Breast Reproductive Pathophysiology Notes
Acknowledgement and Preamble
Page 2: Acknowledgement of Country- RMIT University acknowledges the people of the Woi wurrung and Boon wurrung language groups of the eastern Kulin Nation on whose unceded lands we conduct the business of the University.
RMIT respectfully acknowledges their Ancestors and Elders, past and present.
RMIT also acknowledges the Traditional Custodians and their Ancestors of the lands and waters across Australia where we conduct our business.
Preamble to Reproductive Lectures
Page 3: Scope of content and inclusivity- Content covers typical male and female reproductive systems.
Acknowledges intersex variations: individuals born with physical sex characteristics not fitting typical female or male norms.
Acknowledges transgender individuals who may have reproductive organs different from the typical male/female descriptions in this unit.
Variations will not be covered in these lectures.
Not all trans and gender-diverse people affirm gender via surgery.
Emphasizes avoiding heteronormativity and cisnormativity in language and practices within the context of the reproductive system.
Learning Objectives
Page 4: Learning objectives- Discuss neoplasms of the breast including:
Benign fibroadenoma
Carcinoma in situ (CIS)
Invasive carcinoma (IC)
Fibroadenoma
Page 5: Definition and epidemiology
Fibroadenomas are the most common benign breast tumour.
Presents as round, rubbery, mobile, palpable breast masses.
Typically occur in young women aged 15-35 years.
May be present during pregnancy and lactation.
Multiple fibroadenomas can occur in the same breast or bilaterally in about 20% of cases.
Most are asymptomatic.
Etiology unknown; most likely hormonal relationship – unopposed estrogen.
Persist during reproductive years; can increase in size with estrogen therapy; usually regress after menopause.
Gross appearance: ovoid mass with clearly defined contour; cut surface is firm and grey-white in colour and glistening.
Page 6: Signs, symptoms, and causes
Signs and Symptoms:
Painless, mobile lump in the breast.
Firm and well-defined mass.
May vary in size during the menstrual cycle.
Can be multiple lumps.
Rarely causes nipple discharge.
Causes:
Hormonal changes (estrogen).
Genetic predisposition.
Age most common 15-35 years.
Personal or family history of breast conditions.
Unknown factors (exact causes not fully understood).
Anatomy (contextual): Lobules, Milk duct, Skin, Fatty tissue, Muscles.
Breast Cancer: Overview and Risk Factors
Page 7: Epidemiology and risk factors
Affects 1/8 of women before age 85.
It is the most common diagnosed cancer in Australia (2021).
It is the second most common cause of cancer-related deaths in females.
Incidence increases through the reproductive years and declines slightly after menopause.
Risk factors include:
Age: increasing from reproductive years;
Genetic predisposition: inherited mutations such as BRCA1 and BRCA2;
Estrogen exposure;
Epithelial hyperplasia.
Page 8: Additional risk factors
First-degree or second-degree relative with breast cancer.
Prolonged estrogen exposure: early menarche, late menopause, nulliparity, lack of breastfeeding, exogenous hormones.
Carcinoma of contralateral breast or endometrium.
Radiation exposure: chest radiation.
Lifestyle factors: diet and lack of exercise, alcohol consumption, smoking.
Obesity: aromatase produced in fat cells promotes estrogen production.
Clinical Presentation and Diagnosis
Page 9: Clinical presentation and diagnosis
Presents in four main ways:
1) Palpable lump in the breast;
2) Abnormality detected on mammography;
3) Incidental histological finding in breast tissue removed for another reason;
4) Detection of metastatic deposit in other organs.
Diagnosis includes:
Self examination;
Mammography;
Tissue biopsy.
Page 10: Types of breast cancer
Invasive types:
Invasive ductal carcinoma (IDC);
Invasive lobular carcinoma (ILC).
Non-invasive types:
Ductal carcinoma in situ (DCIS);
Lobular carcinoma in situ (LCIS).
Page 11: DCIS and LCIS (descriptions)
DCIS:
Abnormal cells confined to ducts; in situ.
LCIS:
Abnormal cells confined to lobules; in situ.
Visual aids show progression from normal lobule/duct to abnormal cells in ducts or lobules.
Page 12: Breast cancer development sequence
Normal Duct → Intraductal Hyperplasia → Atypical Ductal Hyperplasia → Ductal Carcinoma In Situ (DCIS) → Invasive Ductal Carcinoma (IDC).
Note the sequential progression from benign proliferative changes to in situ carcinoma and finally invasion.
Page 13: Quadrant distribution (IDC focus)
Distribution percentages (likely for IDC location):
Upper inner quadrant: 25%,
Upper outer quadrant: 45%,
Lower inner quadrant: 15%,
Lower outer quadrant: 10%,
Tail of Spence: 5%.
Most common site: Upper outer quadrant (UOQ).
Signs and Symptoms of Breast Cancer
Page 14: Key signs and symptoms- Palpable lump in the breast or axilla: hard, irregular, sometimes painful and tender.
Altered appearance or contour of the breast.
Skin changes: dimpling or wrinkling (orange peel texture), redness or irritation.
Nipple changes: discharge (bloody), retraction (inverted), texture (scaly, flaky, crusty).
Swelling in or around the breast.
Pain in the breast or nipple that often does not fluctuate with the menstrual cycle.
Enlarged lymph nodes: axillary or clavicular; nodes that drain the breast.
General symptoms: unexplained weight loss, fatigue, or other systemic conditions (possible spread).
Metastasis and Spread
Page 15: Metastasis patterns- Local spread to the skin can cause nipple retraction and discharge.
Lymphatic spread to regional lymph nodes can affect lymphatic drainage of the skin, producing an appearance similar to an orange peel, thick, pitted skin.
Vascular spread to distant sites: brain, lungs (breathlessness), liver, and bone (pathological fractures).
Summary: Learning outcomes reaffirmed
Page 16: You should now be able to- Discuss neoplasms of the breast including:
Benign fibroadenomas;
Carcinoma in situ (CIS);
Invasive carcinoma (IC).