Breast disease Flashcards
(32 cards)
What are the different types of breast malignancy
Ductal Carcinoma in situ - most common Lobular Caarcinoma in situ - rarer Ductal invasive carcinoma Lobular INvasive carcinoma Pagets Inflammatory
What is the screening programme for breast cancer?
Screening every 3 years for women 50-70 currently trialling 47-73
Mammogram
Patients with family hx of breast cancer/BRCA mutation –> screened every year after 40
why are mammograms not used in younger patients
Breast tissue is too dense so ultrasound is used
What are the risk factors for breast cancer
Genetic: - BRCA genes and p53 - Family hx of breast cancer - Family hx of ovarian and prostate cancer - Ashkenazi Jewish descent Obs and Gynae hx - null parity or low parity - no breastfeeding - use of COCP - use of combined HRT - Early menarche and late menopause other - increasing age - past hx of breast cancer or other malignancy - smoking - alcohol
How may breast malignancy present
Painless lump in breast Nipple inversion Peau d'orange Nipple discharge Change in size/shape of breast Overlying skin changes - rash Systemic symptoms - weight loss, night sweats, fatigue
How does Paget’s disease of the breast present
Unilateral eczema of nipple that spreads beyond areola (a way to differentiate from eczema) Itching Erythematous Scaling Erosions and ulceration
How is Pagets disease of the breast investigated
Skin scrapings –> paget cells will be found
Punch biopsy
Wedge biopsy - can help see if DCIS or invasive carcinoma underneath
How may you rule out eczema if suspected Pagets
Give course of oral steroids and see if it clears up
How is suspected breast cancer investigated
Triple assessment
- examination (asymmetry, skin changes, axillary nodes, mobile or tethered lump, nipple inversion, discharge
- USS/ Mammogram
- ultrasound guided FNA or biopsy
Bloods - FBC, U+Es, LFTs, CRP (if suspecting infection or as baseline before treatment) Imaging for staging - CT CAP CXR Abdo USS PET scan - for bony mets
What are the differentials for a breast lump
Breast cyst Fibroadenoma Abscess Mets - neuroendocrine or AML Lymphoma of breast Traumatic fat necrosis Inflammatory carcinoma
How is breast malignancy treated?
Surgery
- wide local exicision - solitary lesion, peripheral tumour
- mastectomy - larger tumours, central tumour, DCIS >4 cm
- Axillary clearance (after sentinel node biopsy)
Chemo
- usually started after primary surgery
- Oestrogen positive - tamoxifen in pre menopausal and aromatase inhibitors in post menopausal
Radiotherapy
- After breast conserving surgery
What is a sentinel node biopsy and what are the complications
Inject dye/radiolabelled dye into tumour and see which nodes it goes to
Seroma and lymphoedema –>will need draining
What are the three hormones breast cancer can be positive or negative for
Progesterone
Herceptin
Oestrogen
Which mutation has a strong association with HER2 positive Cancer
p53
Which mutation has a strong association with Oestrogen positive but HER 2 negative cancer
BRCA2
Also most common hormone receptor combo
Which mutation has a strong association with Oestrogen and HER2 negative cancer
BRCA1
How may a cyst present
Fluid filled mass
May be pain - compression on other structures
most common in over 50s
How is a cyst investigated and treated
Mammogram/USS - presents similarly to malignancy
FNA under ultrasound
What is a fibroadenoma
Smooth, mobile, rubbery, firm, benign tumour of breast
Most common in younger age group 15-35
Less common in post menopausal women due to hormones
How is a fibroadenoma treated
usually left in situ with follow up
removed if >3cm or patient preference
How does duct ectasia present
Yellow/green discharge
Slit like nipple inversion
palpable mass
More likely in menopausal women
What is duct ectasia
Dilating and shortening of the major lactiferous ducts
Mammogram shows dilated calcified ducts
How is duct ectasia managed
Conservatively
total or subtotal exicision if unremitting nipple discharge
How does mastitis present
Skin inflammation and thickening
Cracks in nipple
Can be lactational or non-lactational (tobacco smoking)
