Breast Flashcards
1
Q
What are mastitis and breast abscesses?
A
- inflammation of the breast with or without infection
- mastitis with infection may be lactational or non-lactational
- breast abscesses are localised areas of infection with a walled-off collection of pus, it may or may not be associated with mastitis
2
Q
Describe the aetiology of mastitis/breast abscesses
A
- develops when milk is not properly removed
- can be caused by infection
- Lactational = S.aureus
- Non-lactational = S.aureus or anaerobes
3
Q
What are the risk factors of mastitis/breast abscesses?
A
- Mastitis = breast feeding, poor latch, cracked nipples, use of a breast pump, tight fitting clothes, trauma
- Breast abscess = lactation, smoking, mammary duct ectasia, periductal mastitis, wound infections
4
Q
Summarise the epidemiology of mastitis
A
- common in breast-feeding women
- lactational breast abscesses are common
- non-lactational abscesses tend to occur in 30-60 year old smokers
5
Q
Presenting symptoms of mastitis/breast abscess
A
- abscess presents as painful hot swelling of breast segment
- local pain, especially when breast feeding
- redness, swelling
- fever
- malaise
- decreased milk outflow
- breast tenderness
6
Q
Signs of mastitis/breast abscess on examination
A
- red, swollen, tender breast
- cracked nipple
- non-lactational abscess: scars or tissue distortion from previous episode and signs of duct ectasia
- pyrexia
- tachycardia
7
Q
Investigations for mastitis/breast abscess
A
- diagnosis is usually based on the presentation
- do a breast exam
- US can help detect any abscess and helps differentiate if a mass if a tumour or not
- do a culture to determine the cause if there’s pus
8
Q
Management plan for mastitis/breast abscess
A
- Medical
- antibiotics
- Lactational = flucloxacillin
- non-lactational = flucloxacillin + metronidazole - Surgical
- lactational = incision and drainage
- non-lactational = avoid drainage, remove faulty duct system once the infection has settled
- warm compressions to relieve pain and help milk flow
- avoid bras
- continue breastfeeding to allow milk removal
- have suspicion of sepsis
9
Q
What are the risk factors for breast cancer?
A
- female
- increased oestrogen exposure (earlier period, later menopause)
- more dense breast tissue
- obesity
- smoking
- family history (close relatives)
- combined contraceptive pill (but risk back to normal 10 years after stopping pill)
- hormone replacement therapy
- genetics: BRCA1 (chromosome 17) and BRCA2 (chromosome 13), TP53 and PTEN genes
- ionizing radiation exposure
10
Q
What are the different types of breast cancer?
A
- ductal carcinoma in situ
- lobular carcinoma in situ
- invasive ductal carcinoma
- invasive lobular carcinoma
- inflammatory breast cancer
- Paget’s disease of the nipple
11
Q
Summarise the epidemiology of breast cancer
A
- most common cancer in women
- 40-70 year olds especially
- ## rare in men
12
Q
Presenting symptoms of breast cancer
A
- hard, irregular, painless or fixed lump
- inverted nipple
- skin dimpling or oedema (peau d’orange)
- lymphadenopathy especially in axilla
- weight loss, bone pain, paraneoplastic syndromes
13
Q
Investigations for breast cancer
A
- Triple assessment: examination, imaging (US or mammography) and tissue diagnosis (FNA or biopsy)
- Mammogram / US: increased density, irregular margins, microcalcifications
- Sentinel Lymph node biopsy: tracer injected into tumour and scan identifies to see if spread to lymph node
- Staging: CXR, CT
- Gene expression profiling
14
Q
Treatment of Breast Cancer
A
- Surgery: breast-conserving or mastectomy, might remove axillary lymph nodes if spread there
- Radiotherapy: used in patients with breast-conserving therapy to reduce risk of recurrence
- Chemotherapy: neoadjuvant, adjuvant or treatment
- Hormone treatment: patients with oestrogen-receptor positive breast cancer are given treatment which disrupts the oestrogen stimulating the breast cancer
- Monoclonal antibodies which targets the HER2 receptor (herceptin, perjeta)
