(11.1+2) Breast and Lactation Flashcards

1
Q

Describe the structure of the breasts.

A
  • Blood vessels
  • Fat & fibrous tissues
  • Alveoli in lobules that secrete milk
  • Lactiferous ducts that transport milk
  • Myoepithelial cells that controls the let down of milk
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2
Q

Describe the anatomical position of the breasts.

A
  • Lateral sternal angle - Mid-axillary line

- 2nd - 6th Rib

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3
Q

What milk is formed before it matures? Describe its constituents and how it differs from mature milk?

A

Colostrum Milk first week after birth

  • Less: Water soluble vitamins (B & C) & Fat & Sugar
  • More: Fat soluble vitamins & Proteins & Immunoglobin
  • Fat & Sugar rise over the following 2-3 weeks
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4
Q

Describe the constituents in Mature Milk.

A
  • 90% water
  • 7% Lactate
  • 2% Fat
  • Vitamins
  • Minerals
  • Lactalbumin
  • IgG
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5
Q

Describe how the milk let down is initiated.

A

Suction -> Hypothalamus -> Posterior Pituitary Gland -> dramatic decline in Oxytocin -> Myoepithelial cells contract

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6
Q

Describe the hormonal control of the growth & cessation of the breast tissues (starting from birth to old age).

A

(0) At birth: few Lobules
(1) Puberty (+ Oestrogen): Ducts sprouts and branch & Alveoli formation
(2) Menarche (+ Oestrogen): + number of Lobules & Stromal tissue
(3) Menstrual cycle
- Follicular phase: Lobules inactive
- Post-ovulation: Cells proliferation & Stromal oedema
- Menstruation: - Lobule size
(4) Pregnancy (Progesterone > Oestrogen):
- First 1/2 no lactation yet: Hypertrophy of Tubo-Lobule-Alveolar system & Stroma reduce
- Second 1/2: Differentiated Alveoli capable of milk production
(5) Birth giving (reduced Progesterone:Oestrogen ratio): responsiveness to Prolactin -> milk production
(5) Cessation (- Prolactin & - Turgor damages breast tissue): Atrophy of Lobules
(6) Ageing: Adipose tissue replace Stromal tissue

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7
Q

Describe the hormonal control of milk production.

A

Suction -> Hypothalamus -> reduced Dopamine & Vaso-active Intestinal peptide -> disinhibit Anterior Pituitary Gland -> Prolactin -> turgor & lactation

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8
Q

How do you normally investigate and diagnose breast pathology.

A
  • Clinical: history & family history & examination
  • Imaging: Mammogram & Ultrasound
  • Pathology: Fine Needle Aspiration Cytology & Core Biopsy
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9
Q

List and describe briefly three inflammatory diseases of the breast.

A
  • Mastitis: often Staphylococcus aureus enters via nipple crack/fissure (commonly secondary to breast feeding)
  • Duct Ectasia: dilation & inflammation (mimic carcinoma clinically & mammographically)
  • Fat Necrosis: masses (mimic carcinoma clinically & mammographically)
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10
Q

List and describe briefly three benign epithelial lesions of the breast.

A
  • Epithelial hyperplasia: + cell number -> fill & distend ducts & lobules
  • Fibrocystic changes: cysts formation (mimic carcinoma clinically & mammographically)
  • Papilloma: finger-like projections outward
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11
Q

List and describe briefly two stromal tumours of the breast. At which age groups is each most commonly occur?

A
  • Fibroadenoma often
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12
Q

List and describe briefly two developmental diseases of the breast (may include males).

A
  • Polythelia: 3rd nipple, often appears in the embryonic milk line
  • Gynaecomastia: breast development in males
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13
Q

List the risk factors of breast carcinoma.

A
  • Exposure to Oestrogen e.g. female, pregnancy, long menarche-menopause interval
  • Exogenous Oestrogen e.g. Hormone Replacement Therapy (but Oral Contraceptive Pills not much effect)
  • Genetics: BRCA1 & BRCA2
  • Ageing: often >50, but average diagnostic age is 64
  • Radiation
  • Fat diet & Obesity
  • Breast feeding
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14
Q

Describe the classifications of breast carcinoma.

A
  • Most commonly Adenocarcinoma
  • In situ / Invasive
  • Ductal / Lobules
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15
Q

Suggest ways and sites of metastasis of Invasive breast carcinoma.

A
  • Blood streams
  • Lymphatics / nodes (by the time of diagnosis, >50% of patients have Axillary node metastases)
  • Lungs
  • Bones
  • Brain
  • Liver
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16
Q

Describe the mammogram and histology of Ductal carcinoma in situ.

A
  • Calcification, severe cases with central necrosis, Comedo

- Cluster / Linear branched ducts

17
Q

List some clinical presentations of breast carcinoma.

A
  • Pain
  • Mass: hard, craggy, fixed, irregular
  • +/- Padget’s disease
  • Unilateral red & crusting nipple
  • Discharge: unilateral & spontaneous
18
Q

Describe the mammogram of breast carcinoma.

A
  • Calcification

- Densities

19
Q

What staging method is used for breast carcinoma?

A

TNM

  • Tumour: T1-T4
  • Nodes: N0-N2
  • Metastasis: M0-M1
20
Q

Suggest some managements of breast carcinoma.

A
  • Breast surgery: Mastectomy / Breast conserving surgery
  • Axillary surgery
  • Post-surgical radiotherapy for chest & axilla
  • Chemotherapy
  • Herceptin if Her2 receptors are found
  • Tamoxifen: if Oestrogen receptors are found in excess
21
Q

What may be the differential diagnosis for a patient presenting nipple discharge?

A
  • Carcinoma: if spontaneous and unilateral

- Pituitary adenoma / Oral contraceptive pill use: if milky

22
Q

What may be the differential diagnosis for a patient presenting painful breast?

A
  • Physiological: if cylical & diffuse

- Carcinoma / Inflammation / Cysts / Injury: if cylical & focal

23
Q

What may be the differential diagnosis for a patient presenting masses in the breasts?

A
  • Carcinoma
  • Cysts
  • Normal nodules
24
Q

Describe how the functions of Oestrogen and Progesterone differ in terms of the development of breasts.

A
  • Oestrogen -> ducts development (sprout & branch)

- Progesterone -> Alveoli (milk production)

25
Q

Where is the fat in mature milk produced? How is this different to where the proteins are produced?

A
  • Fat from Smooth Endoplasmic Reticulum

- Proteins from Golgi Apparatus

26
Q

What can be given to mothers to suppress levels of milk production?

A

Exogenous Oestrogen -> suppresses Prolactin

27
Q

Why is Progesterone only pills (not COCP) given to breastfeeding mothers?

A

Oestrogen inhibits Prolactin, reducing milk production

28
Q

What is Gynecomastia? In which groups of people are commonly seen?

A
  • Enlargement of breasts in males
  • Male neonates: due to high Oestrogen levels from the mother
  • Testicular cancer: Leydig cells are stimulated to produce Oestrogen
29
Q

What is it called, the inflammation of the Lactiferous ducts? In which group of women is it commonly seen?

A
  • Duct Ectasia

- Age 50-60

30
Q

What type of tumour are most breast malignancies?

A

Adenocarcinomas

31
Q

Suggest a differential diagnosis for a crusty, red nipple.

A
  • Acute Mastitis
  • Ductal Carcinoma in Situ
  • Paget’s Disease of breast
32
Q

Which breast cancer has the worst prognosis?

A

Invasive Ductal Carcinoma of no Specific Type (IDC-NST)

33
Q

Why may the treatment of a metastasised Lobular Carcinoma be difficult?

A

Metastasis to weird sites e.g. Peritoneum

34
Q

In what type of patient is Tamoxifen beneficial for breast cancer? Why are they at risk of Endometrial cancer?

A
  • Women with excess Oestrogen receptors
  • Tamoxifen = antagonist of Oestrogen receptors
  • However, only a partial antagonist in uterus, therefore still affected by high level of Oestrogen