Breast Lectures 3-4

Question 1

What is a fibroadenoma?

Answer 1

Most common breast tumour in adolescent and young adult women
Benign
Proliferation of epithelial and stormal elements

Question 2

What would a fibroadenoma feel like on palparion?

Answer 2

Well-circumcised, freely mobile. non-painful mass

Question 3

What may happen to a fibroadenoma if left untreated?

Answer 3

May regress with age

Question 4

In a fibroadenoma, if the ducts are distorted/ elongated, what type of growth pattern is this?

Answer 4

Intracanalicular growth pattern

Question 5

In a fibroadenoma, if the ducts are not compressed, what type of growth pattern is this?

Answer 5

Pericanalicular growth pattern

Question 6

Intraductal papilloma?

Answer 6

Benign tumour within breast ducts- can show epithelial hyperplasia

Question 7

What is a symptom of intraductal papilloma?

Answer 7

Nipple discharge

Question 8

What is fat necrosis of the breast?

Answer 8

Benign condition where the adipose tissue is damaged and ultimately leads to cell death and necrosis of the tissue of the breast

->can simulate carcinoma clinically and mammographically

Question 9

What may be indicative of breast fat necrosis in the history?

Answer 9

Antecedent trauma
Prior surgical intervention

Question 10

What would be seen histologically in breast fat necrosis?

Answer 10

Histiocytes with foamy cytoplasm
Lipid-filled cysts

Question 11

What may be seen in breast fat necrosis on mammography?

Answer 11

Fibrosis
Calcifications
Egg shell- whatever that means

Question 12

Phyllodes tumour?

Answer 12

Fleshy tumour, leaf-like pattern and cysts on cut surface
Can be benign, borderline or malignant

->less than 1% of breast tumours

Question 13

How would metastases of a Phyllodes tumour spread?

Answer 13

Haematogenously

Question 14

How common is breast cancer?

Answer 14

Commonest type of cancer in the UK

Female > Male but 390 approx. male breast cancer diagnosis per year in UK

Question 15

Risk factors of breast camcer?

Answer 15

Gender
Age
Age at first pregnancy
Radiation
FH
Personal history
Hormonal treatment
Genetic factors
Obesity, alcohol

Question 16

Which genes are most commonly the cause of hereditary susceptibility to breast cancer?

Answer 16

BRCA1
BRCA2

->BRCA1-20-40%, BRCA2- 10-20%
TP53, PTEN or other genes can cause it

Question 17

Some breast carcinomas can be described as being in situ. What does this mean?

Answer 17

Abnormal cells are only found in the place where they first formed, the original place

Question 18

What are two types of non-invasive carcinomas which are described as being in situ?

Answer 18

Ductal carcinoma in situ
Lobular carcinoma in situ

Question 19

Describe breast tumours which are found in situ.

Answer 19

If preinvasive, does not form a palpable tumour
Only detected on x-ray
No metastatic spread

Risk of invasion depending on grade

Question 20

What are some of the diagnostic procedures for breast tumours?

Answer 20

Clinical examination
Radiology- mammogram, ultrasound, MRI
Fine needle aspiration cytology
Needle core biopsy
Diagnostic excision

Question 21

What will be described in the histology report of a breast tumour?

Answer 21

Invasive vs non-invasive
Histological type e.g. ductla vs lobular
Grade
Size
Margins
Lymph nodes
Oestrogen/progesterone receptor

Question 22

Which is the more common histological type of breast cancer- ductal or lobular?

Answer 22

Ductal - 85%
Lobular- 15%

Question 23

Where would local spread of breast cancer go?

Answer 23

Skin
Pectoral muscles

Question 24

Where would lymphatic spread of a breast cancer go?

Answer 24

Axillary and internal mammary nodes

Question 25

Where would blood spread of a breast cancer go?

Answer 25

Bone Liver Lungs Brain

Question 26

Paget's disease of the nipple?

Answer 26

Rare condition associated with breast disease. Causes eczema like change to the areola.

Question 27

Symptoms of Paget's disease of the nipple?

Answer 27

Pain or itching, scaling and redness Mistaken for eczema Can be ulceration, crusting and serous/bloody discharge from the nipple

Question 28

What is the most common abnormality of the male breast?

Answer 28

Gynecomastia- increase in subareolar tissue

Question 29

What can gynecomastia be associated with?

Answer 29

Hyperthyroidism Liver cirrhosis Chronic renal failure Chronic pulmonary disease Use of hormones- oestrogen, androgens and other drugs

Question 30

How many women will be affected by breast cancer?

Answer 30

1 in 7 ->most common cancer in women

Question 31

Risk factors for breast cancer?

Answer 31

Age- increases with age Previous breast cancer Genetic- BRCA1, BRCA2 Early menarche Late menopause Late or no pregnancy HRT Excess alcohol Weight Post radiotherapy treatment for Hodgkin's disease

Question 32

Which age group get screened for breast cancer?

Answer 32

50-70

Question 33

A lot of patients with breast cancer are asymptomatic and find out through screening. However, what are some of the symptoms a patient with breast cancer may present with?`

Answer 33

Lump Mastalgia- persistent unilateral pain Nipple discharge- bloodstained Nipple changes- Paget's disease, retraction Change in size or shape of breast Dimpling of breast skin Lymphoedema (swelling of arm)

Question 34

Would you be more worried about a painful breast lump or a painless breast lump?

Answer 34

Painless breast lump

Question 35

Anyone who presents with a breast lump requires triple assessment. What are the three parts?

Answer 35

Clinical- history and examination Radiological- bilateral mammograms/ultrasound Cytopathological- core biopsy

Question 36

What would you need to cover in FH in someone presenting with a breast lump?

Answer 36

Previous breast problems FJ Drug history Hormonal status

Question 37

Let's say the lump is in the right breast, which breast would you examine first?

Answer 37

Left- need to know what normal feels like first

Question 38

If nipple discharge was bilateral, how likely is this to be breast cancer?

Answer 38

Less likely as bilateral, would be more likely to be something systemic

Question 39

Is mammography more sensitive in older or younger women?

Answer 39

Older ->younger women have increased presence of glandular tissue so not as sensitive

Question 40

What are the two pathological types of breast cancer?

Answer 40

Ductal carcinoma- 80% Lobular carcinoma- 10% Others- 10%

Question 41

Do breast cancers in situ tend to be invasive or non-invasive?

Answer 41

Non-invasive

Question 42

If breast tumour size is <2cm, what stage of breast cancer is this?

Answer 42

Stage 1

Question 43

If breast tumour size is 2-5cm, what stage of breast cancer is this?

Answer 43

Stage 2

Question 44

If breast tumour size is >5cm, what stage of breast cancer is this?

Answer 44

Stage 3

Question 45

If breast tumour size is invading the surrounding skin, what stage of breast cancer is this?

Answer 45

Stage 4

Question 46

What are the aspects of breast cancer management/treatment?

Answer 46

Surgery +/- radiotherapy +/- chemotherapy +/- hormonal therapy

Question 47

Two types of surgical procedure for breast cancer?

Answer 47

Mastectomy Breast conservation surgery ->always try to do breast conserving therapy, studies show that if good margins and radiotherapy, survival is the same

Question 48

What is meant by sentinel lymph node biopsy?

Answer 48

First node to receive lymphatic drainage, so the first node the tumour spreads to. If negative, the rest of the nodes are also negative for the cancer spread.

Question 49

What are some of the potential complications of axillary treatment?

Answer 49

Lymphoedema Sensory disturbance Nerve damage Vascular damage Radiation-induced sarcoma