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Breast Pathology Flashcards

(52 cards)

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1
Q

How common is breast cancer?

A

Affects 1/8 women

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2
Q

Give risk factors for breast cancer

A

>Age

Early menarche/late menopause

Ionising radiation

FH

Previous breast cancer

COCP/combined hormonal replacement therapy

Genetics

Obesity

Nulliparity

Previous surgery for breast disease

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3
Q

What genes are associated with breast cancer?

A

BRCA 1

BRCA 2

TP53

PTEN

p53 gene mutations

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4
Q

What are the types of non-invasive breast cancer?

A

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS/LISM)

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5
Q

What are the types of invasive breast cancer

A

Invasive ductal carcinoma

Invasive lobular carcinoma

Special types

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6
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma (no special type)

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7
Q

What are the ‘special types’ of breast cancer?

A

Medullary breast cancer

Tubular carcinoma

Mucinous carcinoma

Carcinoma with medullary features

Metaplastic carcinoma

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8
Q

Which type of breast cancer is associated with spread to opposite breast?

A

Invasive lobular carcinoma

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9
Q

Where can breast cancer spread?

A

Local

  • Skin
  • Pectoral muscles

Lymphatic

  • Axillary
  • Internal mammary

Blood

  • Bone
  • Lungs
  • Liver
  • Brain
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10
Q

What investigations are used in breast cancer diagnosis?

A

Mammogram X-ray of the breast, soft tissue opacity, microcalcification

Fine Needle Aspiration Cytology

Biopsy

Staging

  • Hb
  • FBC
  • U&Es
  • LFTs
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11
Q

What tumour marker is most associated with breast cancer?

A

CA 15-3

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12
Q

Describe the screening programme for breast cancer

A

Mammogram every 3 years for women 50-70

After the age of 70 years women may still have mammograms but are ‘encouraged to make their own appointments

Women who are at an increased risk of breast cancer due to their family history may be offered screening from a younger age

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13
Q

How does breast cancer present?

A

Lump of thickening in breast, often painless

Discharge or bleeding

Change in size or contours of breast

Change in colour of appearance of areola

Redness or pitting of skin over the breast, like the skin of an orange

Fixed to deep tissue, invasive

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14
Q

How is breast cancer managed?

A

Surgery

  • Wide local excision/breast conserving surgery, <4cm wide
  • Mastectomy

Radiotherapy

Adjuvant Hormonal therapy

Biological therapy

Chemotherapy

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15
Q

What are the two main groups of anti oestrogen drugs?

A

Selective oestrogen receptor modulators (SERM)

  • Tamoxifen

Aromatase inhibitors

  • Anastrozole
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16
Q

Give adverse effects of SERMS

A

Endometrial cancer

VTE

Menstrual disturbance

  • Vaginal bleeding
  • Amenorrhoea

Menopausal symptoms

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17
Q

Give adverse effects of aromatase inhibitors

A

Osteoporosis

Hot flushes

Arthalgia

Insomnia

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18
Q

What hormonal therapy is used in women with ER+ breast cancer?

A

Anastrozole, post menopausal

Tamoxifen, pre menopausal

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19
Q

What hormonal therapy is used in women with HER2+ breast cancer?

A

Herceptin/Trastuzumab

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20
Q

When is Trastuzumab contraindicated?

A

History of heart disorders

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21
Q

When is radiotherapy used in breast cancer management?

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A

After a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds

For women who’ve had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes

22
Q

When is chemotherapy used in brest cancer management?

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A

Prior to surgery to downstage a primary lesion, allowing breast conserving surgery rather than masectomy

After surgery if axillary node disease

23
Q

Give adverse effects of neo-adjuvant chemotherapy

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A

Nausea

Hair loss

24
Q

Which breast cancer cases are offered a masectomy?

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A

Multifocal tumour

Central tumour

Large lesion in small breast

DCIS >4cm

25
Which breast cancer cases are offered wide local excision?
Solitary lesion Peripheral tumour Small lesion in large breast DCIS \<4cm
26
How is palpable axillary lymphadenopathy at presentation managed?
Axillary node clearance at primary surgery or radiotherapy
27
How is no palpable axillary lymphadenopathy at presentation managed?
Pre-operative axillary US If positive, sentinel node biopsy to assess nodal burden
28
Give a complication of axillary node clearance
Arm lymphedema and functional arm impairment
29
What is inflammatory breast cancer?
Rare but rapidly progressive form of breast cancer caused by obstruction of lymph drainage causing erythema and oedema
30
What are the causes of nipple discharge?
Galactorrhoea Hyperprolactinaemia Mammary duct ectasia Carcinoma Intraductal papilloma
31
Give features of fibroadenoma
**Young women** **Mobile** Smooth Well defined Non-tender Not tethered to underlying structures
32
How are breast fibroadenomas managed?
Surgical excision if \>3cm
33
Give features of breast cysts
Perimenopausal women Soft, fluctuant swelling
34
What mammography sign is seen in breast cyst?
Halo appearance
35
How are breast cycts managed?
Aspiration, followed by re-examination to ensure the lump has gone Those which are blood stained or persistently refill should be biopsied or excised
36
What is paget's disease of the nipple?
Eczematoid change of the nipple associated with an underlying breast malignancy, differs from eczema of the nipple in that it involves the nipple primarily and only latterly spreads to the areolar, while the opposite occurs in eczema
37
Give features of pagets disease of the nipple
Nipple itching Crusty lesion Erythema Thickened skin Bloody nipple discharge Underlying breast lump Palpable axillary node
38
Give features of mammary duct ectasia
Peri/postmenopausal women Nipple discharge, often cheese like, can be brown-green Nipple retraction Tender lump
39
How is mammary duct ectasia managed?
Reassurance, as no specific management Total duct excision can be used in older women if condition is troublesome Microdochectomy can be used in younger women
40
How is periductal masitis managed?
Co-amoxiclav
41
How does periductal massitis present?
Present at younger age than duct ectasia Features of inflammation, abscess or mammary duct fistula Recurrent infection
42
What is periductal massitis strongly associated with?
Smoking
43
How does masitis present?
Breast feeding women Breast pain Tender area that feels firm, warm, swollen Erythema Reduced milk output Fever Raised WCC and CRP
44
How is masitis managed?
Continue breast feeding flucloxacillin for 10-14 days * If systemically unwell, nipple fissure, no improvement 12-24 hours after milk removal, if culture indicates infection * Breastfeeding can continue
45
What organism most commonly causes masitis?
Staph aureus
46
Give a complication of untreated masitis
Breast abscess
47
What is cyclical mastalgia?
Common cause of breast pain due to menstruation
48
How is cyclical mastalgia managed?
Supportive bra Oral and topical analgesia Flaxseed oil and evening primrose oil Referral and hormonal agent consideration * If pain has not responsed with conservative measures after 3 months * Bromocriptine and danazol
49
Give features of intraductal papilloma
Younger patients Blood stained discharge Usually no palpable lump
50
Give features of fibroadenosis
Middle aged women Bilateral 'Lumpy' breasts May be painful Symptoms worsen prior to menstruation
51
Give features of fat necrosis
Trauma Tender
52
When should women with an unexplained breast lump be referred to specialist services?
Refer women aged \>30 with an unexplained breast lump using a suspected cancer pathway referral

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