183
H Sinh D c
B ng11.1 U vú
TABLE 11.1 Breast Tumours
Breast tumour
Benign or
malignant
Fibroadenoma
Benign
Characteristics
Small
Also known as ‘breast mouse’
due to tumour not being
tethered
Sharp edges
Most common type of benign
breast tumour in young
women
Investigations
Treatment
Complications
Undergo triple assessment:
1 Examination
2 Imaging
3 Biopsy
Physical examination for
lumps and masses
Bloods: FBC, WCC, U&Es,
LFTs, TFTs
Radiology: mammogram,
ultrasound scan, fine
needle biopsy under
ultrasound guidance
(core needle biopsy may
be required). Look for
metastasis with CXR,
CT scan and MRI scan
Risk factors for breast cancer:
•
Female
•
Increasing age
•
Family history of breast
cancer
•
Genetic
involvement, e.g.
BRCA 1 (chromosome 17)
and BRCA 2
(chromosome 13)
•
Alcohol
•
Obesity
•
Increased oestrogen
exposure, e.g.:
○
Early menarche
○
Late menopause
○
Oral contraceptive
pill use
○
Hormone
replacement therapy
○
Decreased parity
○
Not breastfeeding
Treatment depends
on the cause of the breast
tumour and whether it is
benign or malignant;
treatment may be split
into 3 modalities:
1 Conservative: patient and
family education; refer to
Macmillan nurses; offer
genetic counselling; provide
psychological assessment
and support
2 Medical: prognosis of
disease is assessed using
the Nottingham Prognostic
Index (NPI):
NPI = (0.2 × invasive size) +
lymph node stage + grade
of tumour
Medical therapy may be
split into adjuvant hormone
therapy, chemotherapy or
HER2 directed therapy,
depending on the type of
tumour
Hormone treatment:
premenopausal women are
treated with tamoxifen
(a selective oestrogen
receptor modulator);
postmenopausal women are
treated with anastrazole
(an aromatase inhibitor).
This is because trials such as
the ATAC trial have
suggested that aromatase
inhibitors are superior to
tamoxifen in postmenopausal
women. If a woman becomes
menopausal during
treatment she will benefit
from switching medications
Chemotherapy and
radiotherapy regimens: vary
depending on tumour type
HER2 directed therapy:
treatment with trastuzumab
(herceptin). This is a
monoclonal antibody against
the extracellular domain of
the HER2 receptor
3 Surgical: the primary aim
of surgery is to remove
the invasive and
noninvasive cancer with
clear margins. Lumpectomy
followed by a radiotherapy
regime has been shown to
be as effective as
mastectomy, but
mastectomy may be
recommended in certain
circumstances such as
multifocal breast disease.
The ipsilateral axilla should
also be assessed with
ultrasound, fine needle
aspiration or core biopsy.
Giai đo n lâm sàng c a
nách nên đư c đánh giá b ng
sinh thi t h ch lympho canh
gác. M c đích là tránh c t b
nách không c n thi t.
Death
Metastasis
Complications of
chemotherapy regimen
Complications of
radiotherapy regimen
Depression
Intraductal
papilloma
Benign
Small
Under areola
Bloody discharge from nipple
Large
Leaf-like projections
Rapid growing
Phyllodes
tumour
Benign
From ductal hyperplasia
Cheesy discharge, confined to
ducts
Ductal carcinoma
in situ (DCIS)
Malignant
High-grade DCIS
Characterised by central
necrosis
Cheesy discharge
Comedocarcinoma Malignant
Invades the dermis and
lymphatic system
Peau d’orange appearance
Retracted nipple
A hard mass
Sharp edges
Most common
Very aggressive
Invasive ductal
Malignant
Bilateral presentation
Invasive lobular
Malignant
Inflammatory
Malignant
Well differentiated
Lacks desmoplastic reaction
Lymphatic infiltrate
Good prognosis
Medullary
Malignant
Paget’s disease of
the breast
Malignant
Epidermal infiltration of ductal
carcinoma
Eczematoid nipple changes
TABLE 11.1 Breast Tumours (Continued )
Breast tumour
Benign or
malignant Characteristics
Investigations
Treatment
Complications
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