11. Breast Lump Flashcards
List the four most common causes of breast lump.
Benign cystic change
Fibroadenoma
Breast cyst
Carcinoma
List some other causes of breast lump.
Fat necrosis Abscess Mastitis Galactocoele Sarcoma Duct papilloma Non-breast lumps (e.g. lipoma, sebaceous cysts)
Which causes of breast lump are most likely in <30yrs
Fibroadenoma
Physiological lumpy breast
Benign cystic change
Which causes of breast lump are most likely in 30-40yrs
Benign cystic change
Breast cyst
Abscess
Carcinoma
Which causes of breast lump are most likely in <45-60yrs
Breast cyst
Abscess
Carcinoma
Which causes of breast lump are most likely in >60yrs
Carcinoma
List two causes of breast lump that are exclusive to breast-feeding women.
Galactocoele
- Occurs shortly after cessation of lactation
- Caused by blockage of lactiferous ducts
- May get infected
Mastitis
- More common in breast-feeding women
Which organisms are usually responsible for mastitis?
Staphylococcus aureus
Staphylococcus epidermidis
List the major risk factors for breast cancer.
Previous breast cancer Family history of breast cancer Chest wall irradiation Previous cancer (in particular: ovarian, endometrial, bowel) Increased exposure to oestrogen
List some examples of increased exposure to oestrogen that can be elicited from a history.
Early menarche Late menopause Nulliparity Late first child (> 30 yrs) HRT COCP Not breast-feeding Obesity
List some important questions that should be asked regarding the history of presenting complaint.
How long has the lump been there for?
Has there been any trauma to the breast?
Is the lump painful?
Has it changed in size? Is the change in size related to your menstrual cycle?
Have you noticed any changes in the skin on the breast?
Have you noticed any discharge?
Are you otherwise fit and well?
Which causes of breast lump appear quite rapidly?
Cysts
Abscesses
Which causes of breast lump appear more gradually?
Fibroadenoma
Carcinoma
Why is it important to ask about breast trauma?
Increases the risk of fat necrosis and infective causes of breast lump (e.g. abscess, mastitis)
Why is it important to ask about the relationship between the changing size of the breast lump and the patient’s menstrual cycle?
The lumps in benign cystic change undergo cyclical changes in size and character
Which causes of breast lump are classically associated with being painful?
Benign cystic change
Abscess
Mastitis
What would warm, erythematous skin overlying the lump suggest?
Infective/inflammatory cause (e.g. mastitis, abscess)
What does tethering of the skin over the lump suggest?
Carcinoma until proven otherwise
Describe the character of the discharge in Breast Carcinoma
Bloody
Describe the character of the discharge in Intraductal Papilloma
Serous or seranguinous
Describe the character of the discharge in Periductal Mastitis
Yellow, green, brown
Describe the character of the discharge in Galactocoele
Milky
Define duct ectasia.
A condition in which the lactiferous ducts become blocked or clogged
Why is it important to check whether the patient is otherwise fit and well?
Most patients with breast lumps don’t have an other symptoms
Patients with infective/inflammatory causes of breast lump (e.g. mastitis, abscess) may experience fever
NOTE: breast cancer rarely leads to systemic signs of malignancy
List some key features of inspection of the breasts.
Asymmetry
Contours
Skin changes
Nipple discharge
List some skin changes of the breast that you should look out for.
Erythema Ulceration Peau d’orange Tethering Radiotherapy tattoos
Describe what a solitary cyst feels like on palpation
Smooth surface + distinct border + firm to lax
NOTE: feels similar to fibroadenoma
Describe what benign cystic change feels like on palpation
Irregular surface + indistinct borders + mixed consistency
Describe what a fibroadenoma feels like on palpation
Smooth surface + distinct borders + rubbery + mobile
Describe what a carcinoma feels like on palpation
Irregular surface + indistinct borders + hard
Tethering?
Lymphadenopathy?
What are the components of triple assessment?
Clinical examination
Radiological examination
FNA and core biopsy
Which types of radiological assessment of the breast lump are offered to patients?
< 35 years = ultrasound
35+ years = two-view mammogram
NOTE: younger women do not get mammograms because their breast tissue is more dense and it is difficult to identify masses
What is the difference between an FNA and a core biopsy?
FNA – samples cells for cytology
Core biopsy – samples tissue for histology
Describe the management of fibroadenomas.
Benign condition that will resolve over several years
Can be removed by excisional biopsy
What are the four most common sites of metastasis of breast cancer?
Liver
Bone
Lungs
Brain
Describe the treatment options for breast cancer.
Local Treatments: Radiotherapy + Surgery
Systemic Treatments: Chemotherapy + Hormonal Therapy + Monoclonal Antibodies
Describe the typical presentation of a patient with a breast abscess.
Sudden appearance of a painful lump
Usually in middle-aged smokers
Fever, skin erythema and tethering may also be found
What important risk factor is strongly associated with breast abscess and non-lactational mastitis?
Smoking
How are breast abscesses treated?
Incision and drainage
Antibiotics
Describe the typical presentation of breast cysts.
Well-circumcribed lump with a smooth surface and firm texture (may be painful)
How can cysts and fibroadenomas be distinguished?
Ultrasound
Cysts will be hypoechoic
Fibroadenomas will be hyperechoic
NOTE: when cysts are drained, the fluid will be green, brown or yellow
What is gynaecomastia?
Enlargement of the breasts in males, either due to hormone imbalance or drug therapy
List some pathological causes of gynaecomastia.
Liver disease
Drugs (e.g. spironolactone, cimetidine, finasteride)
Primary testicular failure (e.g. bilateral cryptorchidism)
Acquired testicular failure
Secondary testicular failure (e.g. panhypopituitarism)
Endocrine tumours (e.g. testicular, adrenal, pituitary)
