BREAST: Identify and describe the major types of breast lump (fibroadenoma, fibroadenosis, cyst, carcinoma).
BREAST: Classification of the main types of carcinoma of the breast
- In situ vs invasive
- Adenocarcinoma (duct or lobules) vs other cell types
BREAST: Describe the aetiology, morphology and pathological consequences of carcinoma of the breast.
Aetiology:
- Incidence increases with age
- FHx, with genetic abnormality (BRCA1/2)
Morphology:
- Most commonly invasive adenocarcinomas, of which 90% are ductal and 5% are lobular
- May be oestrogen receptor positive or negative, with ER positive carrying a better prognosis
- HER-2 and progesterone receptors may also be therapeutic targets. HER2 positive indicates a poorer prognosis
Pathological consequences:
- Paget’s disease of the nipple: Eczematous changes around the nipple
- Local spread: Can lead to tethering and nipple retraction
- Lymphatic spread
- Vascular spread: Bone, lung and ovary (Krunkenburg tumour)
BREAST: List the risk factors for carcinoma of the breast
Genetic factors:
- FHx
Environmental factors:
IN GENERAL *increased oestrogen exposure*
- Early menarche/late menopause
- Nulliparity
- Not breast feeding
- HRT
- Obesity
- Smoking
BREAST: Describe the investigations required for a breast lump
TRIPLE ASSESSMENT
- Clinical examination
- Histology/cytology
- FNA (cystic lump) or core biopsy (solid lump, also best for new breast lumps)
- Mammography and US (or just US if < 35 years old - as breast tissue is too dense for mammography)
BREAST: Describe the principles of management of fibroadenoma, cyst, nipple discharge and breast pain.
- Breast cyst → Radiolucent ‘halo sign’ seen on US
- Duct ectasia sees a slit-like retraction occur, as the ducts shorten
- Causes of nipple discharge
- Green/yellow discharge → duct ectasia
- Bloody/serous discharge → intraductal papilloma
- Bilateral nipple discharge → prolactinoma
BREAST: Describe the clinical staging of breast carcinoma
TNM
Tumour: T1 < 2cm, T2 2-5cm, T3 > 5cm, T4 sees the mass fixed to the chest and peau d’orange
Nodes: N0 = no nodes, N1 = mobile ipsilateral nodes, N2 = fixed nodes
Metastasis: M0 = no distant metastases, M1 = distant metastases
