11. Breast Lump

Question 1

What are 4 most common diagnoses for a breast lump?

Answer 1

Benign cystic change
Fibroadenoma
Cyst
Carcinoma

Question 2

What are the 5 most common diagnoses for a breast lump in women under 30?

Answer 2

Physiologically normal lumpy breast
Benign cystic change
Fibroadenoma
If breastfeeding: Galactocele + Abscess

Question 3

What are the 4 most common diagnoses for a breast lump in women aged 30-45 ?

Answer 3

Benign cystic change
Cyst
Abscess (esp. smokers)
Carcinoma

Question 4

What are the 3 most common diagnoses for a breast lump in women aged 45-60?

Answer 4

Cyst
Abscess (smokers)
Carcinoma

Question 5

What are the most common diagnoses for a breast lump in women aged over 60?

Answer 5

Carcinoma

Question 6

What 2 diagnoses would you only encounter in breast-feeding women?

Answer 6

Galactocele

Mastitis

Question 7

What are the 5 main risk factors for breast cancer?

Answer 7

Previous breast cancer
FH of breast cancer
Previous bowel, ovarian + endometrial cancer
Irradiation to the chest wall
Increased exposure to oestrogen

Question 8

What 7 questions should you ask in a breast lump history?

Answer 8

How long has the lump been there, why was it first noticed?
Breast trauma?
Has the lump got bigger, smaller or stayed the same size? Are changes related to the menses?
Is the lump painful?
Any skin/ nipple change or nipple discharge?
Otherwise fit + well?

Question 9

What 4 key features will you look for on inspection in a breast exam?

Answer 9

(new) Asymmetry
Countours (disruption)
Skin changes
Nipple changes/ discharge

Question 10

What kind of surface, borders, consistency, mobility, fixity and lymphadenopathy do cysts have?

Answer 10

S: Smooth
B: Distinct
C: Firm to lax
M: None
F: None
L: None

Question 11

What kind of surface, borders, consistency, mobility, fixity and lymphadenopathy do fibroadenomas have?

Answer 11

S: Smooth
B: Distinct
C: Rubbery
M: Yes
F: None
L: None

Question 12

What kind of surface, borders, consistency, mobility, fixity and lymphadenopathy do carcinomas have?

Answer 12

S: Irregular
B: Indistinct
C: Hard
M: None
F: Maybe
L: Maybe

Question 13

What makes up the triple assessment for breast lumps?

Answer 13

1. Clinical examination
2. Radiological: <35 US, >35 two view mammogram
3. Fine needle aspiration or core biopsy

Question 14

List 8 causes of increased oestrogen exposure

Answer 14

Early menarche
Late menopause
Nulliparity
Having 1st child >30y
Not breastfeeding
HRT
COCP
Obesity

Question 15

What kind of surface, borders, consistency, mobility, fixity and lymphadenopathy do benign cystic changes have?

Answer 15

S: Irregular
B: Indistinct
C: Mixed
M: None
F: None
L: None

Question 16

Where does breast carcinoma most commonly metastasise to?

Answer 16

Liver
Bone
Lungs
Brain

Question 17

What are the advantages and disadvantages of fine needle aspiration?

Answer 17

A:
Quick
Minimally invasive
Low risk of bruising/ local complications
Can assess hormone receptor status of cell
D:
May have poor sensitivity
In situ + invasive disease can’t be distinguished

Question 18

What are the advantages and disadvantages of core biopsy?

Answer 18

A: In situ + invasive disease can be distinguished as local architecture preserved
D:
Higher risk of local complications + bruising
Results not immediate
Requires LA
More invasive + time consuming

Question 19

What is meant by the letters and numbers used in the scoring system of breast lumps?

Answer 19

P: Physical exam
R: Radiological exam
C: Cytology (FNA)
B: Biopsy (core)
1= Normal 
5= Malignant