Malignant Breast Conditions

Question 1

what is a breast carcinoma in situ?

Answer 1

malignancy that is contained within the basement membrane

seen as a pre-malignant condition

Question 2

what are the two types of breast carcinoma in situ?

Answer 2

ductal carcinoma in situ

lobular carcinoma in situ

Question 3

what is the most common type of non-invasive breast malignancy?

Answer 3

ductal carcinoma in situ

Question 4

what is ductal carcinoma in situ?

Answer 4

malignancy of the ductal tissue of the breast that is contained within the basement membrane

Question 5

why ducts DCIS be treated?

Answer 5

will develop into invasive disease if not treated in about 1/3rd of patients

Question 6

how is DCIS usually diagnosed?

Answer 6

screening mammogram

Question 7

which investigation usually picks up DCIS? what does it show?

Answer 7

mammogram
micro calcifications that are either localised or widespread
then confirmed on biopsy

Question 8

what is the management of DCIS?

Answer 8

• localised DCIS -> complete wide excision

- widespread or multifocal DCIS -> complete mastectomy

Question 9

what is lobular carcinoma in situ?

Answer 9

malignancy of the secretory lobules of the breast that is contained within the basement membrane

Question 10

what are individuals with LCIS more at risk of?

Answer 10

developing invasive breast malignancy

Question 11

how does LCIS usually present?

Answer 11

• usually asymptomatic

- usually diagnosed as an incidental finding on biopsy (not associated with microcalcifications)

Question 12

what is the management of LCIS?

Answer 12

• low grade LCIS is usually monitored rather than excised

- bilateral prophylactic mastectomy can be performed if the individual has BRCA1/2 genes

Question 13

what are the three classes of invasive carcinoma?

Answer 13

• invasive ductal carcinoma
• invasive lobbular carcinoma
• other subtypes, such as medullary carcinoma or colloid carcinoma (IDCs)

Question 14

what is the most. common type of invasive breast cancer?

Answer 14

invasive ductal carcinoma

Question 15

where do most breast carcinomas arise?

Answer 15

in the terminal duct lobular unit

Question 16

which age group is most commonly affected by invasive lobular carcinoma?

Answer 16

older women

Question 17

what are the clinical features of invasive breast carcinoma?

Answer 17

• can present asymptomatically via screening
• breast lump
• asymmetry
• swelling
• abnormal nipple discharge
• nipple retraction
• skin changes
• mastalgia
• palpable lump in the axilla

Question 18

what is the differential diagnosis for all suspected breast cancers?

Answer 18

• benign tumours
• breast cysts
• infective causes

Question 19

what are the investigations for diagnosing invasive breast cancer?

Answer 19

• Triple assessment

examination, imaging, histology or cytology

Question 20

what is the most important prognostic factor in breast cancer?

Answer 20

• nodal status

- size, grade and receptor status also influences prognosis

Question 21

how is the prognosis of primary breast cancer calculated?

Answer 21

Nottingham prognostic index

Question 22

what is the classification used to classify the grade of breast carcinoma?

Answer 22

bloom-richardson classification

Question 23

the status of which receptors are check in women with breast malignancy?

Answer 23

• oestrogen receptor (ER)
• progesterone receptor (PR)
• Human Epidermal growth factor Receptor (HER2)

Question 24

what is the age of women who receive breast screening in the UK? how does it work?

Answer 24

50-70 yrs

mammogram every 3 years

Question 25

what are the risk factors for developing breast cancer?

Answer 25

- female sex - older age - mutations to certain genes - BRCA1/2 - first degree relative - previous benign disease - obesity - alcohol consumption - longer exposure to unopposed oestrogen (early menarche, late menopause, nulliparous, late first pregnancy, oral contraceptives/HRT)

Question 26

what is Paget's disease of the nipple?

Answer 26

rare condition of the nipple - involvement of the epidermic by malignant ductal carcinoma cells

Question 27

what is Paget's disease of the nipple associated with?

Answer 27

- most patient's with Paget's disease will also have an underlying neoplasm

Question 28

what is the clinical presentation of Paget's disease of the nipple?

Answer 28

- itching/redness in the nipple/areola - thickening and flaking of the skin on or around the nipple - roughened and slightly ulcerated nipple - area is painful and sensitive - flattened nipple - +/- yellowish or bloody discharge

Question 29

what is the differential diagnosis for Paget's disease of the nipple?

Answer 29

dermatitis or eczema

Question 30

how can Paget's disease be differentiated from eczema?

Answer 30

paget's always affects the nipple first and then the areola as a secondary event eczema nearly always involves the areola and spares the nipple

Question 31

what investigations are carried out when suspecting Paget's disease of the nipple?

Answer 31

- biopsy - full examination of the breast and axilla - mammograms, US or MRI breast

Question 32

what is the management of Paget's disease of the nipple?

Answer 32

surgery - nipple and areola removed - if underlying malignancy, this will also be removed - if there is underlying breast cancer, may also need radiotherapy

Question 33

what are the different surgical options used to treat breast cancer?

Answer 33

- breast conserving surgery - mastectomy - axillary surgery

Question 34

when is breast conserving surgery indicated?

Answer 34

small, localised tumours that are operable with no evidence of metastatic disease

Question 35

what is the most common form of breast conserving surgery?

Answer 35

wide local excision | - excision of tumour with 1cm margin of macroscopically normal tissue

Question 36

when is a mastectomy indicated?

Answer 36

- multifocal disease - high tumour:breast tissue ratio - disease recurrence - patient choice (reducing risk)

Question 37

what is a sentinel node biopsy?

Answer 37

removal of the first lymph nodes into which the tumour drains

Question 38

what happens after the sentinel nodes are biopsied?

Answer 38

histologically analysed

Question 39

what is axillary node clearance?

Answer 39

removing all nodes in the axilla and sending them for histological analysis

Question 40

what are the possible common complications of axillary node clearance?.

Answer 40

- paraesthesia - seroma formation (pocket of serous fluff) - lymphoedema in the upper limb