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Core Curriculum > 12. Breast Conditions > Flashcards

12. Breast Conditions Flashcards

1
Q

Categorise Breast Conditions by where they affect

A

Lobules:

  • Fibroadenoma
  • Lobular carcinoma

Milk Duct:

  • Ductal Carcinoma
  • Duct Ectasia

Fatty Tissues:

  • Mastitis
  • Abscess
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2
Q

What is included in Benign Breast Disease?

A
  • Fibroadenoma
  • Breast Cyst
  • Duct Ectasia (Non-puerperal mastitis)
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3
Q

Describing Benign Breast Disease: SCTF

A

Site, size, skin, single?
Colour, contour, consistency
Tenderness, temperature, transilluminable
Fluctuant or fixed

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4
Q 
Fibroadenoma
Definition
Epidemiology
Signs
Invx
Mx
A

Definition: Benign breast tumours
Epidemiology: Young women of child-bearing age

S: 1-5 cm, singleC: well demarcated, firm consistency, highly mobileT: tenderlessF:

Invx:
FNA (fine needle aspiration biopsy). USS/mammography

Mx:
Surgical: cryoablation (US guided), excision. Medical: Ormeloxifene

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5
Q 
Duct ectasia
Definition
Epidemiology
Signs
Invx
Mx
A

Definition: Blockage of the milk ducts.

Epidemiology: Peri/post menopausal women (40-50+)

S: small lump behind nipple, nipple inversion
C: nipple discharge (watery/thick/blood stained/green), firm consistency
T: tender
F: fixed

Invx: Biopsy

Mx: Self limiting

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6
Q 
Breast cyst
Definition
Epidemiology
Signs
Invx
Mx
A

Definition: Fluid filled sac within the breast

Epidemiology: Pre menopausal women (30-40s)

S: singleC: well demarcated, highly mobileT: tenderless, transilluminablef: fluctuant

Invx: FNA (fine needle aspiration biopsy). USS/mammography

Mx: Fine needle aspiration/fluid drain

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7
Q 
1. A 60 year old obese woman presents to her GP with a lesion on her breast. The lesion is red, crusted, around her right nipple. The most likely diagnosis is  
A. Breast cyst
B. Breast abscess
C. Paget’s disease of the breast
D. Fibroadenoma
E. Fibrocystic disease
A

C. Paget’s disease of the breast

A: More common in pre-menopausal women; single fluctuant lump
B: No risk factors such as breastfeeding, no symptoms of infection (fever, pain)
D: More common in younger women, single smooth mobile lump
E: More common in menstruating women, changes coicide with menstrual cycle

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8
Q 
2. 22 year old woman presents to clinic with a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable. The most likely diagnosis is:
A. Acute mastits 
B. Breast abscess
C. Breast cyst
D. Fibroadenoma
E. Periductal mastitis
A

D. Fibroadenoma

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9
Q
  1. A 21 year old woman presents to her GP with pain in her right breast. She has just given birth to her first child. On examination, right breast appears swollen, red and there is tenderness on palpation. You do not suspect there are any abscesses present. The most appropriate management plan would be:
    A. Antibiotics
    B. Refer to surgeon for incision and drainage
    C. Refer to breast feeding support group and prescribe analgesia
    D. Watch and wait
    E. Confirm diagnosis with USS
A

C. Refer to breast feeding support group and prescribe analgesia

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10
Q

Breast cancer Epidemiology

A

Most common type of cancer in the UK
Most common cause of death in women ages 35-55
1 in 8 women are diagnosed with breast cancer during their lifetime

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11
Q

Risk factors for Breast Ca?

A 
A FROGMAN
Age
Family history (1st degree relative)
Radiation exposure (to chest)
Obesity and OCP/HRT
Genetics
Menarche (<11) and menopause(>55)
Alcohol, fatty diet
Nulliparity
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12
Q

Familial breast cancer

A

5% of cases
BRCA1 and BRCA2
Harmful BRCA mutation 60-80% lifetime risk of developing Breast Ca Associations with Ovarian and Pancreatic Ca

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13
Q

Signs and Symptoms of breast cancer

A

S: increased size, lump in breast or armpit skin thickening, peau d’orange, skin dimpling/sores, nipple discharge (bloody, crusty), nipple inversion, growing vein
C: hard lump, irregular margins, redness
T: tenderness, red/warm (inflammatory breast Ca)
F: tethered to underlying tissue

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14
Q

Diagnosis of Breast Ca

A
  1. History and Clinical Examination
  2. Imaging
    - Breast screening (50-70 every 3 years) – early detection
    - Mammography
    - USS – better for denser breast tissue (younger patients)
    2 week wait criteria
  3. Pathology FNAC + Core biopsy
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15
Q

Staging of Breast cancer

A

Staging
- Histopathology – most are derived from epithelium lining of ducts/lobules (ductal/lobular carcinoma)

Grading
- Appearance of breast Ca cells compared to normal tissue

TMN Staging

  • Stage 0 = in situ, Paget’s disease of the breast, DCIS
  • Stage 1-3 = within breast, regions LNs
  • Stage 4 = metastatic cancer
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16
Q

Mx of Breast cancer

A
  1. SURGERY
    - Removal of tumour and surrounding LNs
    - Mastectomy, lumpectomy, quadrantectomy
    - Breast reconstruction surgery
  2. MEDICATION
    - ER antagonists e.g. tamoxifen
    - Aromatase inhibitors e.g. letrozole
  3. CHEMOTHERAPY
    - Cyclophosphamide, doxorubicin
  4. MONOCLONAL ANTIBODIES
    - Trastuzumab (HER2)
  5. RADIATION
    Post surgery, reduces risk of recurrence
17
Q 
4. Risk factors for developing breast cancer include:
A. Having only one child
B. Early menarche 
C. Early menopause
D. Anaemia
E. HIV/AIDS
A

B. Early menarche

18
Q
  1. A 56 year old woman presents to her GP after noticing a breast lump 3 weeks ago. On examination, the lump is 3 cm in diameter, firm and tethered to the skin and immobile. There are no overlying skin changes. The next most appropriate investigation is:
A. Total mastectomy
B. Urgent mammogram
C. Urgent USS
D. FNAC
E. Core biopsy
A

B. Urgent mammogram

19
Q
  1. A 22 year old medical student presents to her GP complaining of ‘lumpiness’ in her breasts and nipple discharge for 2 weeks. She is concerned as her mother, who had breast cancer, had the same symptoms before she was diagnosed. What is the next most appropriate investigation?
A. Refer for urgent mammogram
B. Refer for urgent USS
C. Blood hCG levels
D. Reassure and discharge  
E. CT Head
A

C. Blood hCG levels

Why CT head? To rule out prolactinoma

20
Q

Mastitis/Breast abscess

Definition and Epidemiology

A

Mastitis = inflammation of the breast (Pathology = Straph and Strep infection)
Rare complication: can lead to formation of a breast abscess = collection of pus within the tissue.

Epidemiology:

  1. Breastfeeding women – milk stasis(poor breastfeeding technique)
  2. Immunocompromised – HIV/AIDS, diabetes, chronic illness
  3. Primiparous (given birth to 1 child)
  4. Over 30 years old
21
Q

Mastitis/Breast abscess Signs and Symptoms, Invx

A

S: generalised swelling of the breastC: redness, firmT: very tender, warm to touchF: flu like symptoms - fever, aches, fatigue, chills

Ix:

  • Clinical diagnosis
  • USSto distinguish tumour and abscess
  • Biopsy (women not responding to treatment, or non puerperal mastitis)
22
Q

Mastitis/Breast abscess Mx

A

Management of Mastitis:

  1. Encourage breastfeeding (not from affected breast)
  2. Analgesia
  3. Antibiotics - Dicloxacillin or cephalexin (not needed in most cases)

Management of breast abscesses:

  1. US guided FNA
  2. Surgical incision and drainage
23
Q 
7. BRCA gene mutations are associated with breast and which other type of cancer?
A. Biliary
B. Uterine
C. Gastric
D. Ovarian   
E. Colon
A

D. Ovarian

24
Q
  1. A 30 year old female presents with a bruise on her breast. O/E The underlying tissue is tender and lumpy. When asked about trauma, she says she was injured whilst playing a rugby match. What is the most likely diagnosis?
A. Fibroadenoma
B. Fat necrosis
C. Paget’s disease of the breast
D. Mastitis
E. Duct ectasia
A

B. Fat necrosis

25
Q
  1. Which of the following statements regarding breast disease is FALSE?

A. Orange peel skin may be a sign of inflammatory breast cancer
B. Ulcerated breast lumps are generally not concerning
C. Alcohol intake is a modifiable risk factor for breast cancer
D. Women ages 50-70 are offered routine screening every 3 years
E. USS are more suitable for women aged <35 years

A

B. Ulcerated breast lumps are generally not concerning

26
Q

Neck Lump Differentials (Broad)

A 
Infection
Malignancy
Endocrine
Dermatology
Vascular
Congenital/developmental
27
Q

Neck Lump Differentials (Infection)

A

Lymphadenopathy, fever, fatigue (Glandular fever, HIV)

28
Q

Neck Lump Differentials (Malignancy)

A

Lymphadenopathy, night sweats, pain, weight loss, fatigue, growing lump (thyroid Ca, salivary gland Ca)

29
Q

Neck Lump Differentials (Endocrine)

A

Hyper/hypothyroidism goitre

30
Q

Neck Lump Differentials (Dermatology)

A

Sebaceous cyst (arises from blocked sebaceous glands, hair follicles), lipoma (benign tumour of fat tissue)

31
Q

Neck Lump Differentials (Vascular)

A

Carotid body aneurysm

32
Q

Neck Lump Differentials (Congenital/developmental)

A

Thyroglossal cyst (persistent thyroglossal duct – embryonic structure), branchial cyst

Core Curriculum (19 decks)

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