12. Breast Conditions Flashcards
Categorise Breast Conditions by where they affect
Lobules:
- Fibroadenoma
- Lobular carcinoma
Milk Duct:
- Ductal Carcinoma
- Duct Ectasia
Fatty Tissues:
- Mastitis
- Abscess
What is included in Benign Breast Disease?
- Fibroadenoma
- Breast Cyst
- Duct Ectasia (Non-puerperal mastitis)
Describing Benign Breast Disease: SCTF
Site, size, skin, single?
Colour, contour, consistency
Tenderness, temperature, transilluminable
Fluctuant or fixed
Fibroadenoma Definition Epidemiology Signs Invx Mx
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
Duct ectasia Definition Epidemiology Signs Invx Mx
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
Breast cyst Definition Epidemiology Signs Invx Mx
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
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
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
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
D. Fibroadenoma
- 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
C. Refer to breast feeding support group and prescribe analgesia
Breast cancer Epidemiology
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
Risk factors for Breast Ca?
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
Familial breast cancer
5% of cases
BRCA1 and BRCA2
Harmful BRCA mutation 60-80% lifetime risk of developing Breast Ca Associations with Ovarian and Pancreatic Ca
Signs and Symptoms of breast cancer
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
Diagnosis of Breast Ca
- History and Clinical Examination
- Imaging
- Breast screening (50-70 every 3 years) – early detection
- Mammography
- USS – better for denser breast tissue (younger patients)
2 week wait criteria - Pathology FNAC + Core biopsy
Staging of Breast cancer
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