Breast Flashcards
List some common benign breast conditions
Fibroadenoma Duct ectasia Mastitis Breast cysts (fibrocystic breasts) Papilloma
Describe the classic features of fibroadenoma
Affects younger women
Rubbery, very mobile, smooth and well circumscribed lump
Describe the classic features of duct ectasia
Affects older women (normal breast aging)
Caused by duct dilatation + thickening
Presents with greenish nipple discharge
Describe the classic features of mastitis
Two main types. Lactational and non-lactational.
Presents with a hot, tender, swollen, erythematous section of breast tissue- often described as ‘wedge-shaped’
-> can progress to abscess (fluctuant lump)
Describe the classic features of breast cysts
Usually affects women 30+
Multiple firm lumps bilaterally that cause cyclical aching pain as they enlarge
Describe the assessment of breast lumps
Triple assessment:
1) Examination
2) Imaging: USS or mammogram
3) FNA or biopsy
Describe the classic features of ductal papilloma
Bloody nipple discharge, usually no lump/mass
Describe the management of fibroadenoma
Conservative: if asymp + small
-Reassurance, do nothing
Surgical: if >2.5cm, changing, symptomatic
-Excision
Describe the management of duct ectasia
Follow up
Surgical excision if troublesome
Describe the management of mastitis
Breast-feeding: PO fluclox, continue breastfeeding/express, hot compress, paracetamol
Non-lactational: broad spectrum ABx
Describe the classic features of fat necrosis
Post-trauma -> hard, painless, non-mobile mass
Mimics cancer
Describe some pre-malignant breast conditions
Phyllodes tumour: large, painless fast growing mass
DCIS: microcalcification on mammogram. Asymp. Risk of cancer in same breast.
LCIS: incidental finding. Risk of cancer in both breasts.
Paget’s disease: nipple eczema, affects areola. Assoc with DCIS or invasive cancer
Describe the management of pre-malignant breast conditions
All should have surgical management
- WLE eg. DCIS, Phyllodes
- Mastectomy if extensive
- Bilateral in LCIS
Describe the causes of gynaecomastia
- Physiological at puberty
- Obesity
- Chronic liver disease
- Drugs: digoxin, spironolactone
- Congenital: Klinefelter’s
- Endocrine: prolactinoma, testicular tumour
Describe the epidemiology of breast cancer
Most common cancer in F- 1/8 affected lifetime
2nd commonest cause of cancer deaths
Describe the presentation of breast cancer
- Lump: typically painless, hard, craggy, tethered, increasing in size
- Nipple changes: inversion, itching, bleeding, discharge
- Skin changes: dimpling, peau d’orange
- Metastases: lymphadenopathy, headaches, seizures, abdo pain, pathological fractures etc
Describe the types of breast cancer
1) Invasive ductal carcinoma
2) Invasive lobular
Medullary
Mucinous
Papillary
Describe the screening program for breast cancer
From the age of 50-71, all women offered screening 3 yearly
Describe when to refer to secondary care for breast pathology
2WW:
>30 years with unexplained breast lump
>50 years with unilateral nipple changes
Consider if skin changes suggestive of cancer
Consider if unexplained axillary LN >30 years
When should USS and mammography be used?
<40 years or pregnant/lactating: USS 1st line
-> mammography if highly suspicious/confirmed cancer
> 40 years: mammography
USS of axilla in all suspected or confirmed cancer
Describe the management of breast cancer
Depends on stage and receptors Medical: for stage 3+4 and as adjuvant -Radiotherapy: adjuvant to surgical -Chemotherapy: HER2+ have trastuzumab -Endocrine therapy (for ER/PR +): tamoxifen, anastrazole
Surgical: for stage 1 and 2 -Wide local excision + radiotherapy -Mastectomy +/- reconstruction (flaps) \+ Sentinel LN biopsy -If negative and normal LNs on imaging, no need to remove all -If positive: axillary clearance
Describe some complications of breast surgery
Immediate: bleeding, damage to local structures (long thoracic nerve)
Early: haematoma, wound infection
Late: lymphoedema, fat necrosis, recurrence
