Breast Flashcards
(39 cards)
what are the benign lumps of the breast
fibroadenosis/fibrocystic change fibroadenoma cysts fat necrosis phylloides tumour
what is the most common cause of breast lumps
fibroadenosis/fibrocystic change
what causes fibroadenosis
it is a combination of localised fibrosis, inflammatory changes and hormone driven cyclical pain
how does fibroadenosis present
classically between menarche and menopause with lumpy breasts and cyclical pain/swelling
what is the treatment for fibroadenosis
reassurance
anti-inflammatorys
topical evening primrose oil
hormone manipulation
what is a fibroadenoma
benign overgrowth of one lobule of the breast
what age range does fibroadenoma most commonly present in
25-35
what is the presentation of a fibroadenoma
rubbery firm mobile breast lump with little or no pain
how does a fibroadenoma progress
1/3 regress, 1/3 stay the same, 1/3 get bigger
what size does a fibroadenoma have to be to consider removal
> 4cm + symptomatic
what is a breast cyst
Cavities lined by flattened epithelium derived from ductal unit filled with watery fluid
how should breast cysts be treated
drained under USS, and if the fluid is suspicious (blood stained) send for cytology
what causes fat necrosis of the breast
recent trauma mostly
how does a fat necrosis present
firm lump in breast
may be some redness/bruising
what is a phylloides tumour
Rapidly growing benign tumour of the stroma
Smooth, hard lumps
whats the lifetime risk of breast cancer in women
12.5%
what are most breast cancers
90% invasive ductal adenocarcinoma
5% invasive lobular carcinoma
5% lobular/ductal in situ
how does the oestrogen receptor status of breast cancer relate to prognosis
OR positive = better prognosis
how does HER2 receptor status of breast cancer relate to prognosis
HER2 = worse prognosis
what are the pathological consequences of breast cancer
Paget’s Disease of the nipple
Spread of intraductal carcinoma in the breast
leading to eczematous changes around the nipple
any eczematous rash on the breast should be investigated (biopsied)
Local spread
Into overlying skin causing nipple retraction/tethering
Into the pectoral muscles which may cause deep fixation of the tumour
Lymphatic spread
Can prevent lymphatic drainage
Gives the peau d’lorange appearance
Nodes in the axilla are also often involved
Vascular spread
Distal dissemination is most commonly to the bone
Signs of this are pathological fractures and hypercalcaemia
Other sites are the ovaries (krukenberg tumour) and lung
what are common metastases sites for breast cancer
lung, bone, ovary, liver
what are the risk factors for breast cancer
Genetic - 25%
Personal history
Family History
BRCA status
Family - 75% - mostly due to oestrogen exposure early menarche late menopause nulliparity not breast feeding HRT obesity smoking
what is the best way to assess a breast lump
triple therapy
clinical exam
imaging - USS if <35, mammography + USS if >35
FNAC/core biopsy
why is mammography not done on women <35
breast tissue is too dense
