the breast clinic index case year 2 michaelmas term
TRANSCRIPT
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The Breast Clinic
Index case
Year 2 Michaelmas term
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37 year old lady
• Noticed lump in right breast 2 weeks ago
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45 year old woman
• Noticed lump in breast two weeks ago
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28 year old woman
• Noticed lump in left breast two weeks ago
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65 year old man
• Noticed lump in breast two weeks ago
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You are doctor in breast clinic
• You have 15 mins with this patient and have to decide what the lump is likely to be due to
• What are you going to ask in the history?
• What are you going to examine?
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Discussion-
• What are the common causes of a breast lump?
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Discussion
• What specific questions would you ask in the history to help differentiate between the different causes of breast lump?
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Discussion
• What specific things would you check on examination of the breast
What other parts of the body would you examine?
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After 15 mins
• What happens to the patient next?
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Triple Assessment
• History and Examination
• Breast Imaging
• Histology if solid lump
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Breast Imaging
• Mammography
• Ultrasound
• Ultrasound guided core biopsy
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Typical appearance of a breast cancer on mammography
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Features of breast cancer on mammography
• Radio-opaque area or mass
• Irregular edges with fine lines (spiculation)
• Calcification
• Asymmetry
• DCIS may be seen as micro calcification- like sand
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Ultrasound breast cancer
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Ultrasound breast cancer
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Ultrasound of the breast mass
• Solid mass
• Dark with shadowing behind
• Can measure and then biopsy the mass
• Ultrasound the ipsilateral axilla to look for enlarged Lymph nodes
• Give radiological Score of 1 to 5
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Ultrasound guided biopsy
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Histological diagnosis
• Ultrasound guided core biopsy using a large needle and taking several cores under local anaesthetic
• Occasionally do fine needle cytology if v small lesion or technically difficult e.g near implant
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Histological types
• Adenocarcinoma:• Ductal 75%• Lobular 10%• Other types 10-15%• Define grade of tumour, 1 to 3 • Immunohistochemical staining for receptors:
oestrogen, HER2• Give Histological score of 1 to 5
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Multidisciplinary Team
• Breast Clinicians, Radiologists, Pathologists, Nurses, Data managers
• Review of Clinical, Imaging and Pathology
• Check all correlate
• Plan of treatment decided for patient
• Avoids mistakes being made!