Breast Week Flashcards
(119 cards)
1
Q
where does the GP refer patients who present with a breast problem? (eg lump, breast pain, nipple discharge)
A
one stop breast clinic
2
Q
what age group is offered breast screening and how often?
A
50-70 year olds
every 3 years
3
Q
what is the most common cause of green discharge?
A
duct ectasia
4
Q
what is duct ectasia?
A
when a lactiferous duct becomes blocked
5
Q
how many lobules are found in a breast?
A
15-25 lobules
6
Q
what do breast lobules contain?
A
a tubulo-acinar gland which drains via a series of ducts to the nipple
7
Q
what fascia does the breast sit infront of?
A
the pectoralis fascia
8
Q
what are the suspensory ligaments (of Cooper) of the breast made of? what is their function
A
thickenings of the fibrocollaginous tissue that the breast is made of
-connect the pectoralis fascia to the dermis, through adipose tissue
9
Q
what is the expansion of the lactiferous duct near the nipple region called?
A
the lactiferous sinus
10
Q
within a breast lobule, terminal ductules pass breast secretions to what duct?
A
intralobular collecting duct
11
Q
what duct does the intralobular collecting duct pass breast secretions to?
A
lactiferous duct
12
Q
what cells make up the nipple?
A
highly pigmented keratinised stratified squamous epitheijm
13
Q
what is the function of sebaceous glands near the margins of a nipple?
A
to produce sebum to counteract chaffing (which can be caused by suckling)
14
Q
what is the function of smooth muscle cells within the nipple?
A
nipple erection
15
Q
what is the function of the lactiferous sinus?
A
acts as a small milk reseroir
-so baby gets milk instantly as it begins suckling
16
Q
what kind of secretion do sebaceous glands use?
A
holocrine secretion
17
Q
what is holocrine secretion?
A
the cells themselves undergo apoptosis and their cell contents (containing the section) are spilled out of the gland
18
Q
why are sebaceous glands on the nipple different to normal sebaceous glands?
A
usually sebaceous glands secrete onto hair follicles
in the nipple the secretions are directly let out onto the skin surface
19
Q
lipids are secreted into breast milk via which mechanism?
A
apocrine secretion
20
Q
what is apocrine secretion?
A
secretory product is in a vesicle which is taken up to the cell membrane and then pinched off
21
Q
proteins are secreted into breast milk via which mechanism?
A
merocrine secretion
22
Q
what is merocrine secretion (exocytosis)?
A
secretory product is in a vesicle, this vesicle fuses with cell membrane and the vesicle is released
23
Q
what is the main difference between apocrine and merocrine secretion?
A
apocrine - secretory vesicle contains some cytoplasm
merocrine - no cyoplasm
24
Q
what happens to the secretory cells, ducts, and connective tissue in the breast following menopause?
A
secretory cells degenerate
ducts system remain
in connective tissue there is reduced collagen and elastin
25
what is the triple assessment which is done at the one-stop clinic?
1. clinical (history + exam)
2. imaging (US, mammography, MRI)
3. pathology (ie fine needle aspirate, core biopsy)
26
what are the 5 results of an FNA?
```
C1- unsatisfactory
C2- benign
C3- atypia but probably benign
C4- suspicious of malignancy
C5- malignant
```
27
what are the main disadvantages of FNA for a possible breast malignancy?
can't see whether the malignancy is invasive or not
| can't tell what type of tumour it is
28
what are the 2 therapeutic surgical options for breast cancer?
wide local excision
| mastectomy
29
what is a mastectomy?
removal of all breast tissue
30
what are the 6 results of a needle core biopsy?
```
B1- unsatisfacory
B2- benign
B3- atypia but probs benign
B4- suspicious of malignancy
B5a- carcinoma in situ
B5b- invasive carcinoma
```
31
what are the 4 main developmental anomalies of the breast?
hypoplasia
juvenile hypertrophy
accessory breast tissue
accessory nipple
32
when does the presence of accessory breast tissue become more evident?
hormonal states (eg pregnancy)
33
where is the most common place for an accessory nipple?
inferomammary fold
34
what are the 5 main non-neoplastic, non-inflammatory causes of breast lumps?
```
gynaecomastia
fibrocystic change
fibroadenoma
hamartoma
sclerosing lesions
```
35
what is accessory breast tissue?
normal breast tissue in an abnormal place (can be anywhere along the milk line, from axilla to vulva)
36
what are the 3 main inflammatory breast pathologies?
fat necrosis
duct ectasia
acute mastitis/abscess
37
what is gynaecomastia?
breast development in the male
38
do ducts or lobules develop in gynaecomastia?
ducts grow
| no lobar development
39
what are the 4 most common causes of gynaecomastia?
- exogenous or endogenous hormones
- cannabis
- prescription drugs
- liver disease
40
what is the common factor for the causes of gynaecomastia?
the different causes all stimulate oestrogen receptors
41
what age group of women get fibrocystic change?
20-50 years old (majority 40-50)
42
what are the 3 main risk factors of fibrocystic change?
menstrual abnormalities
early menarche
late menopause
43
what are the main symptoms of fibrocystic change?
smooth discrete lumps
| sudden, cyclical pain
44
what is a breast hamartoma?
a lesion of normal breast cell types but in abnormal proportions
45
what is the usual age range for fibroadenomas?
teens to late 20s
46
are fibroadenomas painful or painless?
painless
47
is fibrocystic change painful or painless?
can be painful
48
what benign breast condition does sclerosing adenosis commonly co-exist with?
fibrocystic change
49
is sclerosing adnenosis painful or painless?
painful
50
what is the usual age range for sclerosing adenosis?
20-70
51
what are the main 2 causes of fat necrosis of the breast?
local trauma
| anticoagulation therapy
52
why can anticoagulation therapy cause fat necrosis of the breast?
minor trauma can cause bleeding and subsequent damage
53
what happens to the breast following fat necrosis?
fibrosis and scarring (contraction)
54
what ducts are affected in duct ectasia?
sub-areolar ducts
55
what is a fistula?
a pathological connection between to epithelial surfaces
56
what is the main risk factor for duct ectasia?
smoking
57
why do nipple changes occur with duct ectasia?
periductal inflammation and fibrosis with subsequent scarring
(this causes distorion due to contraction of the tissue)
58
what is the treatment of duct ectasia?
treat acute infections
stop smoking
excise ducts
59
what are the 2 main types of organisms involved in duct ectasia?
mixed organisms
| anaerobes
60
what are the 2 main types of organims involved in acute mastitis? (due to lactation)
staph aureus
| strep pyogenes
61
what is the usual age group for a phyllodes tumour?
40-50 years old
62
what are the 3 groups of phyllodes tumour?
benign
borderline
malignant (sarcomatous)
63
what is the usual age group for an intraduct papilloma?
35- 40 years old
64
what ducts are usually affected by an intraduct papilloma?
sub-areolar ducts
65
what are the 4 main non-epithelial breast malignancies?
malignant phyllodes tumour
angiosarcoma
lymphoma
mets
66
what are angiosarcomas of the breast most commonly secondary to?
radiotherapy for prev breast carcinoma
67
what is a (breast) carcinoma?
a malignant tumour of (breast) epithelial cells
68
what do breast carcinomas arise from?
glandular epithelim in the terminal duct lobular unit (TDLU)
69
a breast carcinoma is actually what type of carcinoma?
adenocarcinoma
70
what is an adenocarcinoma?
a malignant tumour of glandular epithelium
71
what are the 2 main types of precursor lesions for breast carcinoma?
ductal precursor lesions
| lobular precursor lesions
72
an in-situ-carcinoma is confined within what structure?
basement membrane
73
an in-situ-carcinoma is non-obligate precursor of invasive carcinoma, what does this mean?
some will progress to the invasive form, some will not
74
describe the pathway from normal ductal breast tissue to invasive carcinoma?
```
normal
epithelial hyperplasia of usual type
atypical ductal hyperplasia
ductal carcinoma in situ
invasive carcinoma
```
75
what determines whether a lobar precursor for breast carcinoma is called an atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS)?
ALH- less than 50% of lobule involved
| LCIS- more than 50% of lobule involved
76
lobular in situ neoplasisa (ie lobular precursor for breast carcinoma) are usualy E-cadherin negative- how has this happened?
one CDH1 gene has been deleted
| the other CDH1 gene has been mutated
77
ductal carcinomas in situ are usually unicentric, what does this mean?
single duct system affected
78
if a ductal carcinoma in situ involves the nipple, what is it called?
Pagets disease of the breast
79
is paget's disease of the nipple invasive or non-invasive?
non invasive
| still classes as a ductal carcinoma in situ
80
what is a ductal carcinoma in situ 'comedo'?
an area of necrosis within the ductal carcinoma in situ
81
why do we treat ductal carcinomas in situ aggressively now?
because they are a precurors lesion for invasive carcinoma
82
what indicates that a carcinoma in situ has become an invasive carcinoma?
the basement membrane has been breached
83
what is the most commonly diagnosed cancer for men and women in the UK?
men- prostate
| women- breast
84
what are the 6 main risk factors (or groups of risk factors) for carcinoma of the breast?
- age
- reproductive history
- hormones (eg OCP, HRT)
- previous breast disease
- lifestyle
- genetics
85
what about the reproductive history increases breast cancer risk?
early menarche
late menopause
smaller time breast feeding
nulliparity/age over 35 before first child
86
what about the lifestyle increases breast cancer risk?
```
high BMI
low levels of physical activity
alcohol consumption
poor diet
smoking
```
87
why does your risk of breast cancer increase as your BMI increases?
due to increased oestrgen levels (because of the conversion in fatty tissues)
88
what is the sentinel node?
the first node that drains the tumour
89
what are the 6 groups of axillary lymph nodes?
```
anterior
posterior
infraclavicular
central
apical
lateral
```
90
what happens to the amount of differentiation of the tumour as the grade gets higher?
as grade gets higher, differentiation gets poorer
91
what is the single strongest predictor of prognosis of breast carcinoma?
lymph node status
92
if the breast carcinoma expresses ER, what does this mean clinically?
it will respond to anti-oestrogen therapy
| ER- oestrogen receptor
93
what are the 4 anti-oestrogen therapies for ER positive breast carcinoma?
oophrectomy
tamoxifen
GnRH antagonists
aromatase inhibitors
94
if the breast carcinoma expresses HER 2 what does this mean clinically?
it will respond to herceptin
| human epidermal growth factor receptor 2
95
are ER + and/or HER + breast carcinomasgood or bad prognostic indicators?
good prognostic indicators
96
which is more common- breast carcinoma originating in the ducts or in the lobes?
ductal type (80%)
97
what investigation is used for the definite diagnosis of breast cancer?
core needle biopsy
98
what is modified radical mastectomy?
`removal of entire breast and axillary lymph nodes but with preservation of the pectorais major muscle
99
what is the advantage of skin-sparing mastectomy?
peserves the overlying skin leading to a superior aesthetic outcome with breast reconstruction
100
what is the most common benign neoplasm of the breast?
fibroadenoma
101
when during the menstrual cycle is cyclic mastalgia most painful?
just before menstruation
102
what is the diagnosis and treatment of a cyst?
fine needle aspiration
103
why must you palpate the area of a cyst after aspiration?
to be certain there is no residual mass
104
what is the most common cause of spontaneous nipple discharge?
an intraductal papilloma or papillomas
105
why should all intraductal lesions be excised even though they are benign?
so they can be histologically evaluated to ensure they arent an intraductal carcinoma
106
how does pagets disease of the nipple usually present?
dry and scaly eczematous lesion
| a weeping lesion on the surface of the nipple and areola
107
what is the treatment of mastitis?
antibiotics (flucloxacillin) as soon as suspected
108
what is the treatment of a breast abscess?
repeated aspirations
if not working- open surgical drainage under GA
plus antibiotics
109
what is fat necrosis usually secondary to?
breast trauma
110
what is a galactocoele?
a palpable milk-filled cyst
111
how do you diagnose and treat galactocoeles?
FNA
112
what is mondor's disease?
phlebitis with subsequent clot formation in the superficial veins of the breast
113
what is mondor's disease usually associated with?
history of trauma to the breast, eg surgery
114
what is the treatment of mondors disease?
will resolve spontaneosly in 8-12 weeks
115
to ensure the same overall survival rates as mastectomy, what is needed in addition to breast conservation surgery?
clear margins greater than 1mm
| breast radiotherapy
116
what is oncoplastic surgery?
safe oncological surgery while avoiding tissue deformity
| -breast contours reshaped at time of cancer resection
117
what ribs is the breast base over?
2-6
118
what fascia is the breast enclosed with?
superficial fascia
119
what imaging is used to look at breast lumps in a patient under 40 compared to over 40?
under 40: US
| over 40: mammography +/- US
