7.1 Breast Disease Flashcards
What is mastalgia?
Breast pain
What are the clinical presenting features of breast disease?
Physiological swelling
Nodularity
Breast pain - persistent unilateral mastalgia is concerning
Palpable breast lumps
Nipple discharge (including galactorrhoea) - unilateral blood stained is indicative of a malignancy
Breast infection and inflammation, usually associated with lactation
What is thelarche?
Breast enlargement, sometimes initially unilateral, is the first obvious sign of puberty in girls (8-13 years of age).Breast buds may initially be unilateral.
What is the most common benign breast disorder?
Fibrocystic change
How does fibrocystic chance usually present?
Commonly affects women of 20-50 years
Pain and nodularity
Often more sore and painfu leading up to the onset of the period
What is the causation of fibrocystic change of breast tissue?
Hormonal changes
How does a woman with benign breast disease usually present?
Bilateral symptoms
Symptoms greatest a week before menstration and starts to decrease when it starts
On examination, may have area of nodularity or thickening that is poorly differentiated and often in the upper outer quadrant of the breast
Pain and tenderness of breast
What is cyclical mastalgia?
Tenderness and pain in the premenstrual phase of the menstrual cycle
Affects two thirds of menstruating women
Resolves when menstruation starts
Most benign lumps will be one of two things. What are they?
Cysts
Fibroadenomas
How does a benign mass in the breast usually feel?
Three-dimensional Mobile Smooth Regular borders Solid or cystic consistency
How are breast cysts treated?
Examination and referral as difficult to distinguish from tumour
USS
Aspiration if USS shows to be fluid filler
What are fibroadenomas?
benign tumours that are common in young women, with incidence peaking at 20-24 years of age.
They are the most common type of breast lesion.
Arise in breast lobules and are composed of fibrous
and epithelial tissue
How do fibroadenomas present?
They present as firm, non-tender, highly
mobile palpable lumps, regular borders. Hormones seem to be involved in aetiology, and hormone replacement therapy (HRT) increases the incidence.
What is an intraductal papilloma?
A benign growth that occurs within a single milk duct. Can cause discharge, or if it occurs during breast feeding, can block the milk duct, causing swelling and pain as the drainage system is blocked.
What is mammary duct ectasia?
Dilation of major ducts in the breast, filled with creamy fluid and periductal inflammation
Can cause nipple discharge, retracted nipple, acute inflammation, recurrent or chronic inflammation with abscess formation
How is mammary duct ectasia treated?
Surgical excision of the major duct
Correction of the nipple retraction
What causes mastitis?
Breast engorged and drainage not happening during lactation
Staphylococcus infection causing cellulitis and deep infection and may result in abscess.
What is mastitis?
Generalised cellulitis of the breast
How is mastitis treated?
If occurring during lactation then ensure adequate and regular drainage.
If due to staphylococcus infection then give antibiotics and maybe incision and drainage
If due to streptococcus, it may be more diffuse inflammation anal superficial infection treated with local wound care and antibiotics.
How does mastitis present?
Point tenderness
Erythema
Fever
Generally associated with lactation
What is periductal mastitis?
Less diffuse mastitis
More specific in location
When are people referred via the suspected cancer pathway referral to a specialised breast clinic?
Aged ≥30 and have an unexplained breast lump with or without pain
Aged ≥50 with any of the following symptoms in one nipple only
Discharge
Retraction
Other changes of concern
In suspected breast disease patient, which lymph nodes should be examined?
Axillary lymph nodes
What is colostrum?
The thin yellow milky fluid secreted by the mammary gland a few days before or after childbirth
What is the most common causative organism of acute mastitis?
Staphylococcus aureus
