A3- Breast Disease Flashcards
How many lobules are composed in the breast?
What do they do ?
15-20
glandular tissue which produces milk and is embedded in fat
Each lobule in the breast drains into a _________ ____
Each lobule drains into a lactiferous duct
Breast Development
Develop along the m______ ___/m___ ____
• ______ ______ occur along this line
Develop along the mammary ridge/milk line
• Accessory nipples occur along this line
What does thelarche mean
the beginning of breast development
Explain the tanner stages of female puberty?
What does triple assessment include in breast disease
History & Examination
Radiology
Pathology
What do you include in a breast history?
- Introduce yourself
- Presenting complaint
- Risk factors for breast cancer
- Previous breast history
- Past medical history
- Drug history
- Social history
WHat symptom questions do you ask for a breast lump?
- How long have you had the lump?
- Has it changed in size?
- Does it alter with your periods?
- Is it tender?
- Is there any change in the overlying skin?
WHat symptom questions do you ask for a breast pain?
- Common
- Is it cyclical?
- Pubertal/peri-menopausal
- Referred pain
What symptom question would you as if they came in with nipple discharge
Eczema
• Is the eczema on the nipple or the areola?
• Ask about other areas of eczema
Retraction
• Is this longstanding or a new symptom?
Discharge
• 5% of referrals
• 5% associated with cancer
• Is the discharge from one duct or many?
• Is the discharge spontaneous or induced?
• Is the discharge from one or both breasts?
• Frequency
• Colour
• Recent pregnancy
• Menopausal status/age
RF for breast cancer
DOnt forget to ask about previous breast history
This includes?
•Previous breast cancer
•Previous benign disease
•Previous breast surgery
•Recent mammograms (including screening
programme)
•Previous chest wall radiotherapy
Breast exam
Inspection
- Eczema
- Erythema
- Skin puckering
- Frank ulceration
- Scars
- Asymmetry
Breast exam
Palpation
• Flat hand, fingertips
• Cover the whole breast, axillary tail and retro-areolar
area
• Breast lump
• Irregular/regular
• Tender
• Fixed to muscle/skin
• Nipple discharge
Breast exam dont forget
- Axillary and supraclavicular lymph nodes
- Bony tenderness
- Hepatomegaly
- Ascites
Ix that are available for breast
Radiological
• Mammogram (X-ray)
• Ultrasound scan (specific area)
• MRI (Lobular, mammographically occult, Dense breasts,
Multifocal or bilateral disease)
• CT and Bone scan (Systemic disease)
Pathological
• Cytology (Fine Needle Aspiration cytology)
• Core Biopsy
• Vacuum-assisted biopsy/excision
• Excision biopsy
What are some Benign breast conditions
- Congenital problems
- Nipple discharge
- Infection/mastitis, abscess
- Pain /mastalgia
- Gynaecomastia
- Benign neoplasms
Examples of congenital breast conditions
- Extra nipples and breasts
- Absence or hypoplasia of the breast (Poland’s syndrome)
- Chest wall abnormalities (Look at the back!)
- Accessory tissue
Nipple discharge
what do these colours suggest
Clear
Milky
Brown/green
Bloody
- Clear: physiological
- Milky: Pregnancy/ pituitary adenoma
- Brown/green: mammary duct ectasia
- Bloody: Intraductal papilloma 90%, Cancer 10%
Nipple Discharge: Management
Breast Abscess
Management
Aspiration, rarely if any
necrosis may need excision of overlying skin
what is Mastitis
Mastitis is an inflammation of breast tissue that sometimes involves an infection. The inflammation results in breast pain, swelling, warmth and redness. You might also have fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis)
What organism is related to Mastitis
staphylococcus
Mastitis Management?
Oral/IV antibiotics
What are some known medicaiton that are associated with gynaecomastia?
Know commonly associated medications (Warfarin,
Digoxin, PPI, H2 Antagonists, Spironolactone)
Examples Benign lumps
- Fibroadenoma
- Cysts
- Duct Papilloma
- Adenoma
Which bening tumour is hormone dependent
Fibroadenoma
Which tumour is referred to as a leaf-like tumour
•“Leaf-like” tumour, Aetiology unknown
Breast cysts are described as
• Firm, mobile, tender/non tender
What are some Breast Cancer Risks
- Female
- Age >50 female
- Family History
- 1st pregnancy >30yrs
- OCP/HRT
- Alcohol (each unit over 14 per week increases own risk by 6%)
- Peri-menopausal obesity
- Genetic: BRCA/Li-Fraumeni < 5% of breast ca
- Geography: cold countries
RED FLAG symptoms for breast
- Lump: hard, irregular, tethered in breast or armpit
- Change in shape/Distortion
- Ulceration
- Skin changes e.g. Peau d’orange
- Inflammatory changes: Abscess/redness
- Nipple changes e.g. Paget’s disease, discharge, inversion
- Pain is not a common presenting symptom
