A3- Breast Disease

Question 1

How many lobules are composed in the breast?

What do they do ?

Answer 1

15-20

glandular tissue which produces milk and is embedded in fat

Question 2

Each lobule in the breast drains into a _________ ____

Answer 2

Each lobule drains into a lactiferous duct

Question 3

Answer 3

Question 4

Breast Development

Develop along the m______ ___/m___ ____
• ______ ______ occur along this line

Answer 4

Develop along the mammary ridge/milk line
• Accessory nipples occur along this line

Question 5

What does thelarche mean

Answer 5

the beginning of breast development

Question 6

Explain the tanner stages of female puberty?

Answer 6

Question 7

What does triple assessment include in breast disease

Answer 7

History & Examination
Radiology
Pathology

Question 8

What do you include in a breast history?

Answer 8

• Introduce yourself
• Presenting complaint
• Risk factors for breast cancer
• Previous breast history
• Past medical history
• Drug history
• Social history

Question 9

WHat symptom questions do you ask for a breast lump?

Answer 9

• 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?

Question 10

WHat symptom questions do you ask for a breast pain?

Answer 10

• Common
• Is it cyclical?
• Pubertal/peri-menopausal
• Referred pain

Question 11

What symptom question would you as if they came in with nipple discharge

Answer 11

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

Question 12

RF for breast cancer

Answer 12

Question 13

DOnt forget to ask about previous breast history

This includes?

Answer 13

•Previous breast cancer
•Previous benign disease
•Previous breast surgery
•Recent mammograms (including screening
programme)
•Previous chest wall radiotherapy

Question 14

Breast exam

Inspection

Answer 14

• Eczema
• Erythema
• Skin puckering
• Frank ulceration
• Scars
• Asymmetry

Question 15

Breast exam

Palpation

Answer 15

• Flat hand, fingertips
• Cover the whole breast, axillary tail and retro-areolar
area
• Breast lump
• Irregular/regular
• Tender
• Fixed to muscle/skin
• Nipple discharge

Question 16

Breast exam dont forget

Answer 16

• Axillary and supraclavicular lymph nodes
• Bony tenderness
• Hepatomegaly
• Ascites

Question 17

Ix that are available for breast

Answer 17

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

Question 18

What are some Benign breast conditions

Answer 18

• Congenital problems
• Nipple discharge
• Infection/mastitis, abscess
• Pain /mastalgia
• Gynaecomastia
• Benign neoplasms

Question 19

Examples of congenital breast conditions

Answer 19

• Extra nipples and breasts
• Absence or hypoplasia of the breast (Poland’s syndrome)
• Chest wall abnormalities (Look at the back!)
• Accessory tissue

Question 20

Nipple discharge

what do these colours suggest

Clear

Milky

Brown/green

Bloody

Answer 20

• Clear: physiological
• Milky: Pregnancy/ pituitary adenoma
• Brown/green: mammary duct ectasia
• Bloody: Intraductal papilloma 90%, Cancer 10%

Question 21

Nipple Discharge: Management

Answer 21

Question 22

Breast Abscess

Management

Answer 22

Aspiration, rarely if any
necrosis may need excision of overlying skin

Question 23

what is Mastitis

Answer 23

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)

Question 24

What organism is related to Mastitis

Answer 24

staphylococcus

Question 25

Mastitis Management?

Answer 25

Oral/IV antibiotics

Question 26

What are some known medicaiton that are associated with gynaecomastia?

Answer 26

Know commonly associated medications (Warfarin,
Digoxin, PPI, H2 Antagonists, Spironolactone)

Question 27

Examples Benign lumps

Answer 27

• Fibroadenoma
• Cysts
• Duct Papilloma
• Adenoma

Question 28

Which bening tumour is hormone dependent

Answer 28

Fibroadenoma

Question 29

Which tumour is referred to as a leaf-like tumour

Answer 29

•“Leaf-like” tumour, Aetiology unknown

Question 30

Breast cysts are described as

Answer 30

• Firm, mobile, tender/non tender

Question 31

What are some Breast Cancer Risks

Answer 31

• 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

Question 32

RED FLAG symptoms for breast

Answer 32

• 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