Breast Carcinoma and Benign Breast Disease Flashcards
(27 cards)
What is the anatomy of the breast?
- Made of 15-25 lobes
- Each lobe is composed of a group of lobules
- Each lobule consists of multiple acni, within which milk is produced
- The milk drains via terminal ducts into the main duct system
- The duct system opens out at the nipple
=> The entire duct and lobular system is lined by epithelium surrounded by a basement membrane
What is the most common clinical presentation of breast cancer?
- Palpable lump
What are the most likely causes of a breast lump?
=> Vary with age:
- Young women, fibroademona ad fibrocystic change are the most common causes
- In older women, cancer is the most important cause
What does the Triple Assessment of Breast Lumps consist of?
=> Clinical
- History and Examination
=> Radiological
- Mammography (patients > 35 yrs, identifies micro calcifications and densities)
- Ultrasound (patients < 35 years, as breast tissue too dense for mammography)
=> Pathological
- Fine needle Aspiration (FNA)
What is the most common benign tumour of the breast?
Fibroadenoma
=> Most commonly seen in women under the age of 30
What is the clinical presentation of fibroadenoma?
- Firm, mobile, painless lump
What is the management of Fibroadenoma?
- Reassurance and discharge
OR - Excision
What is fibrocystic change?
Benign, non-neolpastic changes in the breast which are the result of minor aberrations in the normal response to cyclical hormonal changes
=> Involves:
- Fibrosis
- Cyst formation
In what age group are fibrocystic changes most commonly seen?
25-45
What is the clinical presentation of fibrocystic changes?
- Breast pain
- Tenderness
- Lumps/cysts
What region of the breast do fibrocystic changes affect?
Terminal Duct Lobular Unit (TDLU)
In what age group is breast cancer most likely to occur in?
40-70
What are the major risk factors of Breast Cancer?
=> Increased lifetime oestrogen exposure through:
- Female sex
- Increasing age
- Obesity - Early menarche, late menopause, long term COCP
=> Family History:
- Germ-line mutation in BRCA 1 and BRCA 2
- Germ-line mutation in p53
=> Alcohol consumption
What are the clinical features of Breast Cancer?
- Hard painless lump
- Nipple inversion and skin dumping
- Ulceration/ fungation
- Peau d’orange
- Nipple eczema
- Palpable axillary nodes
- Metastatic
Where do half of breast cancers occur?
Upper outer quadrant of the breast
What are the investigations in suspected Breast Cancer?
Triple Assessment
What types of cancers are the majority of Breast Cancers?
Invasive adenocarcinomas
What are the 2 most common forms of Breast Cancer?
- Ductal Carcinoma
- Lobular Carcinoma
What are the 2 types of Ductal Carcinoma?
=> Ductal Carcinoma in situ (DCIS):
- Epithelial cells showing cytological changes of malignancy have not invaded through the basement membrane
- Unifocal lesion concentrated in one area of the breast
- Usually does not form a mass, but may be associated with micro-calcifications
- Surgically excised
Left untreated, DCIS can progress to Invasive Ductal Carcinoma (IDC)
=> Invasive Ductal Carcinoma (IDC):
- Tumour cells have invaded through the basement membrane into the adjacent tissue
- Presents as a palpable breast lump
What is Paget’s disease of the nipple?
- Disease affecting the skin of the nipple and areola
- Due to presence of DCIS cells in the epidermis
- The affected skin reacts to the presence of these cells, giving the eczematous clinical appearance
=> Biopsy is required for a diagnosis
What is the microscopic composition of Invasive Lobar Carcinoma?
- Tumour cells which infiltrate the normal breast tissue as linear cords of cells
What are the other less common types of Breast Cancers?
- Tubular
- Cribriform
- Mucinous carcinomas
What are the prognostic factors of Breast Cancer?
=> Tumour Stage - most important
TNM
=> Tumour Grade
3 tier grading system
=> Histological subtype
=> Vascular invasion
=> Excision margins
=> Oestrogen receptor and HER2 status
What is the link between oestrogen receptors and HER2 with Breast Cancers?
=> Oestrogen receptor expression
- ER positive tumours are low grade and less aggressive, more likely to respond to hormonal therapy
- ER negative tumours are high grade and more aggressive, less likely to respond to hormonal therapy
=> HER2 - oncogene
- Over-expressed in breast cancer
- Poorer prognosis and good response to Herceptin
