Breast Lumps

What is the most common cause of breast lumps?

Fibroadenosis / fibrocystic change

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This is caused by a combination of what kinds of activity in the breast?

Localised fibrosis, inflammation, cyst formation, hormone-driven pain (i.e. cyclical).

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What are the symptoms associated with fibrocystic change/fibroadenosis?

Presents between menarche (first period) + menopause exclusively > 'lumpy' breasts. There is cyclical pain/swelling (i.e. comes with period)

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What is a fibroadenoma and what age patients will it normally occur in?

A benign overgrowth of the collagenous mesenchyme in a single lobule of the breast (although one women may have many). Occurs in < 30 years.

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Describe the feeling on palpation of a fibroadenoma

These are smooth and firm lumps which are highly mobile meaning they are difficult to manage to palpate - 'breast mice'. Might be described like marbles which 'run around' in the breast.

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Do fibroademonas cause pain?

These are normally painless, although they may cause very localised pain.

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Describe a cyst and how they would present.

A cyst is a fluid-filled round lump formed by cavities lined by flattened epithelium. They will present as smooth round lumps

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What would be the treatment of cysts which could also be used to confirm the diagnosis?

Ultrasound-guided aspiration to drain the fluid and confirm diagnosis of cysts (the fluid could be sent to cytology if required)

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What is the gold-standard for diagnosing breast lumps and what are the components of this?

TRIPLE ASSESSMENT: Clinical examination; breast imaging (ultrasound for < 35 and u/s + mammography for >35 yrs); Cytology/histology (fine-needle aspiration or core biopsy)

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What is the difference between a core biopsy and an open biopsy (or wide excision)?

Core biopsy = a hollow needle is used to extract a small amount of the abnormal tissue. Wide excision = a 1-2 inch incision is made and then the surgeon excises most/all of the lump (then tested in a lab to ensure more surgery is not needed)

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Which of mammography and ultrasound is better at detecting: a) invasive breast cancer and b) ductal carcinoma in situ?

a) u/s = more accurate for invasive breast cancer detection and b) mammography is most accurate for DCIS

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What type of breast carcinoma accounts for ~80% of breast cancers? Briefly explain this type of tumour.

Invasive ductal carcinoma - it begins in the cells lining the ducts and spreads into the tissue.

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What % of breast cancers are invasive lobular carcinoma? And what does this mean?

10% - these start in the cells lining the lobules and then can spread, e.g. via lymphatics).

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Would a carcinoma which is oestrogen receptor positive (70% of them) have a better or worse prognosis?

Better - it is more receptive to hormonal therapies (block the oestrogen receptor as oestrogen promotes proliferation)

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What are two other receptors which are therapeutic targets?

HER-2 and progesterone

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Is a HER2 positive cancer have a better or worse prognosis?

Worse - HER2 positive = more aggressive

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What rare type of breast cancer which may not form a lump? What physical sign might it present with?

Inflammatory breast cancer.

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What type of breast cancer is 'pre-malignant' or non-invasive?

Ductal carcinoma in-situ (DCIS) - meaning the cancer is contained within the duct from which it originated. Lobular carcinoma in situ can occur as well but is rarer.

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How would a ductal carcinoma in-situ appear on mammography? I

It is seen as microcalcification - unifocal or widespread. I.e. white mass either in one localised place or seen on the image widespread throughout the breast tissue.

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What is Paget's disease of the ******?

It is a rare complication of breast cancer where the cancer cells spread to near the ****** and cause eczematous changes at and around the ******.

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Lifetime risk of breast carcinoma for women in the UK is 1 in _. _% of breast cancer cases are related to BRCA1/2

Lifetime risk of breast carcinoma for women in the UK is 1 in 8. 5% of breast cancer cases are related to BRCA1/2

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List 4 risk factors for beast carcinoma

Early menarche, late menopause, nulliparity (never given birth), non breast-feeder, HRT (hormone replacement therapy), obesity, smoking, genetic (BRCA1/2

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Breast Lumps

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