastatic breast cancer.
The breast is the most common site of cancer in women worldwide, accounting for approximately 24% of female cancers, with highest rates in North America, Western and Northern Europe, and Australia. MBC diagnosed at initial presentation or following treatment for loco-regionally-confined breast cancer, occurs in approximately 40% of breast cancer patients.
Recognise the presenting symptoms of metastatic breast cancer. Recognise the signs of metastatic breast cancer on physical examination.
Bone pain
Pleural effusion
Palpable mass after treatment of the primary tumour
Shortness of breath
Anorexia
Weight loss
Identify appropriate investigations for metastatic breast cancer and interpret the results.
FBC
LFTs
Calcium
CXR
CT (of chest and abdomen)
Bone scan
