(B)- Breast Lumps Flashcards
What is the standard practise for a breast lump?
Triple assessment
- Clinical assessment
- Imaging
- Histology (fine needle aspiration or core biopsy)
What clinical features suggest breast cancer?
- Hard lumps, irregular, painless
- Lumps tethered to the skin or chest wall
- Nipple retraction
- Skin dimpling or peau d’orange
What do NICE guidelines recommend a two week wait referral for with suspected breast cancer?
- Unexplained breast lump in patients 30 or above
- Unilateral nipple changes in patients 50 or above
Consider for
- Unexplained lump in axilla in patients 30 or above
- Skin changes suggestive of breast cancer
Non-urgent referral for unexplained breast lumps in under 30s
When is a mammogram used vs an ultrasound?
Mammogram more for older women e.g. over 50
Ultrasound for younger women
What is a fibroadenoma?
Common benign tumours of stromal duct tissue
- Small
- Mobile
- 20-40 years old
- Respond to oestrogen and progesterone hence why more common in younger women
How do fibroadenomas present?
Painless
Smooth
Round
Well circumscribed
Firm
Mobile
3cm in diameter
Are fibroadenomas cancerous?
No
Not associated with increased breast cancer risk
What are fibrocystic breast changes?
Connective tissues, duct and lobules respond to oestrogen and progesterone
Becomes fibrous and cystic, fluctuates with menstrual cycle
Benign condition, can vary in severity and affect patients quality of life
Lumpy
When do women usually experience symptoms of fibrocystic breast change?
Within 10 days prior to menstruating
Resolves once menstruation begins
What are the symptoms of fibrocystic breast change?
Lumpiness
Mastalgia
Fluctuation of breast size
How is fibrocystic breast change managed?
- Supportive bra
- NSAIDs
- Avoiding caffeine
- Applying heat
- Specialist hormonal treatments, last-line e.g. danazol and tamoxifen
What are breast cysts?
Benign, fluid-filled lumps
Most common cause of breast lumps
30-50, more in perimenopausal period
Pain and fluctuate in size over menstrual cycle
How do breast cysts appear on examination?
Smooth
Well-circumscribed
Mobile
Possibly fluctuant
How are breast cysts treated?
Further assessment to exclude cancer
Aspiration or excision if symptomatic
Slightly increases risk of breast cancer
What is fat necrosis of the breast?
Triggered by trauma, radiotherapy and surgery
Inflammatory reaction causing fibrosis and necrosis of the fat tissue
Does not increase risk of breast cancer
How does fat necrosis present on examination?
Painless
Firm
Irregular
Fixed in local structures
Dimpling or nipple inversion
How is fat necrosis diagnosed?
Triple assessment
Ultrasound or mammogram shows similar appearance to breast cancer, use histology
How is fat necrosis treated?
Conservatively
May resolve spontaneously
Surgical excision if required for symptoms
What is a lipoma?
Benign tumours of fat tissue
Can occur anywhere where there is adipose
How do lipomas present on examination?
Soft
Painless
Mobile
Does not cause skin change
How are lipomas treated?
Conservatively with reassurance
Can be surgically removed
What is a galactocele?
Breast milk filled cysts
Occurs when lactiferous duct is blocked and prevented from draining milk
How do galactoceles present?
Firm
Mobile
Painless lump
Underneath areola
How do you manage a galactocele?
Usually resolve without treatment
Can drain with needle
May become infected and require antibiotics
What is a phyllodes tumour?
Occurs in 40-60 year olds
Smooth
Fast-growing
Well circumscribed
Can be mistaken for a fibroadenoma
What age group is affected most commonly by phyllodes tumours?
40-60s
Are phyllodes tumours malignant?
50% benign
25% borderline
25% malignant
Can metastasise
How are phyllodes tumours treated?
Wide excision
Surgical removal of tumour and surrounding tumour
Can reoccur after removal
Chemotherapy
Malignant or metastatic tumours
